Behavioral Indicators Of Pain Research Articles

Subcutaneous and orally self-administered high-dose carprofen shows favorable pharmacokinetic and tolerability profiles in male and female C57BL/6J mice.

Surgical interventions in mice require appropriate pain relief to ensure animal welfare and to avoid influence of pain on research findings. Carprofen is a non-steroidal anti-inflammatory drug commonly used as an analgesic for interventions inducing mild to moderate pain in laboratory rodents. Despite its frequent use, species-specific data on pharmacokinetics (PK), side effects, and potential impact on behavioral pain indicators are limited. We determined PK and tolerability profiles of carprofen in healthy male and female C57BL/6J mice (n = 42), administered at highest recommended doses via single subcutaneous (s.c.) injection (20 mg/kg) and oral self-administration (25 mg/kg/24 h) per drinking water (d.w.) for 5 days. Plasma concentrations were measured at various time points after the start of the treatment (n = 6 per time point), and side effects were evaluated using a modified Irwin test battery, hematology, and histopathology. Additionally, potential interference with cage-side behaviors commonly used for pain assessment, such as the mouse grimace scale, wheel running, burrowing, nesting, and grooming activity, was investigated. Maximum plasma concentrations of 133.4 ± 11.3 μg/ml were reached 1 h after single s.c. injection with an elimination half-life of 8.52 h. Intake from d.w. resulted in a steady state within 24 h after the start of the treatment with plasma levels of around 60 μg/ml over 5 days in both sexes. The medicated water was well-accepted, and increased d.w. intake was observed in the first 24 h after exposure (p < 0.0001). The Irwin test revealed only minor influence on tested behavior and physiological functions. However, during treatment via d.w., an increase in body temperature (p < 0.0001) was observed, as well as a reduction in voluntary wheel running activity by 49-70% in male mice. Moreover, grooming behavior was slightly affected. Hematology and histopathology were without pathological findings that could be attributed to carprofen treatment. High-dose carprofen can be considered safe and of favorable PK for both administration routes assessed in healthy C57BL/6J mice of both sexes. Further efficacy evaluation of carprofen as monoanalgesic or component of multimodal post-surgical regimens is clearly encouraged; however, the impact on behavioral markers used for pain assessment should be considered in this context.

Non-pharmacological interventions for the prevention of pain during endotracheal suctioning in ventilated neonates.

Pain, when treated inadequately, puts preterm infants at a greater risk of developing clinical and behavioural sequelae because of their immature pain system. Preterm infants in need of intensive care are repeatedly and persistently exposed to noxious stimuli, and this happens during a critical window of their brain development with peak rates of brain growth, exuberant synaptogenesis and the developmental regulation of specific receptor populations. Nearly two-thirds of infants born at less than 29 weeks' gestation require mechanical ventilation for some duration during the newborn period. These neonates are endotracheally intubated and require repeated endotracheal suctioning. Endotracheal suctioning is identified as one of the most frequent and most painful procedures in premature infants, causing moderate to severe pain. Even with improved nursing performance and standard procedures based on neonatal needs, endotracheal suctioning remains associated with mild pain. To evaluate the benefits and harms of non-pharmacological interventions for the prevention of pain during endotracheal suctioning in mechanically ventilated neonates. Non-pharmacological interventions were compared to no intervention, standard care or another non-pharmacological intervention. We conducted searches in June 2023 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, Embase, CINAHL and three trial registries. We searched the reference lists of related systematic reviews, and of studies selected for inclusion. We included randomised controlled trials (RCTs), quasi-RCTs and cluster-RCTs that included term and preterm neonates who were mechanically ventilated via endotracheal tube or via tracheostomy tube and required endotracheal suctioning performed by doctors, nurses, physiotherapists or other healthcare professionals. Our main outcome measures were validated composite pain scores (including a combination of behavioural, physiological and contextual indicators). Secondary outcomes included separate physiological and behavioural pain indicators. We used standard methodological procedures expected by Cochrane. For continuous outcome measures, we used a fixed-effect model and reported mean differences (MDs) with 95% confidence intervals (CIs). For categorical outcomes, we reported the typical risk ratio (RR) and risk difference (RD) and 95% CIs. We assessed risk of bias using the Cochrane RoB 1 tool, and assessed the certainty of the evidence using GRADE. We included eight RCTs (nine reports), which enroled 386 infants, in our review. Five of the eight studies were included in a meta-analysis. All studies enrolled preterm neonates. Facilitated tucking versus standard care (four studies) Facilitated tucking probably reduces Premature Infant Pain Profile (PIPP) score during endotracheal suctioning (MD -2.76, 95% CI 3.57 to 1.96; I² = 82%; 4 studies, 148 infants; moderate-certainty evidence). Facilitated tucking probably has little or no effect during endotracheal suctioning on: heart rate (MD -3.06 beats per minute (bpm), 95% CI -9.33 to 3.21; I² = 0%; 2 studies, 80 infants; low-certainty evidence); oxygen saturation (MD 0.87, 95% CI -1.33 to 3.08; I² = 0%; 2 studies, 80 infants; low-certainty evidence); or stress and defensive behaviours (SDB) (MD -1.20, 95% CI -3.47 to 1.07; 1 study, 20 infants; low-certainty evidence). Facilitated tucking may result in a slight increase in self-regulatory behaviours (SRB) during endotracheal suctioning (MD 0.90, 95% CI 0.20 to 1.60; 1 study, 20 infants; low-certainty evidence). No studies reported intraventricular haemorrhage (IVH). Familiar odour versus standard care (one study) Familiar odour during endotracheal suctioning probably has little or no effect on: PIPP score (MD -0.30, 95% CI -2.15 to 1.55; 1 study, 40 infants; low-certainty evidence); heart rate (MD -6.30 bpm, 95% CI -16.04 to 3.44; 1 study, 40 infants; low-certainty evidence); or oxygen saturation during endotracheal suctioning (MD -0.80, 95% CI -4.82 to 3.22; 1 study, 40 infants; low-certainty evidence). No studies reported SRB, SDB or IVH. White noise (one study) White noise during endotracheal suctioning probably has little or no effect on PIPP (MD -0.65, 95% CI -2.51 to 1.21; 1 study, 40 infants; low-certainty evidence); heart rate (MD -1.85 bpm, 95% CI -11.46 to 7.76; 1 study, 40 infants; low-certainty evidence); or oxygen saturation (MD 2.25, 95% CI -2.03 to 6.53; 1 study, 40 infants; low-certainty evidence). No studies reported SRB, SDB or IVH. Facilitated tucking / four-handed care / gentle human touch probably reduces PIPP score. The evidence of a single study suggests that facilitated tucking / four-handed care / gentle human touch slightly increases self-regulatory and approach behaviours during endotracheal suctioning. Based on a single study, familiar odour and white noise have little or no effect on any of the outcomes compared to no intervention. The use of expressed breast milk or oral sucrose suggests that there is no discernible advantage of one method over the other for reducing pain during endotracheal suctioning. None of the studies reported on any of the prespecified secondary outcomes of adverse events.

Investigating Nurses’ Knowledge, Attitude, and Performance Regarding Pain Management of Non-verbal Critically-Ill Patients in Tanzania Intensive Care Units

Background: Although patients› self-report is the gold standard for pain, many patients admitted to the intensive care units are unable to communicate and express their pain. Accordingly, the nurse must have special abilities to diagnose and manage pain in such conditions. This study assesses nurses’ knowledge, attitude, and performance regarding pain management of non-verbal critically ill adult patients in intensive care units. Methods: This cross-sectional descriptive study was conducted from February to May 2020 among nurses working in four national referral hospitals in Dar es Salaam, Tanzania. The study sample included 202 intensive care unit nurses who were recruited by the census. The data was collected using pre-validated questionnaires, including the knowledge and attitudes survey regarding pain tools, and a performance tool by Eunkyoung. The data were analyzed using the chi-square test, one sample t-test, and Spearman correlation coefficient in the SPSS software, version 20. The significance level was set at P&lt;0.05. Results: The mean knowledge and attitude score was 13.26±2.75, indicating inadequate knowledge and negative attitude. The mean performance score was 2.08±0.16, indicating low performance. No significant relationship was detected between nurses’ knowledge and attitude and their performance according to the t-test (t=2.84, P=0.09) and the Spearman correlation coefficient (r=0.12, P=0.102). Meanwhile, no significant relationships were found between the nurses’ knowledge, attitude, and performance and their demographic characteristics. Conclusion: Planning to increase knowledge and improve the attitude and performance of ICU nurses for better pain management of non-verbal patients is necessary. It is recommended to evaluate the pain of these patients based on the observation of behavioral indicators of pain and choose the appropriate tool for pain assessment.

Evaluation of Pain During Endotracheal Aspiration in Intensive Care Patients Diagnosed with COVID-19

BackgroundEndotracheal aspiration, a procedure that is particularly painful for intensive care patients, has received little attention in terms of pain evaluation specifically among intubated patients with COVID-19 in intensive care. AimThe study aims to assess the level of pain experienced by intubated intensive care patients diagnosed with COVID-19 during an endotracheal aspiration procedure. MethodThe study population was composed of patients admitted to the COVID-19 intensive care unit of the specified hospital between February and March 2021. Of the 56 patients admitted during that period, 47 were contacted and participated in the study. These 47 intubated and sedated patients were evaluated for 94 different expressions of pain during endotracheal aspiration twice a day before and during the procedure. Data were collected using the patient descriptive information form, the Non-Verbal Pain Scale for adults and data observation record form. ResultsIn the study, pain behavior was observed in 54.2% (n = 51) of the 94 observations. The patients were found to experience mild pain with an average score of 3.6 ± 1.07 on the Non-Verbal Pain Scale. The mean pain score before the procedure was found to be significantly different from the mean pain score during the procedure (p < .05), with an increase in pain during the procedure. During the procedure, 33.3% (n = 17) of the patients had a 10% decreased SpO2, and 29.4% (n = 15) had an increase in systolic blood pressure (>20), pulse (>20), and respiration (>10). Additionally, 21.5% (n = 11) of the patients experienced severe incompatibility with the ventilator, and 15.68% had muscle tension. ConclusionsThe study findings showed that nonverbal pain scores of sedated and intubated intensive care patients diagnosed with COVID-19 increased during endotracheal aspiration, accompanied by physiologic pain indicators. Effective pain management should be a priority for nurses. It is important to remember that patients with COVID-19 in the intensive care unit may experience pain while sedated and intubated. A holistic approach should be adopted for the evaluation and relief of pain in these patients. Intensive care nurses should consider physiologic and nonverbal behavioral pain indicators when evaluating pain in patients diagnosed with COVID-19.

Behavioural Indicators of Pain and Suffering in Arthropods and Might Pain Bite Back?

Pain in response to tissue damage functions to change behaviour so that further damage is minimised whereas healing and survival are promoted. This paper focuses on the behavioural criteria that match the function to ask if pain is likely in the main taxa of arthropods. There is evidence consistent with the idea of pain in crustaceans, insects and, to a lesser extent, spiders. There is little evidence of pain in millipedes, centipedes, scorpions, and horseshoe crabs but there have been few investigations of these groups. Alternative approaches in the study of pain are explored and it is suggested that studies on traumatic mating, agonistic interactions, and defensive venoms might provide clues about pain. The evolution of high cognitive ability, sensory systems, and flexible decision-making is discussed as well as how these might influence the evolution of pain-like states.

Skin-to-skin contact-An effective intervention on pain and stress reduction in preterm infants.

The outcomes of pain and stress in preterm infants in the neonatal intensive care units (NICUs) compel the continued search for pain- and stress-reducing interventions. To investigate how skin-to-skin contact (SSC) influences chronic pain and stress in preterm infants in the NICU. The study included 140 preterm infants in the NICU with gestational age less than 34 weeks. The overall design was a baseline-response design. Urine and saliva were collected before (baseline) and after SSC to measure pain and stress markers by enzyme immunoassay method. The behavioral indicators of chronic pain were assessed using the EDIN (Échelle Douleur Inconfort Nouveau-Né-neonatal pain and discomfort). There was a significant decrease in the dopamine level in preterm infants after SSC in comparison with baseline values (85.99 [69.35; 112.20] pg/ml vs. 132.20 [104.80; 183.70] pg/ml), p < 0.001. The β-endorphin and serotonin levels increased after SSC (40.09 [26.81; 70.63] pg/ml vs. 29.87 [20.61; 46.94] pg/ml, p = 0.009 and 25.49 [20.45; 40.08] ng/ml vs. 22.30 [15.13; 31.65] ng/ml, p = 0.011, respectively). A significant decrease in cortisol levels in saliva and urine after SSC in comparison with baseline values (0.125 [0.079; 0.225] μg/dl vs. 0.371 [0.188; 1.002] μg/dl, p = 0.000 and 27.06 [14.59; 35.35] ng/ml vs. 35.25 [19.78; 61.94] ng/ml, p = 0.001, with a simultaneous increase of oxytocin level (57.00 [36.55; 88.49] pg/ml vs. 38.20 [28.78; 56.04] pg/ml, p = 0.009 were revealed. The total pain EDIN score in infants after SSC was below 6 points, significantly decreasing compared to the baseline (p < 0.05). Preterm infants in the NICU experience stress and pain, which were confirmed by the EDIN pain scale and laboratory markers. The level of dopamine and cortisol as pain and stress hormones were reliably high, and normalized after regular SSC. Simultaneously, pain-relieving and anti-stress markers of oxytocin, β-endorphin and serotonin reliably increased in preterm infants in response to the SSC.

The fetal pain paradox.

Controversy exists as to when conscious pain perception in the fetus may begin. According to the hypothesis of cortical necessity, thalamocortical connections, which do not form until after 24-28 weeks gestation, are necessary for conscious pain perception. However, anesthesiologists and neonatologists treat age-matched neonates as both conscious and pain-capable due to observable and measurable behavioral, hormonal, and physiologic indicators of pain. In preterm infants, these multimodal indicators of pain are uncontroversial, and their presence, despite occurring prior to functional thalamocortical connections, has guided the use of analgesics in neonatology and fetal surgery for decades. However, some medical groups state that below 24 weeks gestation, there is no pain capacity. Thus, a paradox exists in the disparate acknowledgment of pain capability in overlapping patient populations. Brain networks vary by age. During the first and second trimesters, the cortical subplate, a unique structure that is present only during fetal and early neonatal development, forms the first cortical network. In the third trimester, the cortical plate assumes this function. According to the subplate modulation hypothesis, a network of connections to the subplate and subcortical structures is sufficient to facilitate conscious pain perception in the fetus and the preterm neonate prior to 24 weeks gestation. Therefore, similar to other fetal and neonatal systems that have a transitional phase (i.e., circulatory system), there is now strong evidence for transitional developmental phases of fetal and neonatal pain circuitry.

Behavioral pain indicators for adults with an intellectual disability: a scoping review protocol.

This scoping review aims to identify and map the behavioral pain indicators observed when adults with an intellectual disability experience pain. Adults with an intellectual disability have more health problems than the general population. The likelihood that this population will experience pain is high, but intellectual disability can obstruct the verbal expression of pain. Adults with an intellectual disability express pain via behavioral pain indicators; however, because no behavioral pain scale exists for this population, observers may misinterpret the pain experienced by adults with an intellectual disability. The review will examine literature about behavioral pain indicators for adults with any type of intellectual disability who are suffering from any type of pain in any country or care setting. The review will be conducted according to the JBI recommendations for scoping reviews. A preliminary search focusing on the concepts of intellectual disability and pain measurement was conducted for PubMed and CINAHL in March 2022. Once the protocol is validated, searches will also be carried out in Embase, JBI EBP Database, the Cochrane Database of Systematic Reviews, ProQuest Dissertations and Theses, PsycINFO, Web of Science Core Collection, ERIC, Google Scholar, MedNar, and the websites of relevant professional associations. Titles and abstracts, and then full-text studies, will be selected independently by 2 researchers and assessed against the inclusion criteria. Relevant information will be imported into a data chart. Any behavioral pain indicators identified will be classified into 14 behavioral categories. Open Science Framework osf.io/8xckf.

Donkey behaviour – an overview of defensive aggression during handling

Abstract Donkeys have significant behaviour variations in comparison with horses, due to each species evolving in different environments. Donkeys have a reduced flight response compared with horses, but an increased tendency to display fight or freeze behaviours. Unlike horses, they can display territorial, defensive behaviour and show a wide range of sexual behaviours that require consideration during management. Donkeys can bond strongly to other donkeys or animals and separating bonded companions can cause stress severe enough to induce the potentially fatal condition hyperlipaemia. Donkeys show stoic body language in response to pain. Awareness of subtle behavioural indicators of fear and pain can improve donkey welfare and improve handler safety.

Efficacy of 3 Buprenorphine Formulations for the Attenuation of Hypersensitivity after Plantar Incision in Immunodeficient NSG Mice.

Buprenorphine is perhaps the most prescribed analgesic for management of postoperative pain in mice. Although various buprenorphine formulations are effective in commonly used immunocompetent mouse strains, a knowledge gap exists regarding its efficacy in immunodeficient mice. Here we used a plantar incision to evaluate the efficacy of 3 buprenorphine formulations for attenuating postoperative mechanical and thermal hypersensitivity in the immunodeficient NSG mouse strain. We also characterized the pharmacokinetics of these formulations over a 72-h period. We hypothesized that all 3 buprenorphine formulations evaluated-the standard preparation and 2 extended-release products (Bup-HCl, Bup-ER, and Bup-XR, respectively)-would attenuate postoperative mechanical and thermal hypersensitivity resulting from a plantar incision in NSG mice. Male and female NSG mice (n = 48) were allocated to 4 treatment groups: saline (0.9% NaCl, 5 mL/kg SC once); Bup-HCl (0.1 mg/kg SC, BID for 2 d); Bup-ER (1.0 mg/kg SC once); and Bup-XR (3.25 mg/kg SC once). Mechani- cal and thermal hypersensitivity assessments were conducted 24 h before surgery and at 4, 8, 24, 48, and 72 h afterward. All groups of mice showed mechanical and thermal hypersensitivity within the first 24 h after surgery. Behavioral pain indicators (guarding, toe-touching [intermittent partial weight bearing], licking the incision, vocalizations) were observed in some mice from each group at every postoperative time point. Plasma buprenorphine was measured in a separate group of mice and concentrations surpassed the suggested therapeutic level (1.0 ng/mL) for less than 4 h for Bup-HCl, for at least 24 h for Bup-ER, and for 72 h for Bup-XR. Our results indicate that at the dosages studied, these buprenorphine formulations do not adequately attenuate postoperative mechanical and thermal hypersensitivity in the plantar incisional model in NSG mice. These findings support the need for strain-specific analgesic protocols for mice used in research.

Evaluating the utility of a CO2 surgical laser for piglet tail docking to reduce behavioral and physiological indicators of pain and to improve wound healing: A pilot study

In the U.S. millions of commercially raised piglets are routinely tail docked. Human and veterinary medical patients experienced reduced inflammation, healing time and post-procedural pain using a CO2 surgical laser compared to standard surgical instruments. Refinement of the tail docking procedure using a laser may improve piglet welfare by reducing tail docking-associated pain compared to cutting pliers. The objectives of this pilot study were to evaluate the ability of a CO2 surgical laser to 1) reduce pain and 2) improve wound healing of piglets after tail docking. Thirty piglets (male and female; 2 days old) were randomly allocated to one of three treatments (n = 10 piglets/treatment): tail docking with side pliers (SP), tail docking with a CO2 surgical laser (LA) or sham-tail docking (control; CON). Piglet vocalizations were recorded during the tail docking procedure and the maximum frequency, amplitude and energy were quantified. Piglet behavior was recorded for 30 min at baseline and at 0, 1, 2, 6, 7, 8, and 24 h post-procedure. Facial images were collected at the same time points to assess facial grimacing using the Piglet Grimace Scale (PGS). Digital images of the tail tip were taken at baseline and up to 168 h post-procedure for wound healing assessment. Infrared thermography (IRT) images of the tail tip and its surrounding tissues were taken at baseline, 0, 0.5, 8, and 24 h post-procedure to assess inflammation. Blood samples were collected from each piglet at baseline and 0.5 h and saliva samples at baseline, 0.5 and 8 h post-procedure for cortisol analysis. The LA and CON groups elicited calls of higher energy than the SP group (P < 0.0001). Across the assessment period, the SP group had higher grimace scores than the LA group (P = 0.03). Additionally, male piglets grimaced more than female piglets (P = 0.009). A treatment effect was observed for both wound scores and IRT (P < 0.0001). At 0 h the SP group had significantly higher wound scores than the LA and CON group (P < 0.0001). At 0 h, the SP group had a greater temperature difference between the tail tip and surrounding tissue compared to the LA group (P = 0.02). Behavioral indicators of pain were not different between the SP and LA piglets. In conclusion, LA piglets had less tail damage immediately post-procedure and lower facial grimace scores throughout the assessment period, suggesting it may have the utility as a less painful alternative to traditional tail docking with cutting pliers in piglets.

Recognition and Assessment of Pain-Related Behaviors in Avian Species: An Integrative Review.

The appropriate recognition and assessment of pain in animals is an essential tool that can be used by veterinary professionals, rehabilitators, household caregivers, and others to provide supportive care and analgesia to patients. Although the use of behavioral, postural, and facial changes to recognize pain have been studied in popular domestic species such as dogs (Canis lupus familiaris), cats (Felis catus), and rabbits (Oryctolagus cuniculus), very little is known relative to avian species. The purpose of this article is to provide a literature review comprising structured searches on the topic of avian pain recognition. The emphasis of the searches were based on the behavioral and postural alterations that have thus far been explored. The literature review was performed in the months of August-September 2020 over 5 online databases: MEDLINE/ PubMed, CAB Direct, Biosis, Zoological Record, and Scopus. Additional "snowballing" was incorporated by looking at the references and articles that cited the 126 articles from the initial abstract and full-text screening. Of the 194 full-text articles reviewed, 132 sources of literature were included in the final analysis. From these 132 sources of literature, 31.8% were general review articles in which avian pain behaviors were described irrespective of species, with others being specific to a particular species (chickens 47.8%, turkeys 7.6%, parrots 3.8%, pigeons [Columba livia] 3%, raptors 3%, and "other" 3%-2 on ducks, 1 on emus [Dromaius novaehollandiae], and 1 on Eurasian blue tits [Cyanistes caeruleus]). Pain stimulus varied depending on species, although the vast majority of the pain stimuli involved welfare issues such as beak trimming, limb abnormalities, and keel bone fractures in chickens. Although information regarding this topic remains limited for many avian species, this review provides a more thorough understanding of behavioral indicators of pain in species such as chickens, turkeys, psittacines, pigeons, raptors, and select others. It is the hope that this review will motivate further interest and future analgesia research for the improvement of avian welfare.

Effect of pneumoperitoneum on gastrointestinal motility, pain behaviors, and stress biomarkers in guinea pigs (Cavia porcellus).

To compare stress markers, gastrointestinal motility, and behavioral indicators of pain between guinea pigs undergoing pneumoperitoneum with carbon dioxide (CO2) and control guinea pigs. Fourteen 4- to 5-month-old intact female Hartley guinea pigs. Guinea pigs were randomized to receive insufflation or serve as controls (anesthesia and abdominal catheter placement without insufflation), with 7 animals/group. Insufflated animals underwent 6 mm Hg of CO2 pneumoperitoneum for 30 minutes. Afterward, results for vital signs, blood glucose, fecal cortisol, appetite, fecal output, and behaviors (via video recording) were compared between the 2 groups. There was no difference between groups and over time for body temperature, heart rate, fecal output in grams, pellets consumed, blood glucose, and fecal cortisol. Guinea pigs that underwent insufflation had significantly more fecal pellets at 36 hours after the procedure. Several behaviors were expressed similarly between groups and over time, such as body turns, incomplete movement, rearing, lying down, drinking, and hiding. Coprophagy occurred less often in the insufflated versus noninsufflated group at 12 h postprocedure but was similar between groups at other time points. At 60 hours after the procedure, insufflated animals spent less time squinting compared to noninsufflated animals. Other behaviors were differentially expressed over time but not between treatments. Overall, there were no major differences in appetite, stress markers, and behaviors between insufflated and control guinea pigs. CO2 insufflation did not appear to cause undue pain or stress in guinea pigs and may be a reasonable technique to use during laparoscopy.

Glucose supply as a way to reduce procedural pain in newborns. Review of research results

Immediately after birth, most newborns undergo a number of medical procedures to assess how the body functions. Some of these procedures are invasive and involve breaking the continuity of the baby's tissues, leading to pain and discomfort. Confirmation of pain sensation by newborns is relatively one of the newer scientific discoveries - this fact was not acceptable until the end of the 1980s. Therefore, analgesia was used very rarely during all medical procedures. Nowadays, medical personnel are aware that the youngest patients also feel pain and should be knowledgeable about its prevention and treatment. The aim of the study is to analyze the available studies on glucose supply as a way to reduce procedural pain in newborns. The non-systematic review of the literature was carried out according to the following keywords: pain, glucose, newborn, prevention, recommendations. Analyzes carried out in neonatal departments and a literature review have shown that pain prevention and treatment still pose many problems, as there are no clear guidelines as to how and methods to administer the therapy. Oral glucose is the most common pain reliever used in neonates during medical interventions. Its mechanism of action remains unclear, but it is believed to have a calming effect and reduce behavioral indicators of pain. The American Academy of Pediatrics recommends the administration of three doses of sucrose appropriate to the gestational age of the newborn, but there is concern about the long-term use of this preventive measure, especially in premature babies, who are at greater risk of hyperglycemia and disturbances in the development of the nervous system.

A multiparametric approach to assessing residual pain experienced by dairy cows undergoing digestive tract surgery under multimodal analgesia

This study assessed residual pain responses of dairy cows undergoing fistulation surgery under multimodal analgesia using a multiparametric method combining behavioural and physiological indicators. A longitudinal study was conducted on five dairy cows, each acting as her own control. The surgery consisted of implanting a ruminal and a duodenal cannula in each cow. The multimodal drug protocol consisted of a combination of N-Methyl-D aspartic Acid antagonists, α2-agonists, and local anaesthetic during surgery, and non-steroidal anti-inflammatory drugs (NSAIDs) and opioid treatment postsurgery. Cow responses to surgery were monitored by direct behavioural observation, physiological assay indicators, and milk production from day (D) −6 days before surgery (D-6) to D13 postsurgery. From the data recorded, the variables that contributed most to the discrimination of days pre- and postsurgery were identified using factorial discriminant analysis. Components 1 and 2 of the factorial discriminant analysis explained 68.2% and 17.9%, respectively, of the total variance. Component 1 was mainly explained by haptoglobin (contribution to axis: 0.885), oxidative stress (ratio of oxidized gluthatione to reduced glutathione (GSH/GSSG), −0.746; vitamin E, −0.683; vitamin A, −0.597; malondialdehyde (MDA), 0.416), and behavioural indicators (general attitude, 0.594). On this axis, the higher the score, the higher were the apathy and haptoglobin and MDA concentrations, and the lower were the GSH/GSSG ratio and concentrations of vitamins A and E. This axis opposed cows on D-6 to cows on D3 and D5; cows on D1 and D13 were intermediate. Component 2 was mainly explained by the Hypothalamic-pituitary-adrenal axis (non-esterified fatty acid (NEFA), 0.686; cortisol, 0.669), milk yield (−0.725), oxidative stress (MDA, −0.584; nitric oxide (NO), 0.454), and behavioural indicators of pain (ear position, 0.467; leg postures, 0.431). On this axis, the higher the score, the higher the NEFA, cortisol, and nitric oxide concentrations; the more the ear and leg pain postures; and the lower the milk production and MDA concentrations. This axis opposed cows on D13 to cows on D1. These results suggest that cows may experience some pain only on D1, whereas on subsequent days, the inflammatory response and oxidative stress did not seem to be associated with pain. Our results should be considered for different surgeries to improve analgesia immediately after surgery, and to provide antioxidants along with NSAIDs to promote recovery.

Evaluation of the Premature Infant Pain Profile-Revised (PIPP-R) e-Learning Module: Immediate and Sustained Competency.

Electronic health (e-health) learning is a potential avenue to educate health professionals about accurately using infant pain assessment tools, although little is known about the impact of e-health interventions on clinical competence. To evaluate whether an e-health learning module for teaching the accurate use of the Premature Infant Pain Profile-Revised (PIPP-R) pain assessment tool results in immediate and sustained competency to assess infant pain. Neonatal intensive care unit (NICU) nurses who participated in a larger study across 2 tertiary NICUs in Canada examining the implementation and clinical utility of the PIPP-R e-learning module completed 2 follow-up evaluations at 1 week and 3 months. Participants were asked to view a video recording of an infant undergoing a painful procedure and to assess the infant's pain intensity response using the PIPP-R measure. Immediate and sustained competency was assessed via interrater consensus of participant-reported PIPP-R scores compared with those of an experienced trained coder. Of the 25 eligible nurses, 22 completed 1-week and 3-month follow-up evaluations. At the 1-week follow-up, 84% of nurses scored the video accurately compared with 50% at 3 months. Behavioral pain indicators were more likely to be scored incorrectly than physiological indicators. Follow-up training after completion of the initial e-learning module training may improve competency related to the clinical use of the PIPP-R tool to assess infant pain over time. Additional study regarding the need and timing of e-health training to optimize sustained competency in infant pain assessment is warranted.

Does UK licensed NSAID administration reduce signs of postoperative pain in calves castrated without local anaesthesia?

PICO question&#x0D; In calves undergoing castration without local or general anaesthesia, do non-steroidal anti-inflammatory drugs (NSAIDs) licensed for use in cattle in the UK administered either before, during or after the procedure reduce signs of postoperative pain?&#x0D; &#x0D; Clinical bottom line&#x0D; Category of research question&#x0D; Treatment&#x0D; The number and type of study designs reviewed&#x0D; Twenty studies were critically appraised. All were controlled trials, of which 17 were randomised. Only NSAIDs licensed for use in cattle in the UK were included in the search strategy and in appraised papers&#x0D; Strength of evidence&#x0D; Moderate&#x0D; Outcomes reported&#x0D; Five studies reported an improvement in both physiological and behavioural indicators of postcastration pain following NSAID administration and a further eight reported improvements in either physiological or behavioural parameters. Seven studies found no improvements in pain indicators&#x0D; Conclusion&#x0D; There is moderate evidence to suggest that NSAID administration before, during or after castration is able to reduce the signs of postoperative pain in calves castrated without anaesthesia. The degree to which pain is reduced is variable and depends upon factors including but not limited to castration method, specific NSAID given, dosage, administration and calf age&#x0D; &#x0D;

Attitudes of the Equestrian Public towards Equine End-of-Life Decisions.

Simple SummaryDelayed death has been identified as a key welfare concern for the U.K. horse population, leading to prolonged suffering. Previous studies have identified common reasons for delaying euthanasia, including financial cost, emotional attachment, peer pressure, negative attitudes towards killing and poor recognition of behavioural indicators of equine pain and stress. The Five Freedoms is a welfare framework that can be used to assess quality of life. We used this framework to create a survey, compiling a list of hypothetical—yet common—scenarios that would have an impact on the overall quality of life of a horse. Participants were asked to indicate to what extent each scenario would have a bearing on an overall decision whether or not to euthanise a horse, or whether it would have had no bearing at all. Participants were also asked if they had had a horse euthanised and to give the reason for such a decision. We received responses from 160 participants and found that the predominant attitude was that most scenarios had no bearing on a decision to euthanise. Principal Component Analysis collected the scenarios into a series of factors that could be labeled according to their themes, the most prominent of which were “Ethology-informed Management”, “Traditional Management”, “Emotional issues” and “Physical Issues”. Participants were most likely to consider euthanasia for physical issues and this was supported by the experiences of participants who had had their horses euthanised. Only a small number of responses also included consideration of affective and/or ethological factors, suggesting that welfare issues concerning affective state and/or behaviour are at risk of being omitted from an end-of-life decision.A key welfare concern for the equine population in the U.K. has been identified as delayed death, leading to prolonged suffering of horses. Reasons why some horse owners fail to have their horses euthanised include financial cost, emotional attachment, peer pressure, negative attitudes towards killing and poor recognition of behavioural indicators of equine pain and stress. The Five Freedoms framework of welfare was used to build a Likert-style survey to investigate the factors underlying attitudes of horse owners towards welfare measures in an end-of-life decision. Participants were asked to respond to hypothetical welfare scenarios and to give details of any horses they had had euthanised. The survey was conducted predominantly via equestrian Facebook groups and obtained 160 participant responses. Reliability of the scale was acceptable, with Cronbach’s . Principal Component Analysis was used to load the hypothetical scenarios onto seven factors containing 62.2% of the variance. The first four factors could be categorized according to “Ethology-informed Management”, “Traditional Horse Management”, “Emotional Issues” and “Physical Issues”. Participants were more likely to consider euthanasia for physical issues, compared with issues relating to affective state and/or ethology, although it was not clear whether this was due to disregard for welfare issues relating to mental health or failure to recognise them as such. A large number of responses stated that the scenario had no bearing on whether a horse should be euthanised, again suggesting a lack of recognition of welfare issues and their implications. When asked to state their reasons for euthanising their horses, participants cited almost exclusively physical reasons, with the exception of those citing dangerous behaviour. Only a small number of responses also included consideration of affective and/or ethological factors, suggesting that welfare issues concerning affective state and/or behaviour are at risk of omission from end-of-life decisions.

Surgical Castration Changes Struggle Behavior and Vocalizations in Male Piglets

ABSTRACT This study assessed acute pain in piglets during castration through behavioral indicators. Piglets (n=88) were randomly allocated to one of two treatments: surgical castration and sham-castration. Within 24 hours after birth, identical castration procedures were followed for both treatment groups, except sham piglets were not castrated. Struggle behavior (curl ups, leg kicks, and body flailing) and vocalization (duration and peak frequency) were analyzed during the castration procedure. Castrated piglets kicked more frequently than sham piglets (28.8 vs. 21.3 kicks/min, SE = 0.09; P = 0.02). Additionally, 51.2% of castrated piglets displayed body flailing, whereas only 4.4% of sham piglets displayed the same behavior (P = 0.03). Castrated piglets responded with more high frequency (≥1,000 Hz) calls than sham piglets (23.6 vs. 18.6 calls/min, SE = 0.26; P = 0.04) and high frequency calls tended to be of longer duration for castrated piglets (0.45 vs. 0.27 sec/call, SE = 0.04; P = 0.08). Results indicate that surgical castration increased the frequency of leg kicks, body flailing, and high frequency calls compared to sham-castration, suggesting these may be useful behavioral indicators of acute pain in piglets.

Diet-induced obesity leads to behavioral indicators of pain preceding structural joint damage in wild-type mice

IntroductionObesity is one of the largest modifiable risk factors for the development of musculoskeletal diseases, including intervertebral disc (IVD) degeneration and back pain. Despite the clinical association, no studies have directly assessed whether diet-induced obesity accelerates IVD degeneration, back pain, or investigated the biological mediators underlying this association. In this study, we examine the effects of chronic consumption of a high-fat or high-fat/high-sugar (western) diet on the IVD, knee joint, and pain-associated outcomes.MethodsMale C57BL/6N mice were randomized into one of three diet groups (chow control; high-fat; high-fat, high-sugar western diet) at 10 weeks of age and remained on the diet for 12, 24, or 40 weeks. At endpoint, animals were assessed for behavioral indicators of pain, joint tissues were collected for histological and molecular analysis, serum was collected to assess for markers of systemic inflammation, and IBA-1, GFAP, and CGRP were measured in spinal cords by immunohistochemistry.ResultsAnimals fed obesogenic (high-fat or western) diets showed behavioral indicators of pain beginning at 12 weeks and persisting up to 40 weeks of diet consumption. Histological indicators of moderate joint degeneration were detected in the IVD and knee following 40 weeks on the experimental diets. Mice fed the obesogenic diets showed synovitis, increased intradiscal expression of inflammatory cytokines and circulating levels of MCP-1 compared to control. Linear regression modeling demonstrated that age and diet were both significant predictors of most pain-related behavioral outcomes, but not histopathological joint degeneration. Synovitis was associated with alterations in spontaneous activity.ConclusionDiet-induced obesity accelerates IVD degeneration and knee OA in mice; however, pain-related behaviors precede and are independent of histopathological structural damage. These findings contribute to understanding the source of obesity-related back pain and the contribution of structural IVD degeneration.