Pain: mechanisms and management in horses

The efficacy of injecting a distillate of the pitcher plant (Sarraceniaceae) adjacent to the palmar digital nerves of horses to ameliorate lameness caused by digital pain

This study aimed to determine the efficacy of instilling extract of the pitcher plant around the palmar digital nerves of horses to ameliorate digit pain causing lameness. Five mixed breed horses were recruited. Horses were determined to be lame because of pain in the distal portion of one or both thoracic limbs by a positive response to a basisesamoid nerve block using 2%^mepivacaine hydrochloride. Gait was evaluated pre- and post-nerve block at 30 min, 3, 7,14 and 21 days. At the 3-week evaluation, the basisesamoid nerve block was repeated using the extract, and the gait was evaluated at similar times. Lameness was evaluated objectively using a wireless, inertial, sensor-based, motion analysis system. The basisesamoid nerve block significantly ameliorated lameness at 30 min when gait was evaluated, but it had no significant effect on lameness after this time. The product containing extract of the pitcher plant had no significant effect on lameness when administered as a basisesamoid nerve block at any time. Extract of the pitcher plant administered adjacent to the medial and lateral palmar digital nerves (i.e., a basisesamoid nerve block) had no efficacy in ameliorating lameness in the distal portion of one or both thoracic limbs. Extract of the pitcher plant likely has no value for treating horses for chronic pain when administered as a regional nerve block.

Assessment of Pain and Inflammation in Domestic Animals Using Infrared Thermography: A Narrative Review

Pain assessment in domestic animals has gained importance in recent years due to the recognition of the physiological, behavioral, and endocrine consequences of acute pain on animal production, welfare, and animal model validity. Current approaches to identifying acute pain mainly rely on behavioral-based scales, quantifying pain-related biomarkers, and the use of devices monitoring sympathetic activity. Infrared thermography is an alternative that could be used to correlate the changes in the superficial temperature with other tools and thus be an additional or alternate acute pain assessment marker. Moreover, its non-invasiveness and the objective nature of its readout make it potentially very valuable. However, at the current time, it is not in widespread use as an assessment strategy. The present review discusses scientific evidence for infrared thermography as a tool to evaluate pain, limiting its use to monitor acute pain in pathological processes and invasive procedures, as well as its use for perioperative monitoring in domestic animals.

The Clinical Pharmacology and Therapeutic Evaluation of Non-Steroidal Anti-Inflammatory Drugs in Adult Horses

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.

Basic Postoperative Care of the Equine Colic Patient

The 3 time periods around colic surgery (preoperative, operative, and postoperative) are all critical to successful outcomes. Although much focus is often paid to the first 2 time periods, the importance of sound clinical judgment and rational decision-making in the postoperative period cannot be overstated. This article will outline the basic principles of monitoring, fluid therapy, antimicrobial therapy, analgesia, nutrition, and other therapeutics routinely used in patients following colic surgery. Discussions of the economics of colic surgery and expectations for normal return to function will also be included.

Intravenous magnesium sulphate in standing horses: effects on physiological parameters, plasma concentration of magnesium and nociceptive threshold tests

A bolus of 50 mg kg ^-1 MgSO₄ (treatment Mg) or the same volume of saline (treatment S) was infused over 15 minutes in 5 adult healthy horses. T0 was the end of the infusion. Physiological parameters were recorded throughout the study period. Measurements of electrical, thermal and mechanical nociceptive thresholds were performed at the pelvic limbs at baseline (before T0), and at specific timepoints. Blood samples were taken at fixed timepoints before, during and until 12 hours after the infusion. For statistical analysis, the 95% confidence intervals (CI's) for the differences in nociceptive thresholds between treatments were calculated. Physiological parameters were compared using a linear mixed model (global α = 0.05, with Bonferroni correction α = 0.0125). The concentrations of ions were also compared with baseline values at specific timepoints, using a linear mixed model. The Pearson's correlation coefficient was derived between the ion concentrations. The 95% CI's of thermal, mechanical and electrical thresholds were [-1; +2]°C, [0; +3] N and [-1; +1] mA (positive differences indicate higher thresholds for treatment Mg), respectively. Heart rate was significantly higher (p < 0.0001) and non-invasive systolic arterial pressure (p < 0.0001) and respiratory rate (p = 0.0002) significantly lower after treatment Mg compared to treatment S. Additionally, non-invasive systolic arterial pressure was significantly different at T45 (p < 0.001). Although mild changes in cardiovascular parameters and plasma concentrations were seen with intravenous administration of MgSO₄, no changes in nociceptive thresholds were detected in standing non-sedated horses.

Nociceptive pain and anxiety in equines: Physiological and behavioral alterations

Pain and anxiety are two of the most important concerns in clinical veterinary medicine because they arise as consequences of multiple factors that can severely affect animal welfare. The aim of the present review was to provide a description and interpretation of the physiological and behavioral alterations associated with pain and anxiety in equines. To this end, we conducted an extensive review of diverse sources on the topic. The article begins by describing the neurophysiological pathway of pain, followed by a discussion of the importance of the limbic system in responses to pain and anxiety, since prolonged exposure to situations that cause stress and pain generates such physiological changes as tachycardia, tachypnea, hypertension, hyperthermia, and heart rate variability (HRV), often accompanied by altered emotional states, deficient rest, and even aggressiveness. In the long term, animals may show deficiencies in their ability to deal with changes in the environment due to alterations in the functioning of their immune, nervous, and endocrinologic systems. In conclusion, pain and anxiety directly impact the homeostasis of organisms, so it is necessary to conduct objective evaluations of both sensations using behavioral scales, like the horse grimace scale, complemented by assessments of blood biomarkers to analyze their correlation with physiological parameters: Heart rate, respiratory rate, HRV, theparasympathetic tone activity index, lactate and glucose levels, and temperature. Additional tools - infrared thermography, for example - can also be used in these efforts to improve the quality of life and welfare of horses.

Pain assessment in horses using automatic facial expression recognition through deep learning-based modeling

The aim of this study was to develop and evaluate a machine vision algorithm to assess the pain level in horses, using an automatic computational classifier based on the Horse Grimace Scale (HGS) and trained by machine learning method. The use of the Horse Grimace Scale is dependent on a human observer, who most of the time does not have availability to evaluate the animal for long periods and must also be well trained in order to apply the evaluation system correctly. In addition, even with adequate training, the presence of an unknown person near an animal in pain can result in behavioral changes, making the evaluation more complex. As a possible solution, the automatic video-imaging system will be able to monitor pain responses in horses more accurately and in real-time, and thus allow an earlier diagnosis and more efficient treatment for the affected animals. This study is based on assessment of facial expressions of 7 horses that underwent castration, collected through a video system positioned on the top of the feeder station, capturing images at 4 distinct timepoints daily for two days before and four days after surgical castration. A labeling process was applied to build a pain facial image database and machine learning methods were used to train the computational pain classifier. The machine vision algorithm was developed through the training of a Convolutional Neural Network (CNN) that resulted in an overall accuracy of 75.8% while classifying pain on three levels: not present, moderately present, and obviously present. While classifying between two categories (pain not present and pain present) the overall accuracy reached 88.3%. Although there are some improvements to be made in order to use the system in a daily routine, the model appears promising and capable of measuring pain on images of horses automatically through facial expressions, collected from video images.

Pressure Algometry for the Detection of Mechanical Nociceptive Thresholds in Horses

Simple Summary

It is difficult to measure pain in horses. As animals are not able to verbalize what they feel, we are left with trying to interpret the different signs that they display when they are in pain. Many of these signs are vague (e.g., not eating their food), but some are more readily identified if the animal moves away or lifts their leg when pressure is applied to a sensitive area. Pressure algometry is a tool used to detect responses to applied mechanical stimuli within painful and nonpainful tissues. Pressure algometry has been used in many different studies, but there is no consensus on how to synthesize this information to better diagnose and treat pain in horses. The purpose of this study was to summarize the results of these studies. Based on that review, we conclude that there is good evidence that pressure algometry is a reliable and objective method to measure pain responses. This information will help to improve the diagnosis and treatment of pain in horses.

Abstract

The clinical assessment of pain is subjective; therefore, variations exist between practitioners in their ability to identify and localize pain. Due to differing interpretations of the signs or severity of pain equine practitioners may assign varying levels of clinical significance and treatment options. There is a critical need to develop better tools to qualify and quantify pain in horses. Palpation is the most common method to detect local tenderness or sensitivity. To quantify this applied pressure, pressure algometry has been used to gradually apply pressure over specified landmarks until an avoidance response is noted, which is defined as the mechanical nociceptive threshold (MNT). Numerous studies have used pressure algometry in different applications to measure MNTs in horses. There is an acute need to establish normative values within different body regions and to develop standardized methods of testing MNTs to better guide practitioners in the diagnosis and treatment of pain. The aim of this systematic review was to summarize the evidence for the use of pressure algometry in horses. There is good evidence that pressure algometry is a repeatable, semi-objective method that can be used in a wide array of clinical and research applications to assess MNTs in horses.

A retrospective evaluation of the effect of perianesthetic hydromorphone administration on the incidence of postanesthetic signs of colic in horses

OBJECTIVE

To describe the incidence of postanesthetic signs of colic (PASC) in horses and determine if perianesthetic administration of hydromorphone was associated with an increased risk of PASC.

STUDY DESIGN

Retrospective, cohort study.

ANIMALS

A total of 409 horses.

METHODS

Anesthesia and clinical records of horses admitted for various procedures from July 2018 to September 2019 were reviewed. Signs of colic and interventions were recorded up to 48 hours after anesthesia. A binomial logistic regression model was used to evaluate the association between the type of surgery, administration of hydromorphone, the duration of anesthesia and the incidence of PASC.

RESULTS

Overall, 25 (6.1%) horses developed PASC within 48 hours of general anesthesia. Of 60 horses that underwent colic surgery, 16 (26.7%) developed PASC. Of 349 horses that underwent noncolic procedures, nine (2.6%) developed PASC. Thus, the incidence of PASC was higher in horses that underwent colic surgery than in horses that underwent noncolic procedures [odds ratio (OR) = 13.74 (5.73-32.95)]. No effect of hydromorphone on the incidence of PASC was identified [OR = 1.61 (0.71-3.62)]. Longer procedures (>2 hours) were identified as an independent risk factor for PASC [OR = 4.13 (1.52-11.22)].

CONCLUSIONS

No association between hydromorphone and an increase in the incidence of PASC was identified. Anesthesia for colic surgery and duration of anesthesia were associated with an increased risk of PASC.

CLINICAL RELEVANCE

Hydromorphone did not increase the incidence of PASC in this population.

Pain: Its Diagnosis and Management in the Rehabilitation of Horses

This article provides a brief overview of pain physiology and its relevance to equine patients. Objective and subjective techniques for assessing pain in the horse are described in depth. Pharmacologic and interventional pain modulation treatments are discussed with a focus on the rehabilitating horse.

Effect of Pre- and Postoperative Phenylbutazone and Morphine Administration on the Breathing Response to Skin Incision, Recovery Quality, Behavior, and Cardiorespiratory Variables in Horses Undergoing Fetlock Arthroscopy: A Pilot Study

This prospective blinded randomized study aimed to determine whether the timing of morphine and phenylbutazone administration affects the breathing response to skin incision, recovery quality, behavior, and cardiorespiratory variables in horses undergoing fetlock arthroscopy. Ten Standardbred horses were premedicated with acepromazine (0.04 mg kg⁻¹ IM) and romifidine (0.04 mg kg⁻¹ IV). Anesthesia was induced with diazepam (0.05 mg kg⁻¹) and ketamine (2.2 mg kg⁻¹) IV at T0. Horses in group PRE (n = 5) received morphine (0.1 mg kg⁻¹) and phenylbutazone (2.2 mg kg⁻¹) IV after induction and an equivalent amount of saline after surgery. Horses in group POST (n = 5) received the inversed treatment. Anesthesia was maintained with isoflurane 2% in 100% oxygen. Hypotension (mean arterial pressure <60 mmHg) was treated with dobutamine. All horses breathed spontaneously. Dobutamine requirements, respiratory rate (f_R), heart rate (HR), mean arterial blood pressure, end-tidal CO₂, inspired (_i) and expired (_e) tidal and minute volume (V_T and V˙E), inspiratory time (IT), and the inspiratory gas flow (V_Ti/IT) were measured every 5 min. Data were averaged during four 15 min periods before (P1 and P2) and after the incision (P3 and P4). Serial blood–gas analyses were also performed. Recoveries were unassisted, video recorded, and scored by three anesthetists blinded to the treatment. The postoperative behavior of the horses (25 demeanors), HR, and f_R were recorded at three time points before induction (T0–24 h, T0–12 h, and T0–2 h) and six time points after recovery (TR) (TR + 2, 4, 6, 12, 24, 48 h). Data were compared between groups using a Wilcoxon test and within groups using a Friedman test or a Kruskal–Wallis signed-rank test when applicable. Tidal volumes (V_Te and V_Ti) were higher in PRE than in POST during all the considered periods but the difference between groups was only significant during P2 (V_Te in mL kg⁻¹ in PRE: 13 [9, 15], in POST: 9 [8, 9], p = 0.01). None of the other variables were significantly different between and within groups. Under our experimental conditions, skin incision did not affect respiratory variables. Administration of pre- versus postoperative phenylbutazone and morphine did not influence recovery quality, HR, f_R, or animal behavior.

The use of nonsteroidal anti-inflammatory drugs in critically ill horses

OBJECTIVE

To review the physiology of the cyclooxygenase (COX) enzymes with reference to the beneficial effects of nonsteroidal anti-inflammatory drugs (NSAIDs) related to their analgesic and antiendotoxic properties as well as the mechanisms responsible for adverse gastrointestinal, renal, and coagulation effects.

DATA SOURCES

Human and veterinary peer reviewed literature

VETERINARY DATA SYNTHESIS

NSAIDs are frequently administered to critically ill horses for their analgesic and anti-inflammatory effects. However, NSAIDs have significant side effects principally on the gastrointestinal mucosa and kidneys. These side effects may be exacerbated in critically ill horses if they have gastrointestinal damage or are volume depleted

CONCLUSIONS

This review provides important information for equine veterinarians and criticalists on the advantages and disadvantages of using traditional NSAIDs and newer equine COX-2 selective NSAIDs for the management of different conditions in critically ill horses.