Steroid-responsive meningitis-arteritis in dogs with noninfectious,nonerosive, idiopathic,immune-mediated polyarthritis

Signs related to spinal pain are commonly reported in dogs with noninfectious, nonerosive, idiopathic immune-mediated polyarthritis (IMPA). This study examined the prevalence and etiology of spinal pain in these dogs through a retrospective review of 62 case records of dogs with IMPA. All dogs with IMPA and signs suggestive of spinal pain were described with regard to age, gender, breed, physical stature, location of vertebral pain, rectal temperature, and clinical laboratory findings. The prevalence of spinal pain in these dogs was 29% (18 of 62). Fourteen of the 18 dogs with spinal pain and IMPA were male. Cerebrospinal fluid (CSF) from 11 dogs with signs of spinal pain was analyzed. Five of these (46%) had concurrent steroid-responsive meningitis-arteritis (SRMA). We concluded that SRMA does occur concurrently in some dogs having IMPA. Meningeal involvement may explain the origin of spinal pain observed in some of these dogs.     

Correlations between acute radiation scores and pain scores in canine radiation patients with cancer of the forelimb

Objective To determine whether there is a correlation between skin acute radiation score (ARS) and pain scores and to determine if skin ARSs can be used to predict future pain scores and increased need for analgesia in dogs undergoing radiation therapy for cancer of the forelimb. Study design Prospective observational study. Animals Seven middle‐aged dogs of various breeds with cancer of the forelimb. Methods Each neoplasm was surgically removed and a histologic diagnosis was obtained. Curative intent radiation therapy was initiated 2½–4½ weeks after surgery. Curative intent radiation therapy was delivered as prescribed. Two trained observers scored the dogs using a visual analog pain scale (VAS), Glasgow composite measure of pain scale, short form (GCMPS) and skin ARS prior to each day’s therapy. Daily scores were averaged and scatter plots were developed. Generalized estimating equation regressions were used to calculate standard error, 95% confidence interval, and p‐values for each relationship. Confidence and prediction bands were plotted. Results A statistically significant correlation between skin ARS and VAS and GCMPS pain scores was identified indicating that as the skin ARS increased so did the pain scores. A general correlation between VAS and GCMPS scores was observed. Early (fraction days 1–6) GCMPS scores were significantly influenced by anxiety behavior unrelated to pain. Skin ARS was found to predict precisely current and future presence of pain, but could only predict a range of potential future pain scores based on the pain management approach in use during this study. Conclusions Skin ARS can provide valuable information for initiating preemptive analgesia and intensifying pain management during curative intent radiation therapy. Daily pain scoring with an acceptable pain scale should be used in conjunction with the skin ARS to improve patient pain management. Clinical relevance Pain is an anticipated consequence of curative intent radiation therapy. Understanding the correlation between pain and skin ARS may facilitate more effective pain management.     

Recognition and quantification of pain in horses: A tutorial review

Pain management is dependent on the quality of the pain evaluation. Ideally, pain evaluation is objective, pain‐specific and easily incorporated into a busy equine clinic. This paper reviews the existing knowledge base regarding the identification and quantification of pain in horses. Behavioural indicators of pain in horses in the context of normal equine behaviour, as well as various physiological parameters potentially useful for pain evaluation, are discussed. Areas where knowledge is sparse are identified and a new equine pain scale based on results from all reviewed papers is proposed. Finally, the most important considerations in relation to the implementation of a pain scale in a hospital setting are discussed.     

Assessment of pain associated with bovine respiratory disease and its mitigation with flunixin meglumine in cattle with induced bacterial pneumonia

Pleuritic chest pain from bacterial pneumonia is often reported in human medicine. However, studies investigating pain associated with bovine respiratory disease (BRD) are lacking. The objectives of this study were to assess if bacterial pneumonia elicits a pain response in calves with experimentally induced BRD and to determine the analgesic effects of transdermally administered flunixin. A total of 26 calves, 6–7 mo of age, with no history of BRD were enrolled into one of three treatment groups: 1) experimentally induced BRD + transdermal flunixin at 3.3 mg/kg twice, 24 h apart (BRD + FTD); 2) experimentally induced BRD + placebo (BRD + PLBO); and 3) sham induction + placebo (CNTL + PLBO). Calves induced with BRD were inoculated with Mannheimia haemolytica via bronchoalveolar lavage. Outcomes were collected from −48 to 192 h post-treatment and included serum cortisol, infrared thermography, mechanical nociceptive threshold, substance P, kinematic gait analysis, visual analog scale (VAS), clinical illness score, computerized lung score, average activity and rumination level, prostaglandin E₂ metabolite, plasma serum amyloid A, and rectal temperature. Outcomes were evaluated using either a generalized logistic mixed model for categorical variables or a generalized linear mixed model for continuous variables. Right front force differed by treatment (P = 0.01). The BRD + PLBO had lower mean force applied to the right front limb (85.5 kg) compared with BRD + FTD (96.5 kg; P < 0.01). Average VAS differed by a treatment by time interaction (P = 0.01). The VAS scores differed for BRD + PLBO at −48 (3.49 mm) compared with 168 and 192 h (13.49 and 13.64 mm, respectively) (P < 0.01). Activity for BRD + PLBO was higher at −48 h (27 min/h) compared with 48, 72, 120, and 168 h (≤ 22.24 min/h; P < 0.01). Activity differed by a treatment by time interaction (P = 0.01). Activity for BRD + FTD was higher at −48 and 0 h (28.2 and 28.2 min/h, respectively) compared to 48, 72, 96, and 168 h (≤23.7 min/h; P < 0.01). Results show a combination of reduced activity levels, decreased force on the right front limb, and increased VAS pain scores all support that bacterial pneumonia in cattle is painful. Differences in right front force indicate that flunixin transdermal may attenuate certain pain biomarkers in cattle with BRD. These findings suggest that BRD is painful and analgesic drugs may improve the humane aspects of care for cattle with BRD.     

Pain and analgesia in pet rabbits within the veterinary environment: a review

Objective

To provide an overview of pain and analgesia in rabbits with the aim of developing a more accurate understanding of these topics. To illustrate and discuss the areas that have advanced in recent years and those that still require further research.

Comparison of postoperative pain after ovariohysterectomy by harmonic scalpel-assisted laparoscopy compared with median celiotomy and ligation in dogs

OBJECTIVE: To compare the effects of postoperative pain after ovariohysterectomy by harmonic scalpel-assisted laparoscopy (HALO) and traditional ovariohysterectomy (OVH) in dogs. STUDY DESIGN: A randomized, blinded, prospective study. SAMPLE POPULATION: Sixteen, purpose-bred, intact female, Beagle dogs. METHODS: Dogs were divided into 2 groups: Group 1 (8 dogs), which had OVH by HALO, and Group 2 (8 dogs), which had traditional OVH. Physiologic data, abdominal nociceptive threshold scores, and University of Melbourne pain scores (UMPS) were recorded at 2, 6, 12, 24, 48, and 72 hours after surgery. Blood samples for measurement of plasma cortisol, glucose, and creatine phosphokinase (CPK) concentrations were collected at the time of the incision, and 2, 6, 12, 24, 48, and 72 hours after surgery. RESULTS: No significant surgical complications occurred. The HALO mean surgical time was significantly longer (55.7 minutes) than traditional OVH (31.7 minutes). No significant differences were observed between groups for the pain measures of heart rate, respiratory rate, temperature, CPK, and glucose concentrations. The OVH group had significantly higher mean plasma cortisol levels at hour 2 after surgery than the HALO group (P=.0001). The mean UMPS were significantly higher in OVH than the HALO group at all postoperative times (P=.0001). The mean nociceptive threshold measurements revealed significantly higher tolerated palpation pressures in HALO than OVH at all postoperative times, except hour 72 (P=.0002). CONCLUSIONS: Dogs appeared to be in less pain with HALO than OVH. The harmonic scalpel coagulated ovarian and uterine vessels completely with minimal collateral damage to surrounding tissues. CLINICAL RELEVANCE: HALO is a safe alternative to OVH and offers a minimally invasive and less painful method of surgery.     

Analgesic and cardiopulmonary effects of premedication with tramadol in calves anesthetized with the infusion of guaifenesin and thiamylal

This study examined the analgesic and cardiopulmonary effects of intravenous (IV) tramadol during general intravenous anesthesia in calves. Calves were premedicated with diazepam (0.2 mg/kg, IV) with tramadol (2 mg/kg, IV) (group T) or saline (group S). Anesthesia was induced by thiamylal sodium (4 mg/kg, IV) and maintained with an infusion (2 ml/kg/hr) of 5% guaifenesin containing thiamylal sodium (2 mg/ml). Additional thiamylal sodium (1–2 mg/kg, IV) was administered when interference from the calves was observed during surgery. The total counts of additional thiamylal sodium administration, analgesia score using a visual analog scale, recovery time, and cardiopulmonary function in the different groups were assessed and compared. Group T showed significantly fewer counts of additional drug administration and a significantly higher analgesia score. Tramadol may provide adequate analgesia with minimal cardiopulmonary changes in calves during general anesthesia.     

A prospective,randomized, blinded,placebo-controlled multisite clinical study of bedinvetmab,a canine monoclonal antibody targeting nerve growth factor,in dogs with osteoarthritis

ObjectiveBedinvetmab is a canine monoclonal antibody targeting nerve growth factor. This study evaluated the efficacy and safety of bedinvetmab for alleviation of pain associated with osteoarthritis in dogs.Study designDouble-blind, randomized, multicentre, placebo-controlled study.AnimalsClient-owned dogs (n = 287) with osteoarthritis.MethodsDogs were randomized (1:1) to subcutaneous injection with placebo (saline, n = 146) or bedinvetmab (0.5–1.0 mg kg^–1, n = 141) administered monthly. After 3 months, 89 bedinvetmab-treated dogs that responded positively based on owner and veterinarian assessments were administered up to six additional doses of bedinvetmab in a single-armed open-label continuation phase. The primary efficacy end point was treatment success based on the owner-assessed canine brief pain inventory (CBPI) on day 28. Treatment success was defined as ≥ 1 reduction in pain severity score (0–10) and ≥ 2 in pain interference score (0–10).ResultsPercentage treatment success was significantly greater in the bedinvetmab group than in the placebo group from day 7 through all assessed time points (p ≤ 0.0025). On day 28, 43.5% of dogs achieved treatment success with bedinvetmab compared with placebo (16.9%) (p = 0.0017). Treatment success continued through days 56 (50.8%) and 84 (48.2%) in the bedinvetmab group and was < 25% in the placebo group at all time points. Sustained efficacy was demonstrated in the continuation phase. Adverse health events occurred at similar frequencies in both groups. They were considered typical for a population of dogs with osteoarthritis and not related to study treatment. Treatment with bedinvetmab demonstrated a significant effect on all three components of CBPI—pain interference, pain severity, quality of life.Conclusions and clinical relevanceThis study demonstrated the effectiveness and safety of bedinvetmab administered monthly for up to 9 months at 0.5–1.0 mg kg^–1 for alleviation of pain associated with canine osteoarthritis.     

蜂针对肺癌合并癌性疼痛患者的疗效观察

观察蜂针联合羟考酮缓释片治疗肺癌合并疼痛与单用羟考酮缓试片临床疗效的比较。选取2017年8月至2018年9月在石家庄市第一医院肿瘤科住院治疗的肺癌癌痛患者78例,随机分为治疗组和对照组各39例。治疗组采用蜂针联合羟考酮缓释片治疗20天,对照组亦治疗20天。结果治疗组有效32例,有效率82.05%;对照组有效15例,有效率61.54%。经X2检验,两组有效率比较有统计学差异(X2=4.05,P<0.05)。治疗组爆发痛次数少于对照组,不良反应发生率低于对照组,生活质量优于对照组,差异有统计学意义(P<0.05)。结论:蜂针结合羟考酮缓释片治疗肺癌合并疼痛疗效确切,可以提高患者生存质量,降低不良反应的发生率。     

Laser acupuncture for acute inflammatory, visceral and neuropathic pain relief: An experimental study in the laboratory rat

Laser acupuncture is defined as the stimulation of traditional acupuncture points with low-intensity, non-thermal laser irradiation. We explored the clinical efficacy of a very low level diode laser wavelength 670 nm (Biolite LP020, RGM, Genoa, Italy), used to stimulate acupoints ST36 Zu San Li and TH5 Waiguan, on well-established experimental models of acute and persistent pain in the rat, e.g. acute inflammatory pain, muscle pain, visceral pain and neuropathic pain. We report the anti-edema and anti-hyperalgesia effects of laser acupuncture in models of acute inflammatory pain, e.g. CFA-induced inflammation and myofascial pain. We also indicate that spontaneous pain and thermal hyperalgesia are reduced in a neuropathic pain model, e.g. axotomy. On the contrary, no effects due to laser-acupuncture were observed on disconfort indices in a model of visceral pain, e.g. cystitis due to cyclophosphamide. We thus provide evidences that acupoints stimulation using a very low intensity laser irradiation can control pain and edema in specific experimental conditions.     

Continuous extradural analgesia in a cow with complex regional pain syndrome

A chronic pain syndrome, similar to the complex regional pain syndrome (CRPS) described in human beings, was diagnosed in a cow with persisting severe pelvic limb lameness. Diagnosis was based on the disproportionate relationship between the severity and duration of pain and the lesion, the failure of conventional analgesic and surgical therapy and the presence of characteristic clinical features. Multimodal therapy, i.e. a mixture of methadone, ketamine and bupivacaine was administered continuously for 17 days via an extradural catheter to counteract nociceptive hypersensitization. Doses were adjusted daily after assessing the effect, using a composite pain score. Physiotherapy was also performed. The diagnosis of CRPS in cattle is unusual. In this case, treatment was successful and the cow was discharged mildly lame and in improving physical condition. Long-term extradural analgesia proved to be safe and effective in the treatment of this syndrome, which was nonresponsive to conventional therapy.     

Pain control in horses: What do we really know?

Currently, approaches to pain control in horses are a mixture of art and science. Recognition of overt pain behaviours, such as rolling, kicking at the abdomen, flank watching, lameness or blepharospasm, may be obvious; subtle signs of pain can include changes in facial expression or head position, location in the stall and response to palpation or human interaction. Nonsteroidal anti‐inflammatory drugs (i.e. phenylbutazone, flunixin meglumine and firocoxib), opioids (i.e. butorphanol, morphine and buprenorphine) and α₂‐adrenergic agonists (i.e. xylazine, detomidine, romifidine and medetomidine) are the most commonly used therapeutic options. Multimodal therapy using constant‐rate infusions of lidocaine, ketamine and/or butorphanol has gained popularity for severe pain in hospitalised cases. Drugs targeting neuropathic pain, such as gabapentin, are increasingly used for conditions such as laminitis. Optimal strategies for management of pain are based upon severity and chronicity, including special considerations for use of intra‐articular or epidural delivery and therapy in foals. Strategies that aim to mitigate adverse effects associated with use of various analgesic agents are briefly discussed.     

The Canine Postamputation Pain (CAMPPAIN) initiative: a retrospective study and development of a diagnostic scale

ObjectiveTo develop a scale to diagnose and assess the severity of postamputation pain (PAP) in dogs.Study designSingle-center retrospective study.AnimalsA total of 66 dogs that underwent thoracic or pelvic limb amputation and 139 dogs that underwent tibial plateau leveling osteotomy (TPLO) at a veterinary teaching hospital.MethodsAn online survey regarding postoperative behavioral changes was sent to owners. Categorical, multiple-choice responses were entered into a univariable logistic regression model and tested for association with amputation using the Wald test. If p < 0.2, variables were forwarded to a multivariable logistic regression model for manual build. Model simplicity and predictive ability were optimized using the area under the receiver operating curve (AUROC) characteristic, and model calibration was assessed using the Hosmer–Lemeshow test. The selected model was converted to an integer scale (0–10), the Canine Postamputation Pain (CAMPPAIN) scale. Univariable logistic regression related each dog’s calculated score to the probability of PAP.ResultsMultivariable logistic regression identified four independent predictors of PAP (p < 0.05): 1) restlessness or difficulty sleeping, 2) episodes of panic or anxiety, 3) sudden vocalization, and 4) compulsive grooming of the residual limb. Score AUROC was 0.70 (95% confidence interval = 0.63–0.78) with good calibration (Hosmer–Lemeshow statistic p = 0.82). A score of 2 corresponded to a risk probability of 0.5. Taking a score ≥ 2 to indicate PAP, score specificity and sensitivity were 92.1% and 36.4%, respectively. When this score was used to diagnose PAP, prevalence was 36.4% (24/66) and 7.9% (11/139) in the amputation and TPLO groups, respectively.Conclusions and clinical relevancePostamputation pain is characterized by specific postoperative behaviors and appears to affect approximately one-third of canine amputees. The CAMPPAIN scale generated from these data could facilitate diagnosis, treatment and further study of PAP but requires external validation.