Pain Management In Animals Research Articles

Pain Management in Animals with Oncological Disease: Opioids as Influencers of Immune and Tumor Cellular Balance.

Advancements in understanding pain physiopathology have historically challenged animals' absence of pain senses. Studies have demonstrated that animals have comparable neural pain pathways, suggesting that cats and dogs likely experience pain similarly to humans. Understanding brain circuits for effective pain control has been crucial to adjusting pain management to the patient's individual responses and current condition. The refinement of analgesic strategies is necessary to better cater to the patient's demands. Cancer pain management searches to ascertain analgesic protocols that enhance patient well-being by minimizing or abolishing pain and reducing its impact on the immune system and cancer cells. Due to their ability to reduce nerve sensitivity, opioids are the mainstay for managing moderate and severe acute pain; however, despite their association with tumor progression, specific opioid agents have immune-protective properties and are considered safe alternatives to analgesia for cancer patients.

Pharmacokinetics of intravenous, oral transmucosal, and intranasal buprenorphine in healthy male dogs.

Effective management of pain in animals is of critical importance but options are limited for treating acute pain in dogs on an outpatient basis. The objective of this study was to compare the plasma concentrations and pharmacokinetics of a concentrated solution of buprenorphine, 1.8 mg/ml (Simbadol™) administered intravenously, intranasally, and via the oral transmucosal (OTM) route in healthy male dogs. Five healthy castrated adult male Beagle‐cross dogs were included in this randomized blocked crossover study. The dogs received 0.03 mg/kg body weight buprenorphine intravenously, intranasally, or via the OTM route, with a minimum 72‐h washout period between treatments. Blood samples were collected at multiple intervals up to 24 h post administration and buprenorphine plasma concentrations were determined by liquid chromatography tandem mass spectrometry. Non‐compartmental pharmacokinetic analysis revealed that the area under the curve of intravenous, intranasal, and OTM routes were 28.0 (15.1–41.3) h × ng/ml, 16.1 (3.4–28.7) h × ng/ml and 10.8 (8.8–11.8) h × ng/ml, respectively. The bioavailability of intranasal and OTM routes were 57.5 (22.7–93.7)% and 41.1 (25.5–69.4)%, respectively. Intranasal and OTM routes of administration of concentrated buprenorphine in dogs may allow for the provision of analgesic care at home.

Current practices of Nepalese veterinarians for the clinical management of pain in animals

The retrospective study was performed to know the trend of recent clinical practices for managing the post-surgical and non-surgical pain in animals. The study included government hospitals, private clinics, organizations working on animal birth control program of Chitwan, Kathmandu, Lalitpur, and Kaski districts of Nepal. Overall, 1,177 and 1,084 animals received analgesics in 2017 and 2018, respectively. Categorically, 81% of cases underwent for soft tissue surgeries, and analgesics were prescribed variably for 1–5 days. However, 5% and 1% were orthopedic and ophthalmic cases that were treated with analgesics for 1–8 days. Remaining, 13% cases that were grouped into miscellaneous type received analgesics for 1–7 days For analgesia, meloxicam was the most preferred non-steroidal anti-inflammatory drug (98%) followed by tramadol (9%), and lignocaine-HCl (8%). Tramadol (9%) and lignocaine-HCl (8%) were prescribed particularly in severely traumatized cases whereas ketorolac (5%) were used in orthopedic cases. Only 18% veterinary patients received preemptive analgesics. Most of the hospitals, clinics and organizations did not perform pain scoring. Proper pain assessment and their scoring are imperative for prescribing the right analgesic for the effective treatment of pain in animals.

Ethical and IACUC Considerations Regarding Analgesia and Pain Management in Laboratory Rodents.

Scientists have ethical and regulatory commitments to minimize pain and distress during their use of sentient laboratory animals. Here I discuss pain as a special form of distress and the long history of ethical and regulatory standards calling on scientists to prevent, minimize, treat or terminate animal pain. Scientists, veterinarians, and IACUC face 2 challenges: knowledge of effective analgesic doses and regimens for all sexes, ages and genotypes of rodent is incomplete, and concerns regarding the effects of analgesic drugs on research outcomes push scientists to request approval to withhold analgesics and leave animal pain unalleviated. IACUC thus conduct what I call an 'ethics of uncertainty,' in which they factor in the limits of available ethically relevant information on the amount of expected animal suffering, the usefulness of analgesics to mitigate this suffering, and the eventual benefits that come from the research. IACUC must factor in current limitations in severity assessments of various experimental manipulations in various strains, inaccurate pain diagnosis, in known effective analgesic and other refinements, and on effects of pain medications and untreated pain on data outcomes, when deciding to allow potentially painful experiments and animal care practices. This article focuses on 3 areas of concern: the limits of veterinary "professional judgment" when the animal model's degree of pain and the efficacy of pain medications are not yet known; the review of proposals with known, unalleviated significant pain and distress (that is, Category E experiments); and the attempt to review the balance between animal welfare harms and scientific objectives. I propose no new regulations, standards, or ethical norms herein but rather explore some of the implications when existing ethical principles are applied to evolving scientific knowledge (and vice versa). I conclude that applying current animal pain management knowledge to prevailing ethical principles will shift IACUC toward greater caution in allowing potentially painful animal experiments, with heightened caution regarding the ability of analgesics to mitigate the animals' pain.

The Management of Pain In Animals on The Clinic Floor

Most animals presented for veterinary care are suffering or will suffer from some pain during restraint, clinical examination, samples collection, diagnostic imaging, parenteral drug administration or clinical procedures et cetera. The Veterinarian is ethically, morally and professionally enjoined to recognize and alleviate such pain. Although most studies on animal pain have been focused on mostly post surgical pain in dogs and cats, animals afflicted with most common external or internal, infectious and non-infectious disease conditions also suffer from pain. Identifying animals in pain alone is difficult except if a Veterinarian with a penchant for the management of pain in animals actively looks out for it in patients. The measurement of pain in animals poses even more difficulties for the Veterinarian than its identification mainly because animals are unable to communicate the locations, the temporal occurance and the severities of the pain they feel just as they don’t of other clinical manifestations. Therefore, animals in pain rely on their owners, handlers or keepers et cetera who actually don’t know how or where it hurts them to provide such details to the Veterinaruan. To complicate matters, the use of validated pain assessment scales in animals is fraught with serious limitations except to some less extent, for the visual analog and the simple descriptive scales which seem applicable in real clinic situations. A multi-modal mode of management in which opioids, non-steroidal anti-inflammatory drugs, local anesthetics, α 2 – adrenergic agonists, NDMA receptor antagonists and ketamine delivered through a variety of routes, at varied dosages and regimens, is advocated for pain management in animals. The need to regularly review the state of the patient vis-à-vis the need to modify the treatment module and regimen cannot be over emphasized when and if a clinical case is under consideration. This may involve the change of medications, the addition of more medications, the reduction in the number of medication, changes in dosages and the regimen in use from time to time. This discuss is aimed at the general Veterinary practitioner who is presented daily with different species and breeds of animals suffering from varieties of clinical conditions or which will undergo a variety of clinical procedures capable of causing pain in the course of veterinary health care delivery in diverse clinic settings.

Mechanical ventilation. Part I: Physiology and pathophysiology

Despite the fact that mechanical ventilation is an integral part of anaesthesia practice, its widespread use in veterinary medicine has yet to be established. The increasing needs and advances in animal pain management, being associated with anaesthetic protocols that can cause hypoventilation, make the use of mechanical ventilation more necessary than ever. Although mechanically ventilating the patient is not pivotal in a substantial number of surgical techniques, inability to do so precludes certain anaesthetic protocols from being used, making the choice of the drugs to be employed troubleshooting. Successful mechanical ventilation requires a thorough understanding of the physiology and pathophysiology of respiration, as well as the way mechanical ventilation affects them. Before any attempt to describe mechanical ventilation, a glossary of technical terms has to be accepted, as long as consensus between the authors has not been found in the literature. Lung elasticity, resistance to flow, inspiration time and the ratio of inspiration to expiration time interact during mechanical ventilation affecting the final result on the patient. Volutrauma, barotrauma, ventilation-perfusion mismatch and cardiac output decrease are some of the adverse effects of mechanical ventilation. The choice of whether or not to use automatic ventilators, the choice of the right equipment and setting the variables correctly on the control panel need a thorough understanding of patient pathology. This article reviews respiration under normal and pathologic conditions and the effects mechanical ventilation exerts on different organ systems. Guidelines for the application of mechanical ventilation under various pathologic conditions are provided.

Using behavioural science to improve pain management

Pain management can be challenging to achieve in practice due to the participation of many different stakeholders and the complex behaviours involved in decision-making. Here, Guen Bradbury and Katie Morton...

Pain and Laboratory Animals: Publication Practices for Better Data Reproducibility and Better Animal Welfare.

Scientists who perform major survival surgery on laboratory animals face a dual welfare and methodological challenge: how to choose surgical anesthetics and post-operative analgesics that will best control animal suffering, knowing that both pain and the drugs that manage pain can all affect research outcomes. Scientists who publish full descriptions of animal procedures allow critical and systematic reviews of data, demonstrate their adherence to animal welfare norms, and guide other scientists on how to conduct their own studies in the field. We investigated what information on animal pain management a reasonably diligent scientist might find in planning for a successful experiment. To explore how scientists in a range of fields describe their management of this ethical and methodological concern, we scored 400 scientific articles that included major animal survival surgeries as part of their experimental methods, for the completeness of information on anesthesia and analgesia. The 400 articles (250 accepted for publication pre-2011, and 150 in 2014–15, along with 174 articles they reference) included thoracotomies, craniotomies, gonadectomies, organ transplants, peripheral nerve injuries, spinal laminectomies and orthopedic procedures in dogs, primates, swine, mice, rats and other rodents. We scored articles for Publication Completeness (PC), which was any mention of use of anesthetics or analgesics; Analgesia Use (AU) which was any use of post-surgical analgesics, and Analgesia Completeness (a composite score comprising intra-operative analgesia, extended post-surgical analgesia, and use of multimodal analgesia). 338 of 400 articles were PC. 98 of these 338 were AU, with some mention of analgesia, while 240 of 338 mentioned anesthesia only but not post-surgical analgesia. Journals’ caliber, as measured by their 2013 Impact Factor, had no effect on PC or AU. We found no effect of whether a journal instructs authors to consult the ARRIVE publishing guidelines published in 2010 on PC or AC for the 150 mouse and rat articles in our 2014–15 dataset. None of the 302 articles that were silent about analgesic use included an explicit statement that analgesics were withheld, or a discussion of how pain management or untreated pain might affect results. We conclude that current scientific literature cannot be trusted to present full detail on use of animal anesthetics and analgesics. We report that publication guidelines focus more on other potential sources of bias in experimental results, under-appreciate the potential for pain and pain drugs to skew data, and thus mostly treat pain management as solely an animal welfare concern, in the jurisdiction of animal care and use committees. At the same time, animal welfare regulations do not include guidance on publishing animal data, even though publication is an integral part of the cycle of research and can affect the welfare of animals in studies building on published work, leaving it to journals and authors to voluntarily decide what details of animal use to publish. We suggest that journals, scientists and animal welfare regulators should revise current guidelines and regulations, on treatment of pain and on transparent reporting of treatment of pain, to improve this dual welfare and data-quality deficiency.

Refinement and partial validation of the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in horses.

BackgroundQuantification of pain plays a vital role in the diagnosis and management of pain in animals. In order to refine and validate an acute pain scale for horses a prospective, randomized, blinded study was conducted. Twenty-four client owned adult horses were recruited and allocated to one of four following groups: anaesthesia only (GA); pre-emptive analgesia and anaesthesia (GAA,); anaesthesia, castration and postoperative analgesia (GC); or pre-emptive analgesia, anaesthesia and castration (GCA). One investigator, unaware of the treatment group, assessed all horses at time-points before and after intervention and completed the pain scale. Videos were also obtained at these time-points and were evaluated by a further four blinded evaluators who also completed the scale. The data were used to investigate the relevance, specificity, criterion validity and inter- and intra-observer reliability of each item on the pain scale, and to evaluate construct validity and responsiveness of the scale.ResultsConstruct validity was demonstrated by the observed differences in scores between the groups, four hours after anaesthetic recovery and before administration of systemic analgesia in the GC group. Inter- and intra-observer reliability for the items was only satisfactory. Subsequently the pain scale was refined, based on results for relevance, specificity and total item correlation.ConclusionsScale refinement and exclusion of items that did not meet predefined requirements generated a selection of relevant pain behaviours in horses. After further validation for reliability, these may be used to evaluate pain under clinical and experimental conditions.

Acute pain in small animals: how far have we come and where are we going?

Acute pain in small animals: how far have we come and where are we going?

Douleur chez l'animal, point de vue de l'agence nationale du médicament vétérinaire

The regulatory classification of drugs used for the management of pain in animals causes problems for veterinary surgeons, which depend on the animal species. The drugs available for food-producing animals must not generate residues toxic for the consumer (MRLs). Therefore, the consumption of foodstuffs of animal origin must take into account the withdrawal period specified in the drug’s marketing authorisation, or a fixed withdrawal period for off-label use. Consequently, there are few drugs available in this indication, as their development is hampered by the lengthy evaluation and authorisation procedures imposed on the manufacturers of veterinary medicinal products. If a drug has not been authorised for veterinary use, the prescriber may use a drug authorised for human use, a drug authorised in another member country, or a drug prepared as an extemporaneous mixture. But these alternatives provide only a partial solution to the scarcity of adequate drugs. A simplification of the procedures involved in drug marketing authorisations and MLRs is expected to promote the introduction of new medicinal products. Prescribers must comply with strict prescribing and dispensing rules due to their pharmacological classification. Dispensing renewals have time limits, which vary depending on the treatment. The relevant authorities have set up restrictions to avoid misappropriation or misuse, but these rules place an additional burden on the access, use, and storage of such drugs.

Moving Toward Interdisciplinary Pain Management

Pain is an unpleasant and emotional experience associated with actual or potential tissue damage. The current method of caring for a person with multiple issues and problems is a "multidisciplinary" approach; however, the disadvantages of a multidisciplinary approach are many. A more desirable alternative is an "interdisciplinary" approach. Interdisciplinary care is predicated on professionals communicating with one another about a single patient and designing care that is in the overall best interest of the patient. This paper describes the formation of the International Veterinary Academy of Pain Management, whose objective is to promote the interdisciplinary approach to animal pain management.

Attitudes of veterinary medical students, house officers, clinical faculty, and staff toward pain management in animals

Objective To determine whether animal factors and level of professional veterinary medical training were associated with attitudes toward pain management in animals. Design Exploratory, descriptive survey. Sample Population Students in the College of Veterinary Medicine and Biomedical Sciences professional veterinary medical curriculum (approx 540) and clinical faculty (approx 50), house officers (approx 25), and support staff (approx 100) in the Colorado State University Veterinary Teaching Hospital. Procedure A descriptive survey including demographic, descriptive, and case-based questions was distributed to participants. Participation was voluntary and survey results were anonymous. Results 357 of 720 surveys were completed and returned (31 by faculty, 29 by staff, 18 by house officers, and 279 by students). There was a high degree of concordance among survey participants regarding the overall importance of treating pain in animals. The extent to which pain should be alleviated and animal factors, such as breed, behavior, and clinical circumstances, accounted for much of the discordance among survey groups. Fourth-year veterinary students indicated that they were occasionally less likely to treat animals for pain than were second- or third-year veterinary students. Clinical Implications The diversity of opinions regarding the necessity or desirability of treating pain in animals, the apparent decrease in the likelihood of senior veterinary students to treat animals for pain under certain circumstances, and evidence of knowledge deficits regarding analgesic treatments among all groups contribute to the likelihood that pain in animals will neither be consistently recognized nor appropriately treated. (J Am Vet Med Assoc 1999;214:238–244)