Pain Management in Veterinary Practice E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1570

Veröffentlichungsjahr: 2013

Beschreibung

Pain Management in Veterinary Practice provides veterinary practitioners with the information needed to recognize and manage pain in a wide range of large, small, and exotic animal species. Encompassing acute, adaptive, and chronic, maladaptive pain, the book provides an up-to-date review of the physiology and pathophysiology of pain. Pain Management in Veterinary Practice offers specific strategies for addressing pain in animals, including local and regional analgesia, continuous rate infusions, and novel methods of analgesic drug delivery. With comprehensive information on the pharmacokinetic and pharmacodynamic characteristics of analgesic drugs, the book goes beyond pharmaceutical options to incorporate scientific information on techniques for complementary treatment, including physical therapy, acupuncture, chiropractic techniques, and nutritional strategies. Pain Management in Veterinary Practice is a valuable resource for developing pain management protocols in the veterinary clinic.

Leseprobe

Contents

Cover

Title Page

Copyright

Contributors

Preface

ORGANIZATION AND FEATURES OF THE BOOK

ACKNOWLEDGMENTS

Section 1: Introduction and Anatomy, Physiology, and Pathophysiology of Pain

Chapter 1: Introduction: Pain: An Issue of Animal Welfare

RECOGNITION AND ASSESSMENT OF PAIN IN ANIMALS

PAIN AND CONSCIOUSNESS

ATTITUDES TOWARD ANIMAL PAIN

PAINFUL HUSBANDRY PRACTICES IN FARM ANIMALS

THE WAY FORWARD

REFERENCES

Chapter 2: Anatomy, Physiology, and Pathophysiology of Pain

NOCICEPTORS

NOCICEPTIVE AFFERENTS

SPINAL CORD

SUPRASPINAL CENTERS

VISCERAL PAIN

NEUROPATHIC PAIN

AUTONOMIC SYSTEM AND PAIN

IMMUNE SYSTEM AND PAIN

SUMMARY

REFERENCES

Chapter 3: Mechanisms of Cancer Pain

PREVALENCE OF CANCER PAIN

CAUSES OF CANCER PAIN

MECHANISMS OF CANCER PAIN

MECHANISMS OF CANCER-RELATED PAIN

POTENTIAL FUTURE TREATMENTS

ALLEVIATION OF CANCER PAIN

SUMMARY

ACKNOWLEDGMENT

REFERENCES

Section 2: Pharmacology of Analgesic Drugs

Chapter 4: Opioids

TERMINOLOGY

STRUCTURE OF OPIOIDS

OPIOID RECEPTORS

PERIPHERAL OPIOID EFFECTS

BASIC OPIOID PHARMACOKINETICS

SIDE EFFECTS OF OPIOIDS

SPECIFIC μ-AGONISTS

OPIOID AGONIST–ANTAGONISTS

OPIOID ANTAGONISTS

OPIOIDS FOR ENTERAL ABSORPTION

BUCCAL ABSORPTION OF OPIOIDS

TRANSDERMAL ROUTE

NEURAXIAL OPIOIDS

SUMMARY

REFERENCES

Chapter 5: Nonsteroidal Anti-Inflammatory Drugs and Corticosteroids

HISTORY

MECHANISMS OF ACTION

CLASSIFICATION OF NSAIDs

ADVERSE EFFECTS AND CONTRAINDICATIONS

CLINICAL USE OF NSAIDs

SELECTED NSAIDs

NSAID USE IN BIRDS, EXOTIC, AND WILD ANIMALS

DOSAGES

CORTICOSTEROIDS

SUMMARY

REFERENCES

Chapter 6: Local Anesthetics

STRUCTURE AND PHYSICAL PROPERTIES

MECHANISM OF ACTION

ANATOMY OF PERIPHERAL NERVES

SYSTEMIC ABSORPTION AND METABOLISM

LOCAL TISSUE AND SYSTEMIC TOXICITY

CLINICAL PHARMACOLOGY OF LOCAL ANESTHETICS

SUMMARY

REFERENCES

Chapter 7: α-2 Adrenoceptor Agonists

PHARMACOLOGY OF α-2 ADRENOCEPTOR AGONISTS

MECHANISMS OF ACTION OF α-2 ADRENOCEPTOR AGONISTS

PHYSIOLOGICAL EFFECTS OF α-2 ADRENOCEPTOR AGONISTS

ROUTES OF ADMINISTRATION OF α-2 AGONISTS

SUMMARY

REFERENCES

Chapter 8: Nontraditional Analgesic Agents

ANTIEPILEPTIC DRUGS

NMDA RECEPTOR ANTAGONISTS

SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITORS

DISEASE MODIFYING OSTEOARTHRITIS DRUGS

BISPHOSPHONATES

EMERGING TREATMENTS

SUMMARY

REFERENCES

Chapter 9: Novel Methods of Analgesic Drug Delivery

TOPICAL DRUG DELIVERY SYSTEMS

TRANSDERMAL DELIVERY SYSTEMS

TRANSMUCOSAL DRUG DELIVERY

EXTENDED RELEASE ORAL OPIOIDS

POLYMER GELS

LIPOSOME-ENCAPSULATED OPIOIDS

SUMMARY

REFERENCES

Chapter 10: Pharmacokinetic Principles for the Design of Intravenous Infusions

DEFINITIONS

DESIGN OF INFUSION SCHEMES

DURATION OF EFFECT

CONTEXT-SENSITIVE HALF-TIME

SUMMARY

REFERENCES

Section 3: Nonpharmacological Pain Therapy

Chapter 11: Canine Rehabilitation

UNDERSTANDING PAIN IN REHABILITATION PATIENTS

ASSESSMENT OF THE REHABILITATION PATIENT

TREATMENT OF MUSCULOSKELETAL PAIN

PRINCIPLES OF PROTOCOL DESIGN

PHASES OF REHABILITATION FOR MUSCULOSKELETAL INJURY

COMMON PHYSICAL THERAPY MODALITIES

SUMMARY

REFERENCES

Chapter 12: Equine Rehabilitation

RISK FACTORS FOR EQUINE LAMENESS

PATIENT ASSESSMENT

REHABILITATION FOR MUSCULOSKELETAL DISEASE AND INJURY

SUMMARY

REFERENCES

Chapter 13: Custom External Coaptation as a Pain Management Tool: Veterinary Orthotics and Prosthetics

PRIMARY AND SECONDARY PAIN GENERATORS ASSOCIATED WITH LIMB DYSFUNCTION OR ABSENCE

THE ROLE OF CUSTOM EXTERNAL COAPTATION IN PAIN MANAGEMENT

PATIENT EVALUATION FROM A V-OP PERSPECTIVE: DIAGNOSIS TO DEVICE

SUMMARY

REFERENCES

Chapter 14: Myofascial Pain Syndrome in Dogs

CHARACTERISTICS OF MYOFASCIAL TRIGGER POINTS

ETIOLOGY OF MYOFASCIAL TRIGGER POINTS

PAIN INITIATION IN MYOFASCIAL PAIN SYNDROME

PERPETUATING FACTORS IN MYOFASCIAL PAIN

DIAGNOSIS OF MTrPs

TREATMENT OF MTrPs

SUMMARY

REFERENCES

Chapter 15: Traditional Chinese Herbal Medicine and Homeopathy in Pain Management

CHINESE HERBAL MEDICINE AND ANALGESIA

SINGLE HERBS WITH ANALGESIC PROPERTIES

HERBAL FORMULAS WITH ANALGESIC PROPERTIES

HOMEOPATHY FOR PAIN MANAGEMENT

SUMMARY

REFERENCES

Chapter 16: Mechanisms of Acupuncture Analgesia

MECHANISMS OF ACUPUNCTURE ANALGESIA

MERIDIANS

CLINICAL PRACTICE OF ACUPUNCTURE

CHRONIC PAIN

SUMMARY

REFERENCES

Chapter 17: Equine Acupuncture

ACUPUNCTURE TECHNIQUES AND PROCEDURES

ACUPUNCTURE FOR GENERALIZED, SYSTEMIC PAIN

ACUPUNCTURE FOR LOCAL PAIN

USE OF ACUPUNCTURE IN COMPETITIVE ATHLETES

ADVERSE EFFECTS

SUMMARY

REFERENCES

Chapter 18: Canine Chiropractic and Pain Management

THE VERTEBRAL SUBLUXATION COMPLEX

CHOOSING PATIENTS THAT WILL BENEFIT FROM CHIROPRACTIC TREATMENT

CHIROPRACTIC EVALUATION

THE CHIROPRACTIC ADJUSTMENT

CONTRAINDICATIONS TO CHIROPRACTIC

CHIROPRACTIC AND CATS

TRAINING AND CERTIFICATION OPTIONS IN VETERINARY CHIROPRACTIC

THE FUTURE OF CANINE CHIROPRACTIC

SUMMARY

RESOURCES

REFERENCES

Chapter 19: Equine Chiropractic

JOINT MOTION

CHIROPRACTIC AND THE RELIEF OF PAIN

INDICATIONS FOR CHIROPRACTIC TREATMENT

CONTRAINDICATIONS TO CHIROPRACTIC MANIPULATION

CHIROPRACTIC MANIPULATION

COMPLICATIONS

CURRENT RESEARCH

SUMMARY

REFERENCES

Section 4: Management of Pain in Veterinary Species

Chapter 20: Recognition and Assessment of Acute Pain in the Dog

LIMITATIONS OF PAIN ASSESSMENT TOOLS

PAIN BEHAVIORS

PAIN SCALES AND PAIN ASSESSMENT

SUMMARY

REFERENCES

Chapter 21: Treatment of Acute Pain in the Dog

OPIOIDS

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)

LOCAL ANESTHETICS

α-2 AGONISTS

KETAMINE

PHYSICAL MODALITIES

NURSING STRATEGIES

SUMMARY

REFERENCES

Chapter 22: Recognition and Assessment of Chronic Pain in Dogs

RECOGNIZING CHRONIC PAIN IN DOGS

PAIN ASSESSMENT SCALES

CLINICAL EVALUATION OF CHRONIC PAIN

SUMMARY

REFERENCES

Chapter 23: Treatment of Chronic Pain in Dogs

TYPES OF CHRONIC PAIN

MANAGEMENT OF CHRONIC PAIN

PHARMACOLOGICAL CONTROL OF CHRONIC PAIN IN DOGS

SUMMARY

REFERENCES

Chapter 24: The Recognition and Assessment of Pain in Cats

SOURCES OF PAIN IN CATS

PAIN AND BEHAVIOR

ASSESSMENT OF PAIN

PAIN ASSESSMENT IN CATS

SUMMARY

REFERENCES

Chapter 25: Treatment of Acute Pain in Cats

CONSEQUENCES OF ACUTE PAIN

GOALS OF TREATMENT OF ACUTE PAIN IN CATS

TREATMENT STRATEGIES

SUMMARY

REFERENCES

Chapter 26: Treatment and Assessment of Chronic Pain in Cats

BARRIERS TO TREATMENT OF CHRONIC PAIN IN CATS

ASSESSMENT OF CHRONIC PAIN IN CATS

INCIDENCE OF CHRONIC PAIN IN CATS

SOURCES OF CHRONIC PAIN IN CATS

DIAGNOSIS OF PAIN IN CATS

TREATMENT OF CHRONIC PAIN IN CATS

PHYSICAL MEDICINE

SUMMARY

REFERENCES

Chapter 27: Cancer-associated Pain and its Management

ASSESSING THE CANCER PATIENT

ANALGESIC STRATEGIES

PALLIATIVE THERAPY

SUMMARY

REFERENCES

Chapter 28: Recognition and Treatment of Pain in the Small Animal Critical Care Patient

CONSEQUENCES OF PAIN IN CRITICALLY ILL PATIENTS

RECOGNITION OF PAIN IN THE CRITICALLY ILL PATIENT

MANAGEMENT OF PAIN IN THE CRITICALLY ILL PATIENT

SUMMARY

REFERENCES

Chapter 29: Recognition and Assessment of Pain in Horses

IDENTIFICATION OF PAIN IN HORSES

SUMMARY

REFERENCES

Chapter 30: Treatment of Acute and Chronic Pain in Horses

CLASSIFICATION OF EQUINE PAIN AND ITS RELEVANCE TO PAIN THERAPY

MULTIMODAL PAIN THERAPY (BALANCED ANALGESIA)

SYSTEMIC ANALGESICS USED IN THE EQUINE PATIENT

LOCOREGIONAL ANESTHESIA AND ANALGESIA

CAUDAL EPIDURAL ANALGESIA

SUMMARY

REFERENCES

Chapter 31: Recognition and Assessment of Pain in Ruminants

RECOGNITION AND ASSESSMENT OF PAIN IN RUMINANTS

SOURCES OF PAIN IN RUMINANTS

PARAMETERS FOR ASSESSING PAIN

INDICATORS OF PAIN IN CATTLE

INDICATORS OF PAIN IN SHEEP

INDICATORS OF PAIN IN GOATS

SUMMARY

REFERENCES

Chapter 32: Treatment of Acute and Chronic Pain in Ruminants

PAIN RECOGNITION AND ASSESSMENT IN RUMINANTS

ANALGESIC DRUGS USED IN RUMINANTS

SUMMARY

REFERENCES

Chapter 33: Recognition and Treatment of Pain in Camelids

RECOGNITION OF PAIN

ANALGESIC DRUGS AND TECHNIQUES

SUMMARY

REFERENCES

Chapter 34: Recognition and Treatment of Pain in Pet Pigs

RECOGNIZING PAIN IN PIGS

TREATMENT OF ACUTE PAIN IN PET PIGS

ANALGESICS FOR CHRONIC PAIN

DRUG WITHDRAWAL TIMES

SUMMARY

ACKNOWLEDGMENTS

REFERENCES

Chapter 35: Recognition and Assessment of Pain in Small Exotic Mammals

CHALLENGES IN ASSESSING PAIN IN SMALL MAMMALS

RECOGNITION AND ASSESSMENT OF PAIN IN SMALL MAMMALS

SPECIES-SPECIFIC SIGNS OF PAIN (TABLE 35.1)

SUMMARY

REFERENCES

Chapter 36: Treatment of Pain in Small Exotic Mammals

SUPPORTIVE CARE AND HUSBANDRY

GUIDELINES FOR TREATMENT OF PAIN IN SMALL MAMMALS

ANALGESICS USED IN SMALL MAMMALS

CHRONIC PAIN

SUMMARY

REFERENCES

Chapter 37: Recognition and Treatment of Pain in Birds

PAIN PATHWAYS IN BIRDS

PAIN-ASSOCIATED BEHAVIORS IN BIRDS

TREATMENT OF PAIN IN BIRDS

SUMMARY

REFERENCES

Chapter 38: Recognition and Treatment of Pain in Reptiles, Amphibians, and Fish

PRESENCE OF A PAIN PATHWAY

CONSEQUENCES OF PAIN

REPTILES AND AMPHIBIANS

DRUG CHOICES FOR REPTILES (TABLE 38.1)

ANALGESIC DRUG CHOICES IN AMPHIBIANS (TABLE 38.2)

FISH

ANALGESIC DRUG CHOICES IN FISH (TABLE 38.3)

NONPHARMACOLOGICAL PAIN MANAGEMENT

SUMMARY

REFERENCES

Section 5: Incorporating Pain Management into Your Practice and Hospice and Palliative Care

Chapter 39: Integrating Pain Management into Veterinary Practice

BUILDING INFRASTRUCTURE AND CREATING CULTURE

FORMAL CERTIFICATION IN PAIN MANAGEMENT

SUMMARY

ONLINE RESOURCES

REFERENCES

Chapter 40: Pain Management in Hospice and Palliative Care

PALLIATIVE CARE

HOSPICE CARE

PAIN, SUFFERING, AND QUALITY OF LIFE IN PALLIATIVE CARE

TREATING PAIN IN HOSPICE AND PALLIATIVE CARE PATIENTS

END-OF-LIFE CARE

SUMMARY

REFERENCES

Index

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Library of Congress Cataloging-in-Publication Data

Pain management in veterinary practice / editors, Christine M. Egger, Lydia Love, Tom Doherty.   pages ; cm   Includes bibliographical references and index. ISBN 978-0-8138-1224-3 (pbk. : alk. paper) - ISBN 978-1-118-76133-5 (emobi) - ISBN 978-1-118-76134-2 (epdf) - ISBN 978-1-118-76160-1 (epub) 1. Pain in animals-Treatment. I. Egger, Christine M., editor of compilation. II. Love, Lydia, editor of compilation. III. Doherty, T. J. (Tom J.), editor of compilation.   [DNLM: 1. Pain Management-veterinary. 2. Veterinary Medicine-methods. SF 925]   SF910.P34P35 2014   636.089′60472-dc23

2013024797

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover images: Front cover, Top and Bottom Left: Gregory Hirshoren, University of Tennessee CVM; Back Cover, Left: Kristie Mozzachio and Valarie V. Tynes; Middle and Right: Gregory Hirshoren

Cover design by Modern Alchemy LLC

Contributors

Henry S. Adair, DVM, MS, CERP, DACVS, DACVSMR Associate Professor, Equine Surgery Director of Equine Performance and Rehabilitation Department of Large Animal Clinical Sciences College of Veterinary Medicine University of Tennessee Knoxville, TN

Alvin J. Beitz, BS, PhD Professor and Chair Distinguished Teacher Department of Veterinary and Biomedical Sciences College of Veterinary Medicine, University of Minnesota St. Paul, MN

Mona Boudreaux DVM, CVA, MMQ Owner A Time To Heal Wonder Lake, IL

Shauna Cantwell, DVM, MVSc, CVA, CVSMT, DACVAA Courtesy Professor University of Florida Medicine Wheel Veterinary Services, Inc. Ocala, FL

Sathya K. Chinnadurai, DVM, MS, DACZM, DACVAA Associate Veterinarian Chicago Zoological Society/Brookfield Zoo Brookfield, IL

Stuart Clark-Price, DVM, MS, DACVIM-LA, DACVAA Assistant Professor, Anesthesia and Analgesia Head, Anesthesia Clinical Service Department of Veterinary Clinical Medicine College of Veterinary Medicine University of Illinois Urbana, IL

Alice Crook, BSc, DVM Coordinator Sir James Dunn Animal Welfare Centre Adjunct Professor Department of Companion Animals Atlantic Veterinary College University of Prince Edward Island Charlottetown, Canada

Lowri Davies, BVSc, MRCVS, CVA, CCRP The SMART Veterinary Clinic Ltd Weigbridge Referral Center Swansea, Wales, UK

Lisa DiBernardi, DVM, DACVIM (Oncology), DACVR (Radiation Oncology) Animal Specialty Hospital of Florida Naples, FL Palm Beach Veterinary Specialists West Palm Beach, FL

Robin Downing, DVM, CVPP, CCRP, DAAPM Hospital Director The Downing Center for Animal Pain Management, LLC Windsor, CO

Bernd Driessen, DVM, PhD, DACVAA, DECVPT Professor, Anesthesiology School of Veterinary Medicine University of Pennsylvania New Bolton Center Kennett Square, PA

Tanya Duke-Novakovski, BVetMed, MSc, DVA, DACVAA, DECVAA Professor, Veterinary Anesthesiology and Analgesia Department of Small Animal Clinical Sciences Western College of Veterinary Medicine University of Saskatchewan Saskatoon, Canada

Lynelle Graham, DVM, MS, DACVAA Clinical Professor of Anesthesia Veterinary Clinical Sciences University of Minnesota St. Paul, MN

Cheryl B. Greenacre, DVM, DABVP (Avian), DABVP (Exotic Companion Mammal) Professor, Avian and Zoological Medicine Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Tennessee Knoxville, TN

Tamara Grubb, DVM, PhD, DACVAA Assistant Clinical Professor, Anesthesia and Analgesia Veterinary Clinical Sciences Washington State University Pullman, WA

Anna Hielm-Björkman, DVM, PhD, CVA (IVAS) Assistant Professor Department of Equine and Small Animal Medicine Pain and Rehabilitation Clinic and Research Center Faculty of Veterinary Medicine Helsinki University Helsinki, Finland

Jacob A. Johnson, DVM, DACVAA Assistant Professor, Anesthesia and Pain Management Auburn University College of Veterinary Medicine Auburn, AL

Keri Jones, DVM, CVPP Medical Director Homeward Bound Animal Hospital Arvada, CO

Martin W. Kaufmann, ABC, c-PED OrthoPets Center for Animal Pain Management and Mobility Solutions Denver, CO

Kip A. Lemke, BS, DVM, MS, DACVAA Professor, Anesthesiology Chief of Anesthesiology Service Department of Companion Animals College of Veterinary Medicine University of Prince Edward Island Charlottetown, Canada

Emma Love, BVMS, PhD, DVA, DECVAA, MRCVS, FHEA, RCVS Senior Teaching Fellow in Veterinary Anaesthesia University of Bristol Bristol, UK

Lydia Love, DVM, DACVAA Director of Anesthesia and Pain Management Animal Emergency and Referral Associates Fairfield, NJ

Karen L. Machin, DVM, PhD Associate Professor Department of Veterinary Biomedical Sciences Western College of Veterinary Medicine University of Saskatchewan Saskatoon, Canada

Steve Marsden, DVM, ND, MSOM, Lac, Dipl.CH, CVA Director College of Integrative Veterinary Therapies Edmonton, Canada

Patrice M. Mich, DVM, MS, DABVP, DACVAA, CCRT Medical Director OrthoPets Center for Animal Pain Management and Mobility Solutions Denver, CO

Kristie Mozzachio, DVM, DACVP Mozzachio Mobile Veterinary Services Hillsborough, NC Adjunct faculty North Carolina State University College of Veterinary Medicine Raleigh, NC

Arthur I. Ortenburger, DVM, MS Associate Professor of Surgery Department of Health Management University of Prince Edward Island Charlottetown, Canada

Cholawat Pacharinsak, DVM, MS, PhD, DACVAA Assistant Professor Director of Anesthesia, Pain Management, and Surgery School of Medicine Stanford University Stanford, CA

Peter J. Pascoe, BVSc, DVA, DACVAA, DECVAA Professor, Veterinary Anesthesia and Critical Patient Care Department of Surgical and Radiological Sciences, School of Veterinary Medicine University of California Davis, CA

Lysa Pam Posner, DVM, DACVAA Associate Professor Anesthesiology Director of Anesthesia Services College of Veterinary Medicine North Carolina State University Raleigh, NC

Bruno H. Pypendop, DrMedVet, DrVetSci, DACVAA Professor, Veterinary Anesthesia and Critical Patient Care Department of Surgical and Radiological Sciences School of Veterinary Medicine University of California Davis, CA

Jane Quandt, DVM, MS, DACVAA, DACVECC  Associate Professor, Anesthesiology College of Veterinary Medicine University of Georgia Athens, GA

Jessica K. Rychel, DVM, CVMA, CCRP Veterinary Emergency and Rehabilitation Hospital Fort Collins, CO

Reza Seddighi, DVM, MS, PhD, DACVAA Assistant Professor, Anesthesia and Analgesia Department of Large Animal Clinical Sciences College of Veterinary Medicine University of Tennessee Knoxville, TN

Kersti Seksel, BVSc (Hons), MRCVS, MA (Hons), FACVSc, DACVB, CMAVA, DECVBM-CA Registered Veterinary Specialist, Behavioral Medicine Sydney Animal Behavior Service Seaforth, Australia

Yael Shilo, DVM, DACVAA Senior Anesthesiologist, Anesthesia Department Veterinary Teaching Hospital Koret School of Veterinary Medicine The Hebrew University of Jerusalem Rehovot, Israel

Lesley J. Smith, DVM, DACVAA Clinical Professor of Anesthesiology and Pain Management Department of Surgical Sciences School of Veterinary Medicine University of Wisconsin Madison, WI

Kevin J. Stafford, MVB, MSc, PhD, FRCVS, FANZCVSc Professor Institute of Veterinary Animal and Biomedical Sciences Massey University Palmerston North, New Zealand

Dave Thompson, DVM Clyde Park Veterinary Clinic Wyoming, MI

Lesa Thompson, MA, BVM&S, DZooMed (Mammalian), MSc, MRCVS, RCVS Tokyo, Japan

Valarie V. Tynes, DVM, DACVB Premier Veterinary Behavior Consulting Sweetwater, TX

Alexander Valverde, DVM, DVSc, DACVAA Associate Professor, Anesthesiology Department of Clinical Studies Ontario Veterinary College University of Guelph Guelph, Canada

Rick Wall, DVM, CCRP, DAAPM Certified Myofascial Trigger Point Therapist Center for Veterinary Pain Management and Rehabilitation The Woodlands, TX

Kate L. White, MA, Vet MB, DVA, DECVAA, MRCVS Clinical Associate Professor, Anesthesia Head of Division of Medicine College of Veterinary Medicine University of Nottingham Sutton Bonington Campus Loughborough, UK

Bonnie Wright, DVM, DACVA, CVMA, CVPP, CCRP Veterinary Emergency and Rehabilitation Hospital Fort Collins, CO

Laura Zarucco, DMV, PhD Associate Professor of Surgery Dipartimento di Scienze Veterinarie Scuola di Agraria e Medicina Veterinaria Università degli Studi di Torino Grugliasco, Italy

Preface

New analgesics and new formulations of old analgesics are constantly being introduced to the veterinary market, yet the ability to recognize and quantify pain in veterinary species remains a challenge. Pain assessment and scoring systems are being validated in many veterinary species, but clinically relevant, objective methods of assessment of all types of pain in all species remain elusive. Ultimately, it is left to the caregiver to decide if analgesic therapy is indicated, and this requires empathy and logic. The purpose of this book is to provide the reader with easily accessible, evidence-based information to aid in the recognition and treatment of pain in veterinary species.

ORGANIZATION AND FEATURES OF THE BOOK

Section I begins with an introductory chapter discussing welfare issues associated with pain and its management in veterinary species. The chapters that follow provide a review of the current understanding of the physiology and pathophysiology of acute pain, chronic pain, and cancer pain.

Section II provides extensive information about the pharmacology of opioids, nonsteroidal anti-inflammatory drugs, alpha-2 adrenoreceptor agonists, local anesthetics, and non-traditional analgesics (e.g., anti-epileptic drugs, NMDA receptor antagonists, and nutritional supplements). Novel methods of drug delivery and the pharmacokinetics of continuous rate infusions are also discussed.

The non-pharmacological management of pain, including physical therapy, orthotics and prosthetics, myofascial trigger point therapy, acupuncture, chiropractic, herbal therapy, and homeopathy are discussed in Section III. These chapters are not intended to provide expert training in these areas. They are meant to provide a basic explanation of some techniques that can be easily incorporated into daily practice and to discuss scientific evidence, or lack thereof, supporting these modalities.

The recognition and treatment of acute and chronic pain in dogs, cats, small exotic mammals, birds, reptiles, amphibians, fish, camelids, ruminants, pigs, and horses is discussed in Section IV. Chapters on the treatment of cancer pain and the recognition and treatment of pain in intensive care patients are also included. The chapters in this section discuss pharmacological and non-pharmacological strategies for use in each species to provide a balanced pain management protocol. Much of the information from these chapters is summarized in tables to allow easy access to information.

The fifth and final section includes a chapter describing strategies for incorporating pain management into veterinary practice, including some economic and legal considerations, and a final chapter discussing veterinary hospice and palliative care.

ACKNOWLEDGMENTS

The authors wish to thank the staff of Wiley for their support and encouragement. This work would not have been possible without the contributions of the authors who come from academic, research, and clinical practice backgrounds in the USA, Canada, Great Britain, Europe, New Zealand, and Australia. A feature common to all is the desire to improve the recognition, prevention, and treatment of pain in animals. We hope that this book contributes significantly to that endeavor.

Christine M. Egger Lydia Love Tom Doherty

Section 1

Introduction and Anatomy, Physiology, and Pathophysiology of Pain

Chapter 1. Introduction: Pain: An Issue of Animal WelfareAlice Crook

Chapter 2. Anatomy, Physiology, and Pathophysiology of PainYael Shilo and Peter J. Pascoe

Chapter 3. Mechanisms of Cancer PainCholawat Pacharinsak and Alvin J. Beitz

1

Introduction: Pain: An Issue of Animal Welfare

Alice Crook

There has been considerable progress since the early 1990s in pain research in animals and in our understanding of related physiology and pharmacology, enabling great strides to be made in pain management. But pain is still a huge welfare issue for animals: farm animals are routinely subjected to painful husbandry procedures with no anesthesia or analgesia; perioperative pain management in small and exotic animals is inconsistent; and management of cancer-related and chronic pain remains a challenge. Pain can diminish animal well-being substantially due to its aversive nature, the distress arising from the inability to avoid such sensations, and the secondary effects that may adversely affect the animal's quality of life (QOL). Pain may affect an animal's appetite, sleep habits (e.g., fatigue), grooming (e.g., self-mutilation), ability to experience normal pleasures (e.g., reduced play and social interaction), personality and temperament, and intestinal function (e.g., constipation), and may prolong the time needed for recovery from the underlying condition (ACVA, 1998; McMillan, 2003). Untreated pain may also result in systemic problems; for example, hepatic lipidosis in cats as a result of inappetance and inadequate caloric intake (Mathews, 2000).

Much is known about the recognition and assessment of pain in animals; however, more work is needed to develop valid and reliable pain scoring systems for all species that are practical in real-life situations. Perception of animal pain directly affects analgesic usage, and there is a wide range in attitudes among veterinarians, farmers, and pet owners. This can best be addressed through education. There are also economic, regulatory, and other constraints to effective pain management, particularly in large animals.

RECOGNITION AND ASSESSMENT OF PAIN IN ANIMALS

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (IASP, 1994). The experience of pain is always subjective. Self-reporting is the gold standard in people, yet how can we know the experience of animals?

Three approaches are used in the recognition and measurement of pain in animals. The first approach includes measures of general body function or productivity (e.g., food and water intake, weight gain) that are relatively easy to quantify; such measures reflect what was happening to the animal over the period between observations. The second approach includes physiological measures (such as changes in heart rate or cortisol concentrations) that are widely used in studies assessing pain in animals (Stafford & Mellor, 2005; Vickers et al., 2005; Whay et al., 2005) and are, in principle, particularly useful in prey species that are considered stoic and therefore unlikely to show pronounced behavioral responses until injuries are advanced (Phillips, 2002; Rutherford, 2002). However, the physical restraint required to obtain such measurements may itself be stressful and confound the results (Weary et al., 2006). Also, while cortisol measurements are useful for comparing treatments and controls, they are not useful in assessing the degree of pain an individual animal is experiencing (Rutherford, 2002).