Contact heat thermal threshold testing in beagle dogs: baseline reproducibility and the effect of acepromazine, levomethadone and fenpipramide

Quantitative sensory testing in canine musculoskeletal pain: Findings from a systematic review, meta-analysis feasibility assessment, and limitations

Quantitative sensory testing (QST) allows the study of pain mechanisms, patient phenotyping, and response to therapy. The goals of this study were to conduct a systematic review of the use of QST in dogs with musculoskeletal disease including osteoarthritis (OA), and to assess, by means of a meta-analysis, the ability of QST to differentiate affected dogs from healthy controls. The study protocol was registered; three bibliographic databases were screened. Studies involving QST in healthy dogs and those with musculoskeletal disease were included. Data were extracted using a standardized form. Assessment of quality and risk of bias were performed using the CAMARADES critical assessment tool. Twenty-nine articles met the inclusion criteria [systematic review (n = 11); meta-analysis (n = 28)]. In the systematic review, ten studies performed static QST: mechanical [punctate tactile (n = 6); mechanical pressure (n = 5)]; thermal [cold (n = 3); hot (n = 4)]; electrical (n = 1); and one study performed dynamic QST [conditioned pain modulation (n = 1)]. Most studies were of good scientific quality and showed low to moderate risk of bias. A meta-analysis was not possible due to numerous and severe issues of heterogeneity of data among studies. Methods to reduce risk of bias and use of reporting guidelines are some of the most needed improvements in QST research in dogs. Standardization of QST methodology is urgently needed in future studies to allow for data synthesis and a clear understanding of the sensory phenotype of dogs with and without chronic pain including OA.

Plasma levels of a methadone constant rate infusion and their corresponding effects on thermal and mechanical nociceptive thresholds in dogs

Background

The present study aimed to collect pharmacokinetic data of a methadone continuous rate infusion (CRI) and to investigate its effect on mechanical and thermal nociceptive thresholds. Seven, 47 to 54 months old beagle dogs, weighing 9.8 to 21.2 kg, were used in this experimental, randomized, blinded, placebo-controlled crossover study. Each dog was treated twice with either a methadone bolus of 0.2 mg kg^− 1 followed by a 0.1 mg kg^− 1 h^− 1 methadone CRI (group M) or an equivalent volume of isotonic saline solution (group P) for 72 h. Mechanical and thermal thresholds, as well as vital parameters and sedation were measured during CRI and for further 24 h. Blood samples for methadone plasma concentrations were collected during this 96 h period.

Results

Percentage thermal excursion (%TE) increased significantly from baseline (BL) until 3 h after discontinuation of CRI in M. Within P and between treatment groups differences were not significant. Mechanical threshold (MT) increased in M until 2 h after CRI discontinuation. Bradycardia and hypothermia occurred in M during drug administration and dogs were mildly sedated for the first 47 h. Decreased food intake and regurgitation were observed in M in five and four dogs, respectively. For methadone a volume of distribution of 10.26 l kg^− 1 and a terminal half-life of 2.4 h were detected and a clearance of 51.44 ml kg^− 1 min^− 1 was calculated. Effective methadone plasma concentrations for thermal and mechanical antinociception were above 17 ng ml^− 1.

Conclusion

A methadone CRI of 0.1 mg kg^− 1 h^− 1 for 3 days after a loading dose results in steady anti-nociceptive effects in an acute pain model in healthy dogs. Main side effects were related to gastrointestinal tract, hypothermia, bradycardia and sedation.

Remote Controlled Nociceptive Threshold Testing Systems in Large Animals

Simple Summary

Measurement of the nociceptive threshold (NT) is widely used in the study of pain and its alleviation. This records the intensity of a stimulus that causes pain to the test subject. The end point of the test that indicates when the subject experiences pain, the NT, is a behavioural escape response. Detection of a reliable and repeatable response depends on the animal behaving normally throughout testing. Restraint and an unfamiliar environment may prevent the animal from displaying normal behaviour and impede acquisition of robust NTs. Remotely controlled testing enables NT data to be collected from unrestrained animals behaving normally. Development of a remote controlled system for measurement of thermal and mechanical NTs in a range of large animal species is described. Normal “baseline” thermal and mechanical NTs from untreated animals are reported. This information can be used to improve both the welfare of the animals under investigation and the quality of the data collected. Remote controlled systems are now in use worldwide in both the study of pain physiology and in developing new pharmaceutical and non-drug-based methods of pain relief.

Abstract

Nociceptive threshold (NT) testing is widely used for the study of pain and its alleviation. The end point is a normal behavioural response, which may be affected by restraint or unfamiliar surroundings, leading to erroneous data. Remotely controlled thermal and mechanical NT testing systems were developed to allow free movement during testing and were evaluated in cats, dogs, sheep, horses and camels. Thermal threshold (TT) testing incorporated a heater and temperature sensor held against the animal’s shaved skin. Mechanical threshold (MT) testing incorporated a pneumatic actuator attached to a limb containing a 1–2 mm radiused pin pushed against the skin. Both stimuli were driven from battery powered control units attached on the animal’s back, controlled remotely via infra-red radiation from a handheld component. Threshold reading was held automatically and displayed digitally on the unit. The system was failsafe with a safety cut-out at a preset temperature or force as appropriate. The animals accepted the equipment and behaved normally in their home environment, enabling recording of reproducible TT (38.5–49.8 °C) and MT (2.7–10.1 N); precise values depended on the species, the individual and the stimulus characteristics. Remote controlled NT threshold testing appears to be a viable refinement for pain research.

Quantitative sensory testing in dogs with painful disease: A window to pain mechanisms?

Evaluation of the response to externally applied physical stimuli, such as pressure, heat, or cold is termed quantitative sensory testing (QST). QST may be used to identify and quantify alterations (gain or loss) in function of the sensory systems which detect and mediate these phenomena in both man and animals, and potentially discriminate peripheral and central sensitisation. It has been postulated that evaluation of QST parameters may predict response to analgesics, ultimately increasing the individualisation of treatment for pain. However, while there do appear to be correlations between QST measures and responses to analgesics in man, there is currently insufficient evidence to recommend QST to direct clinical treatments. The use of psychophysical testing, such as QST, in non-verbal subjects presents additional challenges, and requires familiarity with species and individual responses. This narrative review describes the investigations into QST in clinical populations of dogs to date, and discusses the potential benefits and limitations of such testing.

Development and initial validation of a sensory threshold examination protocol (STEP) for phenotyping canine pain syndromes

OBJECTIVE

To study the feasibility and test-retest repeatability of a sensory threshold examination protocol (STEP) and report the quantitative sensory threshold distributions in healthy dogs.

STUDY DESIGN

Prospective, observational, cohort study.

ANIMALS

Twenty-five healthy client-owned dogs.

METHODS

Tactile sensitivity test (TST) (von Frey filaments), mechanical thresholds (MT with 2, 4 and 8 mm probes), heat thresholds (HT) and responsiveness to cold stimulus (CT at 0 °C) were quantitatively assessed for five body areas (BAs; tibias, humeri, neck, thoracolumbar region and abdomen) in a randomized order on three different occasions. Linear mixed model and generalized linear mixed models were used to evaluate the effects of body weight category, age, sex, BA, occasion, feasibility score and investigator experience. Test-retest repeatability was evaluated with the intra-class correlation coefficient.

RESULTS

The STEP lasted 90 minutes without side effects. The BA affected most tests (p ≤ 0.001). Higher thresholds and longer cold latencies were scored in the neck (p ≤ 0.024) compared to other BAs. Weight category affected all thresholds (p ≤ 0.037). Small dogs had lower MT (∼1.4 N mean difference) and HT (1.1 °C mean difference) than other dogs (p ≤ 0.029). Young dogs had higher HT than adults (2.2 °C mean difference) (p = 0.035). Gender also affected TST, MT and HT (p < 0.05) (females versus males: TST odds ratio = 0.5, MT = 1.3 N mean difference, HT = 2.2 °C mean difference). Repeatability was substantial to moderate for all tests, but poor for TST. There was no difference in thresholds between occasions, except for CT. Test-retest repeatability was slightly better with the 2 mm MT probe compared to other diameters and improved with operator experience.

CONCLUSIONS AND CLINICAL RELEVANCE

The STEP was feasible, was well tolerated and showed substantial test-retest repeatability in healthy dogs. Further validation is needed in dogs suffering pain.

Relationship between the melanocortin-1 receptor (MC1R) variant R306ter and physiological responses to mechanical or thermal stimuli in Labrador Retriever dogs

OBJECTIVE

Variants in the MC1R gene have been associated with red hair color and sensitivity to pain in humans. The study objective was to determine if a relationship exists between MC1R genotype and physiological thermal or mechanical nociceptive thresholds in Labrador Retriever dogs.

STUDY DESIGN

Prospective experimental study.

ANIMALS

Thirty-four Labrador Retriever dogs were included in the study following public requests for volunteers. Owner consent was obtained and owners verified that their dog was apparently not experiencing pain and had not been treated for pain during the previous 14 days. The study was approved by the Institutional Animal Care and Use Committee.

METHODS

Nociceptive thresholds were determined from a mean of three thermal and five mechanical replications using commercially available algometers. Each dog was genotyped for the previously described MC1R variant (R306ter). Data were analyzed using one-way anova with post hoc comparisons using Tukey's test (p < 0.05).

RESULTS

Thirteen dogs were homozygous wild-type (WT/WT), nine were heterozygous (WT/R306ter), and eight were homozygous variant (R306ter/R306ter) genotype. Four dogs could not be genotyped. A significant difference (p = 0.04) in mechanical nociceptive thresholds was identified between dogs with the WT/WT genotype (12.1±2.1 N) and those with the WT/R306ter genotype (9.2±2.4 N).

CONCLUSION

A difference in mechanical, but not thermal, nociceptive threshold was observed between wild-type and heterozygous MC1R variants. Differences in nociceptive thresholds between homozygous R306ter variants and other genotypes for MC1R were not observed.

CLINICAL RELEVANCE

Compared with the wild-type MC1R genotype, nociceptive sensitivity to mechanical force in dogs with a single variant R306ter allele may be greater. However, in contrast to the reported association between homozygous MC1R variants (associated with red hair color) and nociception in humans, we found no evidence of a similar relationship in dogs with the homozygous variant genotype.

Influence of tramadol on acute thermal and mechanical cutaneous nociception in dogs

OBJECTIVE

The aim of the study was to evaluate the influence of tramadol on acute nociception in dogs.

STUDY DESIGN

Experimental, blinded, randomized, crossover study.

ANIMALS

Six healthy laboratory Beagle dogs.

METHODS

Dogs received three treatments intravenously (IV): isotonic saline placebo (P), tramadol 1 mg kg^-1 (T1) and tramadol 4 mg kg^-1 (T4). Thermal thresholds were determined by ramped contact heat stimulation (0.6 °C second^-1) at the lateral thoracic wall. Mechanical thresholds (MT) were measured using a probe containing three blunted pins which were constantly advanced over the radial bone, using a rate of force increase of 0.8 N second^-1. Stimulation end points were defined responses (e.g. skin twitch, head turn, repositioning, vocalization) or pre-set cut-out values (55 °C, 20 N). Thresholds were determined before treatment and at predetermined time points up to 24 hours after treatment. At each measurement point, blood was collected for determination of O-desmethyltramadol concentrations. The degree of sedation and behavioural side effects were recorded. Data were analysed by one-way anova and two-way anova for repeated measurements.

RESULTS

Thermal nociception was not influenced by drug treatment. Mechanical nociception was significantly increased between P and T1 at 120 and 240 minutes, and between P and T4 at 30, 60, 240 and 420 minutes. T1 and T4 did not differ. O-desmethyltramadol (M1) maximum plasma concentrations (C_max) were 4.2±0.8 ng mL^-1 and 14.3±2.8 ng mL^-1 for T1 and T4, respectively. Times to reach maximum plasma concentrations (T_max) were 27.6±6.3 minutes for T1 and 32.1±7.8 minutes for T4. No sedation occurred. There were signs of nausea and mild to moderate salivation in both groups.

CONCLUSION AND CLINICAL RELEVANCE

Tramadol was metabolized marginally to O-desmethyltramadol and failed to produce clinically relevant acute antinociception. Therefore, the use of tramadol for acute nociceptive pain is questionable in dogs.

Validation of a modified algometer to measure mechanical nociceptive thresholds in awake dogs

This study was conducted to validate the use of a modified algometer device to measure mechanical nociceptive thresholds in six dogs. Dogs were administered morphine intravenously (IV) at 1 mg/kg or saline at equivolume in a crossover design with one-week washout period. Mechanical nociceptive thresholds were determined before, after the administration of treatments at 5 minutes, and hourly for 8 hours. Thresholds were recorded at the carpal pad, metacarpal foot pad, tibia, femur, and abdomen. Heart rates, body temperature, and respiration were recorded at similar time points. Thresholds increased significantly (P < 0.05) from baseline values for up to 3 hours at tibia and abdomen, 4 hours at metacarpal pad, and 5 hours at the carpal pad and femur. Hypothermia, bradycardia, and change in respiration were observed in all dogs after morphine injection. Saline did not alter any threshold levels during the eight-hour study period, indicating no evidence of tolerance, learned avoidance, or local hyperaesthesia. The device and methods of testing were well tolerated by all the dogs. Results suggest that the modified algometer and method of application are useful to measure nociceptive mechanical thresholds in awake dogs.

Refinement of a thermal threshold probe to prevent burns

Thermal threshold testing is commonly used for pain research. The stimulus may cause burning and merits prevention. Thermal probe modifications hypothesized to reduce burning were evaluated for practicality and effect. Studies were conducted on two humans and eight cats. Unmodified probe 0 was tested on two humans and promising modifications were also evaluated on cats. Probe 1 incorporated rapid cooling after threshold was reached: probe 1a used a Peltier system and probe 1b used water cooling. Probe 2 released skin contact immediately after threshold. Probe 3 (developed in the light of evidence of 'hot spots' in probe 0) incorporated reduced thermal mass and even heating across the skin contact area. Human skin was heated to 48℃ (6℃ above threshold) and the resulting burn was evaluated using area of injury and a simple descriptive scale (SDS). Probe 1a cooled the skin but required further heat dissipation, excessive power, was not 'fail-safe' and was inappropriate for animal mounting. Probe 1b caused less damage than no cooling (27 ± 13 and 38 ± 11 mm(2) respectively, P = 0.0266; median SDS 1.5 and 4 respectively, P = 0.0317) but was cumbersome. Probe 2 was unwieldy and was not evaluated further. Probe 3 produced even heating without blistering in humans. With probe 3 in cats, after opioid treatment, thermal threshold reached cut-out (55℃) on 24 occasions, exceeded 50℃ in a further 32 tests and exceeded 48℃ in the remainder. No skin damage was evident immediately after testing and mild hyperaemia in three cats at 2-3 days resolved rapidly. Probe 3 appeared to be suitable for thermal threshold testing.