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Topic:Pain Management

Pain management in horses involves various strategies and interventions designed to alleviate discomfort and improve the well-being of equine patients. It encompasses pharmacological approaches, such as the use of non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and other analgesics, as well as non-pharmacological methods like physical therapy, acupuncture, and environmental modifications. Effective pain management aims to address both acute and chronic pain conditions, which can result from injuries, surgeries, or diseases such as laminitis and arthritis. This page aggregates peer-reviewed research studies and scholarly articles that explore the mechanisms, efficacy, and safety of different pain management techniques in horses, contributing to the understanding and advancement of equine veterinary care.
Morphine synovial fluid concentrations after intravenous regional limb perfusion in horses during standing sedation.
Equine veterinary journal    June 17, 2024   doi: 10.1111/evj.14114
Kilcoyne I, Nieto J, Nottle BF, Flynn H, Knych HK.Addition of morphine to the perfusate while performing intravenous regional limb perfusion (IVRLP) may be helpful in treating painful infectious orthopaedic conditions of the distal limb. Objective: The main objective of this study was to determine synovial morphine concentrations following IVRLP with morphine alone or in combination with amikacin. Methods: Randomised cross-over in vivo experiment. Methods: Six horses underwent IVRLP with 0.1 mg/kg morphine sulphate diluted to 60 mL using 0.9% NaCl (M group) or combined with 2 g amikacin and 0.9% NaCl (MA group) with a 2-week washout per...
Fasting horses perioperatively decreases manure production and increases time to manure output postoperatively: a controlled randomized trial.
Journal of the American Veterinary Medical Association    June 12, 2024   1-8 doi: 10.2460/javma.24.04.0235
Barton CK, Hector RC, Hendrickson DA, Kawcak CE, Nelson BB, Goodrich LR.To compare 3 perioperative feeding regimens and their effect on anesthetic complications, manure output, and colic proportion in healthy horses. Methods: 45 horses presenting for elective orthopedic procedures were randomly assigned to 1 of 3 groups: not fasted (NF; continuous access to hay perioperatively), fasted muzzled (FM; 10-hour preoperative fast with slow refeeding postoperatively and muzzle placement), or fasted not muzzled (FNM; same as FM without muzzle placement). Anesthetic protocol was standardized. Outcomes compared between groups included anesthesia time, arterial oxygenation, ...
Functional infrared thermography imaging can be used to assess the effectiveness of Maxicam Gel® in pre-emptively treating transient synovitis and lameness in horses.
Frontiers in veterinary science    June 11, 2024   Volume 11 1399815 doi: 10.3389/fvets.2024.1399815
de Carvalho JRG, Del Puppo D, Littiere TO, de Sales NAA, Silva ACY, Ribeiro G, de Almeida FN, Alves BG, Gatto IRH, Ramos GV, Ferraz GC.Diagnosing and treating lameness in horses is essential to improving their welfare. In equine orthopedic practice, infrared thermography (IRT) can indirectly detect soreness. Non-steroidal anti-inflammatory drugs can treat painful and inflammatory processes in horses. Using IRT, the efficacy of meloxicam (Maxicam Gel) was evaluated in pre-treating transient synovitis in horses induced by a middle carpal joint injection of lipopolysaccharides (LPS) from 055:B5 at a dose of 10 endotoxin units. Unassigned: In a cross-over design, six healthy horses were randomly assigned to receive either 0.6 ...
Primary phenotypic features associated with caudal neck pathology in warmblood horses.
Journal of veterinary internal medicine    June 3, 2024   doi: 10.1111/jvim.17125
Dyson S, Zheng S, Aleman M.Detailed descriptions of clinical signs associated with radiological findings of the caudal cervical vertebral column are not available. Objective: Describe the clinical features associated with neck pain or stiffness, neck-related thoracic limb lameness, proprioceptive ataxia consistent with a cervicothoracic spinal cord or nerve lesion, and their frequency of occurrence compared with control horses. Methods: A total of 223 Warmblood horses. Methods: Case-control study. Controls and cases were recruited prospectively. All horses underwent predetermined lameness and neurologic examinations. Th...
A novel approach to ear pain in the horse: A case report.
Open veterinary journal    May 31, 2024   Volume 14, Issue 5 1309-1312 doi: 10.5455/OVJ.2024.v14.i5.26
Lardone E, Landi A, Franci P.During electrochemotherapy (ECT), a chemotherapeutic drug is injected into the tumor and then an electroporation is provided. In horses, ear manipulation may be very painful, and combining a loco-regional technique with sedation might be a good option to avoid anesthesia-related risks. A two-injection-point block of the internal and external pinna and acoustic meatus was described in horse cadavers, and it permitted complete stain of all three branches of the great auricular nerve (GAN), internal auricular nerve branch (IAB), lateral auricular branch (LAB), and caudal auricular nerve (CAN), su...
Is it pain, or is it behaviour?
The Veterinary record    May 3, 2024   Volume 194 Suppl 1 9 doi: 10.1002/vetr.4204
Pearson G.This year BVA Live will, for the first time, feature farm animal and equine CPD. Among the varied topics on offer, Gemma Pearson will be presenting an introduction to equine behavioural medicine, examining the link between emotional and physical health in horses.
Comparative efficacy of low-volume retrobulbar anesthesia using three commercial local anesthetics in adult horses.
Journal of the American Veterinary Medical Association    May 3, 2024   1-11 doi: 10.2460/javma.24.02.0121
Tooley ZC, Eaton JS, Grant-Counard SM, Ilkenhans SM, Hetzel SJ, Bartholomew KJ.To compare the efficacy of low-volume (5-mL) locoregional retrobulbar anesthesia ("retrobulbar block") by use of 3 commercial local anesthetic formulations. Methods: 8 healthy adult mares. Methods: A block-randomized, masked, controlled design was used. A single ultrasound-guided retrobulbar block was performed with 2% lidocaine, 2% mepivacaine, or 0.5% bupivacaine (n = 5 eyes/group). Contralateral eyes served as untreated controls. End points performed at baseline and time intervals up to 24 hours postblock included the following: assessment of neurophthalmic reflexes/responses, intraocular p...
Effect of hospitalization on equine local intestinal immunoglobulin A (IgA) concentration measured in feces.
Journal of equine veterinary science    April 30, 2024   Volume 137 105078 doi: 10.1016/j.jevs.2024.105078
May A, Gerhards H, Wollanke B.During hospitalization horses may develop gastrointestinal conditions triggered by a stress-associated weak local immune system. The prospective, clinical trial was conducted to find out whether fecal immunoglobulin A (IgA) concentrations could be determined in hospitalized horses and how they changed during hospitalization and in response to various stressors. Samples were obtained from 110 horses and a control group (n = 14). At arrival in the hospital, horses were categorized into pain grades (1-5), and elective versus strenuous surgery (> 2 hours, traumatic and emergency procedures). Feces...
The Detection of Thoracolumbar Spine Injuries in Horses with Chronic Laminitis Using a Novel Clinical-Assessment Protocol and Ultrasonographic Examination.
Animals : an open access journal from MDPI    April 30, 2024   Volume 14, Issue 9 doi: 10.3390/ani14091364
Guedes JRB, Vendruscolo CP, Tokawa PKA, Carvalho AM, Johnson PJ, Faleiros RR.Postural adaptation is a prominent feature in horses affected by laminitis. Laminitis induces intense pain, especially in the forelimbs, prompting affected horses to assume a caudally displaced trunk posture, resulting in the hyperflexion of the thoracolumbar spine. This study assessed the nature and prevalence of thoracolumbar injuries in horses with chronic laminitis compared to horses without it. Sixty horses were used (thirty laminitic and thirty non-laminitic) of different athletic purposes and ages (2-20 years). The experimental protocol entailed a single assessment of horses' thoracolum...
Comparison of Xylazine and Lidocaine Infusion versus Medetomidine Continuous Rate Infusion during General Anesthesia with Isoflurane in Horses Undergoing Emergency Laparotomy.
Veterinary sciences    April 29, 2024   Volume 11, Issue 5 doi: 10.3390/vetsci11050196
Straticò P, Guerri G, Bandera L, Celani G, Di Nunzio L, Petrizzi L, Varasano V.(1) The main goals of general anesthesia include pain management and a safe anesthetic protocol for smooth recovery. In this retrospective study, we compared two anesthetic protocols for general anesthesia with isoflurane during emergency laparotomy: sedation with xylazine and the intraoperative infusion of lidocaine (X group) versus medetomidine as a preoperative sedation and intraoperative infusion (M group). (2) The medical records of horses who underwent emergency laparotomies between 2016 and 2023 were reviewed. According to the anesthetic protocol, patients were allocated to the X or M g...
Pressure pain mapping of equine distal joints: feasibility and reliability.
Frontiers in pain research (Lausanne, Switzerland)    April 25, 2024   Volume 5 1342954 doi: 10.3389/fpain.2024.1342954
Gisler J, Chiavaccini L, Blum S, Montavon S, Spadavecchia C.Osteoarthritis is a prevalent degenerative joint disease initiating chronic pain and lameness in horses. While several objective gait analysis systems have been developed and validated to quantify lameness severity in horses, methods to evaluate whether peripheral sensitization contributes to the pain experienced are missing. Unassigned: To evaluate whether periarticular pressure pain mapping could be proposed as an auxiliary assessment tool in horses. Specific aims were to evaluate the feasibility and intra- and inter-rater reliability of pressure pain thresholds (PPT) determination at sites ...
The pharmacokinetics and pharmacodynamics of fentanyl administered via transdermal patch in horses.
Frontiers in pain research (Lausanne, Switzerland)    March 20, 2024   Volume 5 1373759 doi: 10.3389/fpain.2024.1373759
Reed RA, Berghaus LJ, Reynolds RM, Holmes BT, Krikorian AM, Sakai DM, Ishikawa Y, Knych HK.Understanding the pharmacokinetics and pharmacodynamics of fentanyl in horses is crucial for optimizing pain management strategies in veterinary medicine. Unassigned: Six adult horses were enrolled in a randomized crossover design. Treatments included: placebo, two 100 mcg/h patches (LDF), four 100 mcg/h patches (MDF), and six 100 mcg/h patches (HDF). Patches were in place for 72 h. Blood was obtained for fentanyl plasma concentration determination, thermal threshold, mechanical threshold, heart rate, respiratory rate, and rectal temperature were obtained prior patch placement and at m...
Review of intra-articular local anaesthetic administration in horses: Clinical indications, cytotoxicity, and outcomes.
Equine veterinary journal    November 8, 2023   Volume 56, Issue 5 870-883 doi: 10.1111/evj.14027
Webster A, Pezzanite L, Hendrickson D, Griffenhagen G.Equine practitioners frequently inject local anaesthetics (LA) intra-articularly in both diagnosis of lameness and for pain management intra- or post-operatively with synovial endoscopy. Recent reviews of the human and veterinary literature support the concept that chondrotoxicity of LA on joint tissues depends on the type of drug, dose administered, and duration of exposure. The purpose of this review is to summarise the current literature describing intra-articular local anaesthetic use, including both in vitro and in vivo studies, and to draw some comparisons to literature from other specie...
Topical nonsteroidal anti-inflammatory drugs.
CMAJ : Canadian Medical Association journal = journal de l\'Association medicale canadienne    September 19, 2023   Volume 195, Issue 36 E1231 doi: 10.1503/cmaj.230578
Bhat C, Rosenberg H, James D.No abstract available
Topical nonsteroidal anti-inflammatory drugs.
CMAJ : Canadian Medical Association journal = journal de l\'Association medicale canadienne    September 19, 2023   Volume 195, Issue 36 E1231 doi: 10.1503/cmaj.230578
Bhat C, Rosenberg H, James D.No abstract available
Modified abaxial sesamoid nerve block provides enhanced proximal diffusion compared to basisesamoid block and lower proximal diffusion than traditional low plantar nerve block in equine hind limbs: ex vivo and in vivo study.
Journal of the American Veterinary Medical Association    August 29, 2023   1-6 doi: 10.2460/javma.23.04.0212
Estrada RJ, Alvarado GJ, Vargas A, Vargas J, Vargas D, Chacón R, Razquin P, Vindas R.To determine the proximal diffusion distance of radiopaque contrast medium and mepivacaine/methylene blue solution and incidence of inadvertent intrasynovial and intravascular injections of modified sesamoid nerve block (MASB) when compared with traditional plantar nerve analgesia techniques of the equine distal hind limb. Methods: Ex vivo model: 18 hind limbs; and in vivo model: 5 horses in a crossover study. Methods: In the ex vivo model, a mepivacaine/methylene blue solution was used to compare the diffusion distance between MASB, basisesamoid block (BSB), and traditional low plantar block ...
Phenylbutazone concentrations in synovial fluid following administration via intravenous regional limb perfusion in the forelimbs of six adult horses.
Frontiers in veterinary science    August 24, 2023   Volume 10 1236976 doi: 10.3389/fvets.2023.1236976
O'Brien M, Mochel JP, Kersh K, Wang C, Troy J.Pain management is critical to equine welfare with non-steroidal anti-inflammatory drugs (NSAID) commonly used in horses. However, systemic NSAID use is limited by harmful gastrointestinal and renal side effects. Intravenous regional limb perfusion (IVRLP) is a technique used in horses that produces high, local antibiotic concentrations while limiting systemic circulation. NSAID-IVRLP would be a novel method of local pain management while limiting systemic NSAID side effects. To date, NSAID-IVRLP administration has not been reported in horses. This study aimed to identify the pharmacokinetics ...
Animal model for tendinopathy.
Journal of orthopaedic translation    August 14, 2023   Volume 42 43-56 doi: 10.1016/j.jot.2023.06.005
Luo J, Wang Z, Tang C, Yin Z, Huang J, Ruan D, Fei Y, Wang C, Mo X, Li J, Zhang J, Fang C, Li J, Chen X, Shen W.Tendinopathy is a common motor system disease that leads to pain and reduced function. Despite its prevalence, our mechanistic understanding is incomplete, leading to limited efficacy of treatment options. Animal models contribute significantly to our understanding of tendinopathy and some therapeutic options. However, the inadequacies of animal models are also evident, largely due to differences in anatomical structure and the complexity of human tendinopathy. Different animal models reproduce different aspects of human tendinopathy and are therefore suitable for different scenarios. This rev...
18F-sodium fluoride positron emission tomography provides pertinent additional information to computed tomography for assessment and management of tarsal pain in horses.
Journal of the American Veterinary Medical Association    August 9, 2023   1-8 doi: 10.2460/javma.23.03.0164
Espinosa-Mur P, Spriet M, Manso-Diaz G, Arndt S, Perez-Nogues M, Roman JL, Garcia-Mata R, Katzman SA, Galuppo LD.To assess the value of 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) for imaging the tarsus and proximal metatarsus and compare it with CT and lameness evaluation. Methods: 25 horses with lameness localized to the tarsal and proximal metatarsal regions that underwent 18F-NaF PET/CT between 2016 and 2021. Methods: 18F-NaF PET and CT images were retrospectively independently evaluated by 3 observers. Standardized uptake values (SUV) were used to characterize 18F-NaF uptake. Correlation between PET and CT findings with subjective and objective maximum (Max-D) and minimum pelvic...
Pharmacokinetic modelling of orally administered cannabidiol and implications for medication control in horses.
Frontiers in veterinary science    August 9, 2023   Volume 10 1234551 doi: 10.3389/fvets.2023.1234551
Eichler F, Poźniak B, Machnik M, Schenk I, Wingender A, Baudisch N, Thevis M, Bäumer W, Lischer C, Ehrle A.Cannabidiol (CBD) products gain increasing popularity amongst animal owners and veterinarians as an alternative remedy for treatment of stress, inflammation or pain in horses. Whilst the use of cannabinoids is banned in equine sports, there is limited information available concerning CBD detection times in blood or urine. The aim of this study was to determine the pharmacokinetic properties of CBD following oral administration in the horse to assist doping control laboratories with interpreting CBD analytical results. Part 1: dose escalation study: Single oral administration of three escalatin...
Further comments on: Complications following diagnostic and therapeutic sacroiliac joint region injections in horses: A study describing clinicians’ experience.
Equine veterinary journal    August 8, 2023   Volume 55, Issue 5 927 doi: 10.1111/evj.13970
Gray P.No abstract available
Longitudinal evaluation of fentanyl concentrations in equine plasma and synovial fluid following application of transdermal fentanyl patches over one carpal joint.
Veterinary surgery : VS    August 3, 2023   doi: 10.1111/vsu.13990
Ortega McCormack JJ, Reed RA, Epstein KL, Camus MS, Knych HK.To determine if transdermally delivered fentanyl can achieve greater concentrations of fentanyl in synovial fluid when applied over a synovial structure. Conclusion: Application of fentanyl matrix patches directly over the CMCJ did not result in increased fentanyl concentrations in the synovial fluid of the treated intercarpal joint in normal horses.
Evaluation of frontal and infratrochlear nerve blocks for standing sedated frontonasal sinusotomy in horses.
Veterinary surgery : VS    July 22, 2023   Volume 53, Issue 1 38-44 doi: 10.1111/vsu.13997
Elliott SM, Giancola SC, Moorman V.To determine if targeted blocking of frontal and infratrochlear nerves provided anesthesia for the approach to a frontonasal sinusotomy. Methods: Two part study: Part 1 randomized crossover design; Part 2 proof of concept. Methods: N = 12; six each in Parts 1 and 2. Methods: Part 1: Each horse had either frontal and infratrochlear nerve blocks or a line block performed with 2% mepivacaine hydrochloride. Mechanical nociceptive thresholds (MNT) were obtained at five sites along a proposed frontonasal sinusotomy prior to injection, and at 10, 60, and 120 min after blocking. After a 4 day ...
Effect of pony morphology and hay feeding methods on back and neck postures.
Journal of animal physiology and animal nutrition    July 14, 2023   Volume 108 Suppl 1 3-14 doi: 10.1111/jpn.13861
Bordin C, Raspa F, Harris P, Ellis AD, Roggero A, Palestrini C, Bergero D, Valle E.The application of hay feeding devices, such as the use of hay nets or slow feeders, can help with the management of weight in ponies; however, there is still a lack of knowledge regarding their effect on equine posture. Therefore, the aim of the study was to assess the effect of different feeding devices on the posture of ponies using morphometric analysis. Two different breed types, Shetland type (SH, n = 5) versus Welsh Cob type (WC, n = 4), were fed the same forage in four different ways: on the ground (G), using a fully filled haynet (HF), using a partially filled haynet (HL) and...
Ketoprofen in horses: Metabolism, pharmacokinetics, and effects on inflammatory biomarkers.
Drug testing and analysis    July 13, 2023   doi: 10.1002/dta.3543
Knych HK, McKemie DS, Kass PH, Stanley SD, Blea J.Ketoprofen is an anti-inflammatory drug that is commonly administered to racehorses for the alleviation of musculoskeletal pain and inflammation. This study represents a comprehensive examination of the metabolism (in vivo and in vitro), pharmacokinetics and ex vivo pharmacodynamics, of ketoprofen in horses. The in vitro metabolism as well as specific enzymes responsible for metabolism was determined by incubating liver microsomes and recombinant CYP450 and UGT enzymes with ketoprofen. For the in vivo portion, 15 horses were administered a single intravenous dose of 2.2-mg/kg ketoprofen. Blood...
Post-anesthetic CPS and EQUUS-FAP scores in surgical and non-surgical equine patients: an observational study.
Frontiers in pain research (Lausanne, Switzerland)    July 12, 2023   Volume 4 1217034 doi: 10.3389/fpain.2023.1217034
Reed RA, Krikorian AM, Reynolds RM, Holmes BT, Branning MM, Lemons MB, Barletta M, Quandt JE, Burns CC, Dantino SC, Sakai DM.Equine pain scoring may be affected by the residual effect of anesthetic drugs. Unassigned: To compare pain scores in the hours immediately following anesthetic recovery to baseline pre-anesthetic scores in equine patients undergoing surgical and non-surgical procedures. Unassigned: Clinical observational study. Unassigned: Fifty adult horses undergoing anesthesia for surgical or non-surgical procedures were enrolled. Horses underwent pain scoring using the Composite Pain Score (CPS) and Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) prior to anesthesia (T0) and foll...
Pharmacokinetics of acetaminophen after a single Oral administration of 20 or 40 mg/kg to 7-9 Day-old foals.
Frontiers in veterinary science    July 6, 2023   Volume 10 1198940 doi: 10.3389/fvets.2023.1198940
Gold JR, Grubb T, Court MH, Villarino NF.Acetaminophen is utilized in human infants for pain management and fever. Neonatal foals might benefit from administration of acetaminophen but effective and safe dosage regimens for neonatal foals remains to be determined. Unassigned: The objective was to determine the plasma pharmacokinetics of acetaminophen following oral administration of a single dose of 20 mg/kg or 40 mg/kg to neonatal foals. A secondary objective was to evaluate any changes in hematology and biochemistry profiles. Unassigned: Randomized study. Unassigned: Eight clinically healthy 7-9-day old Quarter Horse foals (3 c...
Response to comments on Complications following diagnostic and therapeutic sacroiliac joint region injections in horses: A study describing clinicians’ experiences.
Equine veterinary journal    June 29, 2023   Volume 55, Issue 5 925-926 doi: 10.1111/evj.13964
Nagy A, Dyson S.No abstract available
Transdermal Flunixin Meglumine as a Pain Relief in Donkeys: A Pharmacokinetics Pilot Study.
Metabolites    June 21, 2023   Volume 13, Issue 7 doi: 10.3390/metabo13070776
McLean AK, Falt T, Abdelfattah EM, Middlebrooks B, Gretler S, Spier S, Turoff D, Navas Gonzalez FJ, Knych HK.Recent approval of transdermal flunixin meglumine (FM) (Banamine®) in cattle has opened the door for the drug's potential application in other species. Transdermal FM could provide a safe and effective form of pain relief in donkeys. In order to evaluate the pharmacokinetics and effects of FM on anti-inflammatory biomarkers in donkeys, a three-way crossover study design was employed. In total, 6 healthy donkeys were administered transdermal (TD) FM at a dosage of 3.3 mg/kg, and oral (PO) and intravenous (IV) doses of 1.1 mg/kg body weight. Blood samples were collected over 96 h to determine t...
Gabapentin: Clinical Use and Pharmacokinetics in Dogs, Cats, and Horses.
Animals : an open access journal from MDPI    June 20, 2023   Volume 13, Issue 12 doi: 10.3390/ani13122045
Di Cesare F, Negro V, Ravasio G, Villa R, Draghi S, Cagnardi P.Gabapentin is an anticonvulsant drug, which presents an established clinical efficacy in human patients for the management of refractory partial seizures, secondarily generalized tonic-clonic seizures, and for the control of chronic neuropathic pain. Gabapentin was synthesized as a structural analogue of the inhibitory neurotransmitter GABA, with GABA-mimetic effects, able to cross the blood-brain barrier. In veterinary medicine, is extra-label used in combination with other treatments to control seizures when other drugs are no longer effective or become toxic or for neuropathic pain treatmen...
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