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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.
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...
The effect of acute equine temporomandibular joint inflammation on response to rein-tension and kinematics.
Frontiers in veterinary science    June 19, 2023   Volume 10 1213423 doi: 10.3389/fvets.2023.1213423
Reisbig NA, Pifko J, Lanovaz JL, Weishaupt MA, Carmalt JL.Although the temporomandibular joint (TMJ) is the major contact point between the reins in the riders' hand, the bit in the mouth, and the rest of the horse under saddle, the role of inflammation of this joint on equine locomotion and rein tension is unknown. Unassigned: To determine the effect of acute TMJ inflammation on rein-tension and horse movement when horses were long-reined on a treadmill. Unassigned: A randomized, controlled, cross-over design. Unassigned: Five horses were trained by one clinician to walk and trot on a treadmill wearing long-reining equipment instrumented with a rein...
Effects of subconjunctival ropivacaine, liposomal bupivacaine, and mepivacaine on corneal sensitivity in healthy horses.
Veterinary surgery : VS    June 18, 2023   doi: 10.1111/vsu.13980
Gonzalez GA, Betbeze C, Wills R, Eddy A, Mochal-King C, Fontenot RL.To evaluate corneal sensitivity and adverse events following subconjunctival administration of three local anesthetics in horses. Methods: Randomized, masked, crossover study. Methods: Twelve healthy adult mares. Methods: The subconjunctival space of the treated eye was injected with 0.2 mL of liposomal bupivacaine (1.3%), ropivacaine (0.5%), or mepivacaine (2%). All horses received each medication once and the contralateral eye received saline (control). Corneal touch threshold (CTT) was measured using a Cochet-Bonnet esthesiometer before sedation, after sedation, and at specified intervals...
Application of the Ridden Horse Pain Ethogram to 150 Horses with Musculoskeletal Pain before and after Diagnostic Anaesthesia.
Animals : an open access journal from MDPI    June 9, 2023   Volume 13, Issue 12 doi: 10.3390/ani13121940
Dyson S, Pollard D.The Ridden Horse Pain Ethogram (RHpE) was developed to facilitate the recognition of musculoskeletal pain. The aim of this study was to document changes in RHpE scores before and after diagnostic anaesthesia was performed to alleviate pain ± when the saddle was changed. One hundred and fifty horses underwent ridden exercise as part of an investigation of poor performance. The RHpE was applied before and after the interventions. Fifty-two (34.7%) horses exhibited a bilaterally symmetrical short step length and/or restricted hindlimb impulsion and engagement. Fifty-three (35.3%) horses had epis...
Pharmacokinetics, clinical efficacy and safety of acetaminophen (paracetamol) in adult horses with naturally occurring chronic lameness.
Equine veterinary journal    June 7, 2023   Volume 56, Issue 1 202-214 doi: 10.1111/evj.13959
Mercer MA, Davis JL, McKenzie HC, Byron CR, Kelleher ME, Trager L, Cecere TE, Wilson KE, Council-Troche RM, Werre SR.Acetaminophen is used clinically in horses with musculoskeletal pain; however, no studies have been performed in horses with chronic lameness. Objective: To determine the pharmacokinetics, safety and efficacy of chronic dosing of acetaminophen in horses with naturally occurring chronic lameness. Methods: Longitudinal. Methods: Twelve adult horses with chronic lameness were treated with acetaminophen (30 mg/kg PO) every 12 h for 21 days. Plasma concentrations of acetaminophen were analysed on days 7 and 21 via LC-MS/MS and noncompartmental pharmacokinetic analysis. Lameness was evaluated ...
Gastrojejunostomy as a treatment for gastric outflow disorders in four adult horses.
Australian veterinary journal    May 30, 2023   Volume 101, Issue 8 302-307 doi: 10.1111/avj.13249
Brabon A, Labens R, Ramachandran A, Dart AJ, Dowling BA.Four adult horses with histories of moderate abdominal pain and inappetence were diagnosed with delayed gastric emptying and gastric impaction attributed to pyloroduodenal obstruction (three cases) or duodenitis (one case). A stapled side-to-side gastrojejunostomy was performed on all horses. Two horses returned to work and survived ≥3 years. One horse was euthanased 6 months post-surgery due to recurrent abdominal pain, and one was found dead 5 months postsurgery after an unattended foaling.
Horse Grimace Scale Does Not Detect Pain in Horses with Equine Gastric Ulcer Syndrome.
Animals : an open access journal from MDPI    May 12, 2023   Volume 13, Issue 10 doi: 10.3390/ani13101623
Ferlini Agne G, May BE, Lovett A, Simon O, Steel C, Santos L, Guedes do Carmo L, Barbosa B, Werner LC, Daros RR, Somogyi AA, Sykes B, Franklin S.Equine gastric ulcer syndrome (EGUS) is a highly prevalent and presumptively painful condition, although the amount of pain horses might experience is currently unknown. The aims of this study were to determine if the Horse Grimace Scale (HGS) could identify pain behaviours in horses with and without EGUS and if severity would be positively associated with the HGS score. Horse grimace scale scores were assessed blindly using facial photographs by seven observers and involved evaluation of 6 facial action units as 0 (not present), 1 (moderately present) and 2 (obviously present). Lameness exami...
The Clinical Pharmacology and Therapeutic Evaluation of Non-Steroidal Anti-Inflammatory Drugs in Adult Horses.
Animals : an open access journal from MDPI    May 10, 2023   Volume 13, Issue 10 doi: 10.3390/ani13101597
Mercer MA, Davis JL, McKenzie HC.This review firstly examines the underlying pathophysiology of pain and inflammation associated with orthopedic disease and endotoxemia. Then, it reviews the clinical pharmacology (pharmacokinetics and pharmacodynamics) of both conventional and non-conventional NSAIDs in the adult horse, and finally provides an overview of different modalities to evaluate the therapeutic efficacy of NSAIDs in research.
Critical Care of the Colic Patient: Monitoring, Fluid Therapy, and More.
The Veterinary clinics of North America. Equine practice    May 9, 2023   Volume 39, Issue 2 287-305 doi: 10.1016/j.cveq.2023.03.011
Barton C, Hassel DM.A successful outcome to management of the critical colic patient is highly dependent on how the patient is monitored and treated, particularly, in the perioperative period. In this article, we will provide an update on monitoring techniques, advances in fluid therapy, nutrition management and pharmacotherapeutic agents, inclusive of pain monitoring and management, prokinetics, and management of systemic inflammatory response syndrome and the hypercoagulable state.
Recurrent Colic: Diagnosis, Management, and Expectations.
The Veterinary clinics of North America. Equine practice    April 28, 2023   Volume 39, Issue 2 399-417 doi: 10.1016/j.cveq.2023.03.014
Mair T, Sherlock C.Most recurrent episodes of non-specific colic are self-limiting, and the results of clinical examinations are unremarkable. Differentiating these cases from serious diseases can be difficult, but repeated evaluations are warranted. Horses presenting with very frequent bouts of colic are more likely to have serious diseases and a higher mortality rate compared to horses presenting with less frequent bouts of transient colic. Horses with recurrent bouts of prolonged colic are more likely to have motility issues or partial intestinal obstruction. Non-gastrointestinal diseases can also cause recur...
Repeat Celiotomy-Current Status.
The Veterinary clinics of North America. Equine practice    April 28, 2023   Volume 39, Issue 2 325-337 doi: 10.1016/j.cveq.2023.03.012
Freeman DE, Bauck AG.Repeat celiotomy can be lifesaving in horses with a surgically treatable postoperative obstruction, although guidelines for its use are lacking, except for uncontrollable postoperative pain. Overdiagnosis of ileus as the cause of postoperative obstruction could delay a second surgery so the disease progresses beyond a manageable level of severity. Although many horses respond favorably to repeat celiotomy, complications can be severe and life threatening, such as incisional infection and adhesions. Repeat celiotomy does not seem to exacerbate postoperative ileus, despite additional surgical ma...
Review of the Mechanism of Action and Use of Bisphosphonates in Horses.
Journal of equine veterinary science    April 27, 2023   Volume 127 104503 doi: 10.1016/j.jevs.2023.104503
Yocom A, Contino E, Kawcak C.Bisphosphonates are a group of drugs that can reduce bone resorption by incorporating into the crystal structure of exposed hydroxyapatite where they are taken up by osteoclasts. Bisphosphonates have several other mechanisms of action including reducing pain and inflammation and altering macrophage function. There are two types of bisphosphonates-nitrogenous and non-nitrogenous, the latter of which is used in horses. This article provides a literature-based review of the proposed mechanisms of action and therapeutic uses of bisphosphonates including a brief review of bone response to disease. ...
Serum nerve growth factor in horses with osteoarthritis-associated lameness.
Journal of veterinary internal medicine    April 21, 2023   Volume 37, Issue 3 1201-1208 doi: 10.1111/jvim.16718
Kendall A, Lützelschwab C, Lundblad J, Skiöldebrand E.Nerve growth factor (NGF) is a neurotrophin that is increased in osteoarthritic joints of horses. In humans, NGF has been associated with pain, and both synovial and serum NGF concentrations are increased in osteoarthritic patients. Studies in humans also have shown that serum NGF concentration can increase with stress. Serum NGF concentration should be evaluated in horses with osteoarthritis-associated lameness. Objective: Quantify and compare serum NGF concentration in horses with osteoarthritis-associated lameness and sound horses. Additionally, the impact of short-term stress on serum NGF ...
Analysis of Various Facial Expressions of Horses as a Welfare Indicator Using Deep Learning.
Veterinary sciences    April 10, 2023   Volume 10, Issue 4 283 doi: 10.3390/vetsci10040283
Kim SM, Cho GJ.This study aimed to prove that deep learning can be effectively used for identifying various equine facial expressions as welfare indicators. In this study, a total of 749 horses (healthy: 586 and experiencing pain: 163) were investigated. Moreover, a model for recognizing facial expressions based on images and their classification into four categories, i.e., resting horses (RH), horses with pain (HP), horses immediately after exercise (HE), and horseshoeing horses (HH), was developed. The normalization of equine facial posture revealed that the profile (99.45%) had higher accuracy than the fr...
Pharmacokinetics and effects of codeine in combination with acetaminophen on thermal nociception in horses.
Journal of veterinary pharmacology and therapeutics    April 6, 2023   Volume 46, Issue 5 311-325 doi: 10.1111/jvp.13126
Tueshaus T, McKemie DS, Kanarr K, Kass PH, Knych HK.Codeine and acetaminophen in combination have proven to be an effective analgesic treatment for moderate-to-severe and postoperative pain in humans. Studies have demonstrated that codeine and acetaminophen, when administered as sole agents, are well tolerated by horses. In the current study, we hypothesized that administration of the combination of codeine and acetaminophen would result in a significant thermal antinociceptive effect compared with administration of either alone. Six horses were administered oral doses of codeine (1.2 mg/kg), acetaminophen (20 mg/kg), and codeine plus aceta...
Evaluation of Three Methods of Sensory Function Testing for the Assessment of Successful Maxillary Nerve Blockade in Horses.
Journal of veterinary dentistry    April 3, 2023   Volume 42, Issue 1 48-54 doi: 10.1177/08987564231164769
McAndrews A, Zarucco L, Hopster K, Stefanovski D, Foster D, Driessen B.Maxillary nerve blocks (MNBs) commonly facilitate dental surgeries in standing horses. The goal of this prospective, blinded, cross-over design trial including 15 client-owned horses was to evaluate 3 methods of sensory function testing for confirming a successful MNB. Testing was performed bilaterally before sedation, 5 min after sedation, and 15 and 30 min after MNB with 0.5% bupivacaine and involved a needle prick dorsal to each naris, hemostat clamping of each nostril, and gingival algometry (measuring sensitivity to pain). Responses to stimulation were numerically scored and scores were s...
The impact on physical performance, pain and psychological wellbeing of chronic low back pain patients during 12-weeks of equine- facilitated therapy intervention.
Frontiers in veterinary science    March 14, 2023   Volume 10 1085768 doi: 10.3389/fvets.2023.1085768
Mattila-Rautiainen S, Venojärvi M, Rautiainen H, Keski-Valkama A.Equine - Facilitated Therapy (EFT), an equine environment, and horses themselves can meet many physical and mental health needs beyond diagnostic categories. The horse's ability to produce a walk-like movement and the participant's ability to connect to non-judgemental living creatures, both of which can benefit participation and construct a positive self-image for chronic pain patients. The objective of this study is to evaluate the impact of EFT on perceived physical performance, level of pain, pain acceptance, depression and anxiety, and quality of life within a 12-week intervention for chr...
Comparison of Asymmetry During Trot In-Hand With Evaluations of Discomfort and Pain in Horses While Exercised.
Journal of equine veterinary science    March 11, 2023   Volume 126 104282 doi: 10.1016/j.jevs.2023.104282
Soiluva J, Häyrinen L, Gangini G, Öistämö R, Gracia-Calvo LA, Raekallio MR.Traditional visual lameness assessment is subjective. Ethograms have been developed for evaluating pain and objective sensors to detect lameness. Heart rate (HR) and heart rate variability (HRV) have been used to evaluate stress and pain. The aim of our study was to compare subjective and behavioral lameness scores, a sensor system measuring movement asymmetry, HR, and HRV. We hypothesized that these measures would show related trends. In 30 horses, an inertial sensor system was used to measure movement asymmetries during trot in-hand. A horse was categorized as sound if each asymmetry was les...
Evaluation of Thermal Changes of the Sole Surface in Horses with Palmar Foot Pain: A Pilot Study.
Biology    March 10, 2023   Volume 12, Issue 3 doi: 10.3390/biology12030423
Zaha C, Schuszler L, Dascalu R, Nistor P, Florea T, Imre K, Rujescu C, Sicoe B, Igna C.Horses with palmar foot pain do not show a typical increase in temperature in the palmar aspect of the hoof and heel due to low blood flow. The objectives of the current study were to determine the changes and differences in the thermographic pattern of the sole surface in horses with unilateral palmar foot pain and non-lame horses before and after training. We hypothesized that the thermal pattern and the local temperature of the frog area and toe area would be similar, with an increased local temperature after training in both lame and non-lame horses. A pilot study was conducted to investig...
Concentrations, pharmacokinetics and selected pharmacodynamics of morphine and its active metabolites following oral administration to horses.
Journal of veterinary pharmacology and therapeutics    March 8, 2023   Volume 46, Issue 4 238-249 doi: 10.1111/jvp.13122
Poth MKM, McKemie DS, Traynham M, Kass PH, Knych HK.The metabolism and pharmacokinetics of intravenous (i.v.) morphine in the horse have been described; however, administration of therapeutic doses has also been associated with neuroexcitation and adverse gastrointestinal effects. In this study, we hypothesized that oral administration would lead to comparable concentrations of morphine and its presumed active metabolite, morphine 6-glucuronide (M6G) without the adverse effects associated with i.v. administration. Eight horses were administered a single i.v. dose of 0.2 mg/kg morphine and oral doses of 0.2, 0.6, and 0.8 mg/kg of morphine in a...
Antinociceptive effects of bupivacaine injected within the internal abdominis rectus sheath in standing healthy horses.
Veterinary anaesthesia and analgesia    March 4, 2023   Volume 50, Issue 3 294-301 doi: 10.1016/j.vaa.2023.02.013
Ishikawa Y, Sakai DM, Im JS, Zhang S, Reed RA, Quandt JE, Baldo CF, Walters B, Barletta M.To evaluate a regional anesthetic technique for blocking the abdominal midline in horses. Methods: Anatomical description and prospective, crossover, placebo-controlled, blinded study. Methods: Adult horses; two cadavers, six healthy animals. Methods: In stage 1, 0.5% methylene blue with 0.25% bupivacaine (0.5 mL kg) was injected using ultrasonography into the internal rectus abdominis sheath (RAS) of two cadavers with a one-point or two-point technique. The dye spread was described after the dissection of the abdomens. In stage 2, each horse was injected with 1 mL kg of 0.9% NaCl (treatment P...
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