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A practical guide for veterinary technicians and nurses on essential concepts of animal pain management
Pain management is an essential aspect of medical care, but in the field of veterinary medicine it poses unique challenges. Learning to recognize animal pain, to advocate for patient care, and to build and implement pain management protocols allows veterinary nursing teams to be more effective and vastly improves patient outcomes. Mastering this aspect of veterinary medicine means developing an understanding of pain physiology and pharmacology of pain management drugs, the necessity of various analgesics in different care environments, and how to tackle obstacles to animal pain care.
Pain Management for Veterinary Technicians and Nurses, 2nd edition provides a robust update to the only textbook on this subject directed at veterinary technicians in the US. Already a standard text for its coverage of small companion animals, this book now also covers analgesic techniques in horses, lab animals, and zoo species, making it a valuable resource for technicians in a range of professional and clinical situations. Updated to incorporate the latest evidence-based medicine, it promises to continue as the essential introduction to this oft-overlooked but critical dimension of veterinary medicine.
Pain Management for Veterinary Technicians and Nurses readers will also find:
Pain Management for Veterinary Technicians and Nurses is a valuable guide for veterinary technicians in both general and specialized anesthetic practice, as well as veterinary students and general veterinary practitioners.
Stephen Niño Cital, RVT, RLAT, SRA, CVPP, VTS-LAM, is a Veterinary Technician Specialist in Research Anesthesia and Certified Veterinary Pain Practitioner. He is a Lab Manager for Howard Hughes Medical Institute at Stanford University and is an administrator for the Veterinary Anesthesia Nerds, LLC. Stephen is also a partner at Remedy Veterinary Specialists leading the pain service in the San Francisco Bay Area of California.
Tasha McNerney, CVT, CVPP, VTS, is a Veterinary Technician Specialist in Anesthesia and Analgesia and a Certified Veterinary Pain Practitioner. She is a board member of the International Academy of Pain Management and founder of Veterinary Anesthesia Nerds. She is the Training Director at a large specialty referral hospital in the Philadelphia area.
Darci Palmer, BS, LVT, VTS, is a Veterinary Technician Specialist in Anesthesia and Analgesia and a Clinical Teaching Specialist at Tuskegee University College of Veterinary Medicine. She is Executive Secretary for the Academy of Veterinary Technicians in Anesthesia and Analgesia and Administrator for Veterinary Anesthesia Nerds. She works as a private consultant, author, and lecturer in Auburn, AL.
List of Contributors xxiii
Foreword xxvii
Acknowledgments xxix
About the Companion Website xxxi
1 Advancing Veterinary Pain Management into a New Era 1 Mary Ellen Goldberg
1.1 Introduction 1
1.2 Brief History of Human Pain Management 1
1.3 Veterinary Pain Management Through the Centuries 3
1.4 Animal Research Contributions 3
1.5 History of Animal Nursing Staff 4
1.5.1 National Association of Veterinary Technicians in America Recognized Veterinary Technician Specialty Academies 4
1.6 Eyewitness to 50 Years of Changes for Veterinary Technicians 5
1.7 Veterinary Technician Pioneers in Pain Management 6
1.8 Future Directions for Veterinary Technician Pain Management 7
1.9 Conclusion 7
References 7
2 Careers in Animal Pain Management 9 Tasha McNerney and Stephen Niño Cital
2.1 Introduction 9
2.2 Pain Management Certifications Available for Veterinary Technicians/Nurses 9
2.2.1 Certified Veterinary Pain Practitioner (CVPP) 9
2.2.2 Veterinary Technician Specialist (Anesthesia and Analgesia), and Veterinary Technician Specialist (Laboratory Animal Medicine - Research Anesthetist) 10
2.2.3 Veterinary Technician Specialist (Physical Rehabilitation) 11
2.2.4 Surgical Research Anesthetist (SRA) 11
2.2.5 The University of Tennessee Companion Animal Pain Management Certificate Program 11
2.2.6 AAHA Pain Management Guidelines Certificate Course (AAHA Pain Management Champion) 11
2.2.7 WSAVA Certificate in Pain Management 12
2.2.8 Canine Rehabilitation Veterinary Technician Certifications 12
2.2.9 Equine Rehabilitation Veterinary Technician Certifications 12
2.2.10 Certified Equine Massage Therapist 12
2.2.11 Animal Acupressure and Massage 12
2.2.12 TCVM Veterinary Technician Programs Offered by the Chi Institute 12
2.2.13 Animal Acupuncture 13
2.2.14 Low- Stress Certifications 13
2.2.15 Veterinary Anaesthesia and Analgesia (MSc), (PgDip), (PgCert), or (PgProfDev) 13
2.2.16 Canine Arthritis Management Practitioner (CAMP) 14
2.2.17 Certified Companion Animal Rehabilitation Therapist (CCAT) 14
2.3 Leveraging Veterinary Technicians in Pain Management 14
2.4 Conclusion 15
3 Pain Physiology and Psychology 17 Stephen Niño Cital, Tasha McNerney, and Robin Saar
3.1 Introduction 17
3.2 What Is "Pain" 17
3.2.1 The Negative Effects of Pain 18
3.3 Breaking Down the Nociceptive Pathway 18
3.3.1 Transduction 18
3.3.2 Transmission 20
3.3.3 Modulation 20
3.3.4 Perception 20
3.3.5 The Dorsal Horn 21
3.3.6 Ventral Horn and Intermediate Zone 23
3.3.7 White Matter 23
3.3.8 Descending Pathways 23
3.3.9 Spinothalamic Tract 23
3.3.10 Spinoreticular Tract 24
3.3.11 Peripheral Sensitization 24
3.3.12 Central Sensitization 24
3.4 The Endocannabinoid System and Pain 27
3.5 The Gate Control Theory 28
3.6 Psychological Aspects of Pain 29
3.6.1 Personality and the Pain Experience 29
3.6.2 Stress and Anxiety on Pain 29
3.6.3 Pain Catastrophizing 29
3.6.4 Boredom and Pain 30
3.6.5 Neuroplasticity and the Memory of Pain 31
3.6.6 Caregiver Placebo 31
3.7 Types of Pain 32
3.7.1 Somatic, Visceral, and Referred Pain 32
3.7.2 Physiological/Adaptive/Acute Pain 32
3.7.3 Pathological/Maladaptive/Chronic Pain 33
3.7.4 Neuropathic Pain 33
3.7.5 Radicular Pain 34
3.7.6 Chronic/Persistent Postsurgical Pain 34
3.7.7 Complex Regional Pain Syndrome 35
3.7.8 Social Resilience and Pain 35
3.8 The Microbiome and Pain Pathophysiology 35
3.8.1 What Is a Microbiome? 36
3.8.2 Determining "Healthy" in a Microbiome 37
3.8.3 Gut Microbiome Imbalance or Dysbiosis 37
3.8.4 The Gut- Brain Axis 38
3.8.5 Microbial Derived Mediators 38
3.8.6 Pathogen- Associated Molecular Patterns (PAMPs) 38
3.8.7 Microbial- Derived Metabolites 39
3.8.8 Neurotransmitters or Neuromodulators 39
3.8.9 Endocannabinoid Axis 41
3.8.10 Pain Medication and the Microbiome 42
References 42
4 Integrating Pain Recognition and Scoring in Companion, Equine, Food and Fiber Species, and Exotic/Lab Animal Species 47 Stephen Niño Cital, Ian Kanda, Taly Reyes, Jessica Birdwell, and Mary Ellen Goldberg
4.1 Introduction 47
4.2 Pain Domains 48
4.2.1 Pain Intensity and Affect 48
4.2.2 Temporal Dimensions 48
4.2.3 Location and Bodily Distribution of Pain 48
4.3 Disposition and Personality 48
4.4 Breed or Species Bias 50
4.5 Dysphoria, Emergence Agitation, and Emergence Delirium 51
4.6 Placebo, Caregiver Placebo, and Placebo- by- Proxy 52
4.7 Non-species- specific Assessments 52
4.7.1 Quantitative Sensory Testing (QST) 52
4.7.2 Temporal Summation (TS) 53
4.7.3 Nociceptive Withdrawal Reflex (NWR) 53
4.7.4 Gait Analysis 53
4.7.5 Pain Biomarkers 53
4.7.6 Machine Learning and Artificial Intelligence (AI) 54
4.7.7 Activity Monitors (AMs) 54
4.7.8 Facial Expression or Grimace Scales 55
4.8 Clinical Pain Scoring Tools (Canine and Feline) 55
4.8.1 Canine Acute Pain Scoring 56
4.8.1.1 Glasgow Composite Measure Pain Scale - Short and Long Forms (CMPS) (Validated) 56
4.8.1.2 French Association for Animal Anesthesia and Analgesia Pain Scoring System (4A- Vet) (Validated) 58
4.8.1.3 University of Melbourne Pain Scale (UMPS) (Validated) 58
4.8.2 Canine Chronic Pain Scoring 58
4.8.2.1 Canine Brief Pain Inventory (CBPI) (Validated) 58
4.8.2.2 Helsinki Chronic Pain Index (HCPI) (Validated) 59
4.8.2.3 Liverpool Osteoarthritis in Dogs (LOAD) (Validated) 59
4.8.3 Feline Acute Pain Scoring 59
4.8.3.1 Glasgow Composite Measure Pain Scale- Short- Form (CMPS- SF) (Validated) 59
4.8.3.2 Feline Grimace Scale (FGS) (Validated) 60
4.8.4 Feline Chronic Pain Scoring 60
4.8.4.1 Client- specific Outcome Measures - Feline (CSOMf) (Validated) 60
4.8.4.2 Montreal Instrument for Cat Arthritis Testing- caretaker (MI- CAT-(c)) (Validated) 60
4.8.4.3 Feline Musculoskeletal Pain Index (FMPI) (Not Validated) 60
4.8.4.4 Oral Pain Scale - Canine/Feline (COPS-C/F) (Validated) 62
4.8.4.5 Cincinnati Orthopedic Disability Index (CODI) (Not Validated) 62
4.8.4.6 HHHHHMM Scale (Not Validated) 62
4.8.4.7 VetMetrica(TM) Health- related Quality of Life (HRQoL) (Validated) 62
4.8.4.8 Food and Fiber Species Pain Recognition and Scoring 63
4.9 Bovids 63
4.9.1 Indications of Pain in Cattle 71
4.10 Small Ruminants and Camelids 71
4.11 Swine 73
4.11.1 Normal Behavioral Observations in Swine 73
4.12 Equid Pain Recognition and Scoring 73
4.12.1 Horses 74
4.12.1.1 Appearance of the Normal Horse 74
4.12.1.2 Somatic Pain Indicators 75
4.12.1.3 Signs of Laminitis Pain Vary with the Progression of the Disease 75
4.12.1.4 Visceral Pain Indicators 75
4.12.1.5 Horse Grimace Scale 75
4.12.2 Donkeys 77
4.13 Exotic Species Pain Recognition and Scoring 77
4.13.1 Birds 77
4.13.2 Appearance of a Non- painful Bird 78
4.13.3 Appearance of a Painful Bird 78
4.13.4 Developing a Pain Score in Birds 81
4.14 Reptiles 82
4.14.1 Appearance of a Nonpainful Reptile 82
4.14.2 Appearance of a Reptile in Pain 82
4.14.3 Developing a Pain Score in Reptiles 83
4.15 Amphibians and Fish 84
4.15.1 Appearance of a Nonpainful Fish and Amphibian 84
4.15.2 Appearance of a Painful Fish and Amphibian 84
4.15.3 Developing a Pain Scoring Assessments in Fish and Amphibians 84
4.16 Small Exotic Mammals 85
4.16.1 Appearance of Nonpainful Small Exotic Mammals 85
4.16.2 Appearance of Painful Small Exotic Mammals 85
4.16.3 Developing a Pain Score in Small Exotic Mammals 85
References 89
5 Analgesia Pharmacology 95 Darci Palmer and Stephen Niño Cital
5.1 Introduction 95
5.2 Definitions 95
5.3 Analgesic Drugs 96
5.4 Opioids 97
5.4.1 Full Opioid Agonists 97
5.4.2 Individual Drug Facts 99
5.4.2.1 Morphine 99
5.4.2.2 Meperidine (Pethidine) 99
5.4.2.3 Methadone 99
5.4.2.4 Hydromorphone 100
5.4.2.5 Oxymorphone 100
5.4.2.6 Fentanyl, Remifentanil, Sufentanil, Alfentanil, Carfentanil 100
5.4.2.7 Fentanyl Patches 100
5.4.2.8 Codeine 101
5.4.2.9 Hydrocodone and Oxycodone 101
5.4.2.10 Tramadol 101
5.4.2.11 Tapentadol 102
5.4.3 Partial Agonist Opioids 102
5.4.3.1 Buprenorphine 102
5.4.3.2 Simbadol 104
5.4.3.3 Zorbium 104
5.4.3.4 Sustained or Extended Release (SR or ER) Buprenorphine 104
5.4.3.5 Buprenorphine Patches 105
5.4.4 Agonist/Antagonist Opiods: Butorphanol and Nalbuphine 105
5.4.5 Opioid Antagonists: Naloxone, Nalmefene, Naltrexone 105
5.4.6 Mixing Opioids 106
5.5 Non- steroidal Anti- inflammatory Drugs (NSAIDs) 106
5.5.1 Washout 108
5.5.2 Piprant Class 108
5.6 Corticosteroids 109
5.7 Cannabinoids 109
5.8 Local Anesthetics 110
5.8.1 Nocita 110
5.8.2 Systemic Toxicity 110
5.8.3 Lidocaine as a CRI 111
5.9 Gabapeninoids 111
5.9.1 Gabapentin 111
5.9.2 Pregabalin 112
5.10 Alpha- 2 Agonists 112
5.10.1 Xylazine, Medetomidine, Dexmedetomidine, Romifidine, Detomidine 112
5.10.2 Zenalpha® (Medetomidine and Vatinoxan) 113
5.11 N- Methyl- D- Aspartate (NMDA) Antagonists 114
5.11.1 Ketamine and Tiletamine 114
5.11.2 Precautions/Contraindications 115
5.11.3 Amantadine and Memantine 115
5.12 Neurokinin- 1 Inhibitors 115
5.13 Bisphosphonates 116
5.14 Acetaminophen (Paracetamol) 116
5.15 Frunevetmab (Solensia®) and Bedinvetmab (Librela®) 117
5.16 Polysulfated Glycosaminoglycans (PSGAGs) 117
5.17 Dipyrone (Metamizole) 117
5.18 Tricyclic Antidepressants (TCAs), Selective Serotonin Reuptake Inhibitors (SSRIs), and Serotonin- Norepinephrine Reuptake Inhibitors (SNRIs) 118
5.19 Acepromazine 119
5.20 Trazodone 119
References 119
6 Regional Anesthesia and Local Blocks 127 Imeldo Laurel, Jeanette M. Eliason, Amy Dowling, Tasha McNerney, and Stephen Niño Cital
6.1 Introduction 127
6.2 Current Drug Options for Regional Anesthesia and Nerve Blocks 128
6.2.1 Mixing Local Anesthetics 129
6.2.2 Adjunctive Agents 129
6.2.3 Volume Expansion, Onset Time, and Buffering 129
6.2.4 Maximum Recommended Dose (MRD) 130
6.2.5 Equipment Selection 131
6.3 Dental and Facial Regional/Local Anesthesia 133
6.4 Dentistry and Facial Blocking Techniques 133
6.4.1 Inferior (Caudal) Alveolar Nerve Block (Extraoral/Intraoral) 133
6.4.2 Middle Mental Foramen Nerve Block 135
6.4.3 Infraorbital Nerve Block 136
6.4.4 Major Palatine Block: Small Animal 137
6.4.5 Caudal Maxillary Block 138
6.4.6 Auriculopalpebral Nerve Block: Motor Blockade of the Eyelid 138
6.4.7 Retrobulbar Block 140
6.4.8 Frontal Nerve (Supraorbital Foramen) Block 140
6.4.9 Auriculotemporal Block + Greater Auricular Block 142
6.5 Common Regional and Local Anesthetic Techniques: Less Specified 143
6.5.1 Intraperitoneal Lavage Technique for Dogs and Cats 143
6.5.2 Incisional Line Block 143
6.5.3 Circumferential Block 144
6.6 Regional and Local Blocks of the Thorax and Abdomen 144
6.6.1 Intercostal Blocks 144
6.6.2 Interpleural Block 146
6.6.3 Intratesticular and Spermatic Cord Block 147
6.6.4 Sacrococcygeal Block 147
6.6.5 Epidural 149
6.6.6 Spinal Anesthesia 153
6.6.7 Epidural Catheter 153
6.6.8 Erector Spinae Plane Block (ESP) 156
6.6.9 Thoracic Paravertebral Block 157
6.6.10 Transverus Abdominis Plane (TAP) Block 158
6.7 Blocks of the Limbs 160
6.7.1 Femoral- Saphenous Nerve Complex Block 160
6.7.2 Sciatic Nerve Block 162
6.7.3 Brachial Plexus Block 164
6.7.4 Radial, Ulnar, Median, and Musculocutaneous (RUMM) Nerve Blocks 166
6.8 Common Equine Techniques 167
6.8.1 Local Analgesia for Horse Castration 167
6.8.2 Caudal Epidural in the Horse 167
6.9 Common Production Animal Techniques 168
6.9.1 Analgesia for Castration 168
6.9.2 Cornual Nerve Block 170
6.9.3 Analgesia for Livestock Epidural 171
6.9.4 Local Anesthetic Blocks for Exotics and Laboratory Animals 174
References 175
7 Analgesia for Acute Pain 179 Tasha McNerney, Melissa Streicher, and Karen Maloa Roach
7.1 Introduction 179
7.2 Fear, Anxiety, and Stress in the Acute Pain Response 180
7.3 Multimodal Therapies 180
7.4 Types of Acute Pain 181
7.4.1 Surgical Pain 181
7.4.1.1 Premedication 182
7.4.1.2 Induction 183
7.4.1.3 Maintenance 183
7.4.1.4 Postoperative Analgesic Medications 183
7.4.1.5 Pain Vacation 184
7.4.1.6 Take- home Analgesics 184
7.4.1.7 Local Anesthesia Techniques 185
7.5 Creating an Effective Acute Pain Analgesic Plan 185
7.5.1 Continuous Rate Infusions 185
7.6 Analgesia Plans for Painful Procedures 186
7.6.1 Reproductive Tract Surgery 186
7.6.1.1 Premedication 187
7.6.1.2 Regional Anesthesia 187
7.6.1.3 Maintenance 187
7.6.1.4 Postoperative Analgesic Plan 187
7.6.1.5 Home Medications 187
7.6.2 Analgesia for Surgery Involving the Eye 188
7.6.2.1 Premedication 188
7.6.2.2 Regional Anesthesia 188
7.6.2.3 Maintenance 188
7.6.2.4 Postoperative Analgesic Plan 188
7.6.2.5 Home Medications 188
7.6.3 Analgesia Techniques for Surgery Involving the Ear 189
7.6.3.1 Premedication 189
7.6.3.2 Regional Anesthesia 189
7.6.3.3 Maintenance 189
7.6.3.4 Postoperative Analgesic Plan 189
7.6.3.5 Home Medications 189
7.6.4 Gastrointestinal Procedures or Acute Abdominal Pain 190
7.6.4.1 Premedication 190
7.6.4.2 Maintenance 190
7.6.4.3 Regional Anesthesia 190
7.6.4.4 Postoperative Analgesic Plan 191
7.6.4.5 Home Medications 191
7.6.5 Thoracic Procedures 191
7.6.5.1 Premedication 191
7.6.5.2 Maintenance 192
7.6.5.3 Regional Anesthesia 192
7.6.5.4 Postoperative Analgesic Plan 192
7.6.5.5 Home Medications 192
7.6.6 Protocols for Patients with Cranial Disease, Injury, or Neurosurgery 193
7.6.6.1 Premedication 194
7.6.6.2 Maintenance 194
7.6.6.3 Regional Anesthesia 194
7.6.6.4 Postoperative Analgesic Plan 194
7.6.6.5 Home Medications 194
7.6.7 Analgesia Protocols for the Patient with Urinary Disease 194
7.6.7.1 Premedication 194
7.6.7.2 Regional Anesthesia 195
7.6.7.3 Maintenance 195
7.6.7.4 Postoperative Analgesic Plan 195
7.6.7.5 Home Medications 195
7.6.8 Minimally Invasive Procedures 195
7.6.8.1 Premedication 195
7.6.8.2 Regional Analgesia 196
7.6.8.3 Maintenance 196
7.6.8.4 Postoperative Analgesic Plan 196
7.6.8.5 Home Medications 196
7.7 Orthopedic Procedures 196
7.7.1 Orthopedic Procedures of the Forelimb 196
7.7.1.1 Premedication 196
7.7.1.2 Maintenance 196
7.7.1.3 Regional Anesthesia 196
7.7.1.4 Postoperative Analgesic Plan 197
7.7.1.5 Home Medications 197
7.7.2 Hindlimb Amputation, Spinal Disease, Spinal Surgery, and Pelvic Fracture Repair 197
7.7.2.1 Premedication 198
7.7.2.2 Maintenance 198
7.7.2.3 Regional Anesthesia 198
7.7.2.4 Postoperative Analgesic Plan 198
7.7.2.5 Home Medications 198
7.7.3 Surgery of the Tail 198
7.7.4 Mandibulectomy/Maxillectomy 200
7.7.4.1 Inferior Alveolar (Mandibular) Blocks 200
7.7.4.2 Maxillary Blocks 200
7.8 Postoperative Patient Evaluation 201
7.9 Management of Painful Dermatologic Conditions 201
7.9.1 Sensory Perception in the Skin 202
7.9.2 Recognizing Cutaneous Discomfort 202
7.9.3 Painful and Pruritic Cutaneous Conditions 203
7.9.3.1 Allergic Skin Disease 204
7.9.3.2 Skin Infections 204
7.9.3.3 Autoimmune and Immune- mediated Dermatopathies 206
7.9.3.4 Cutaneous Burns 207
7.9.4 Treatment of Cutaneous Pain and Pruritus 211
7.10 Conclusion 212
References 212
8 Analgesia for the Pregnant, Neonatal, and Pediatric Patient 217 Darci Palmer and Natalie Pedraja
8.1 Introduction 217
8.1.1 Pain Management During Pregnancy 217
8.1.2 Analgesic Drugs Used During Pregnancy and C- Sections 218
8.1.2.1 Nonsteroidal Anti- inflammatory Drugs (NSAIDs) 219
8.1.2.2 Opioids 219
8.1.2.3 Alpha- 2 Agonists 221
8.1.2.4 Dissociative Agents 222
8.1.2.5 Local and Regional Blocks 222
8.2 Postoperative Analgesia 224
8.3 Anesthesia and Analgesia Case Management for a Cesarean Section 224
8.4 Pain Management for Neonates and Pediatrics 227
8.4.1 Insulting the Neonatal Pain Pathways 227
8.4.1.1 NMDA Receptors 228
8.4.1.2 Cutaneous Receptors 228
8.4.2 Treatment of Pain in Neonatal and Pediatric Patients 228
8.4.2.1 Opioids 228
8.4.2.2 Nonsteroidal Anti- inflammatory Drugs (NSAIDs) 229
8.4.2.3 Alpha- 2 Agonists 229
8.4.2.4 Local and Regional Blocks 229
References 229
9 Analgesia in the Emergency and Critical Care Setting 233 Heather Ann Scott and Rachel Stauffer
9.1 Introduction 233
9.2 Treating Pain in the Emergency and Critical Care Veterinary Patient 233
9.3 Evaluating Pain in ER and ICU Patients 234
9.4 Nursing Care and the Role of Pain Management in Kirby's Rule of 20 239
9.5 Pain and the Physiological Stress Response: A Summary 240
9.6 Sleep Deprivation 241
9.7 Windup Pain in the ER 242
9.8 Techniques and Nuances for Analgesic Delivery in the Emergency Room 242
9.8.1 Pain Vacations (Acute Pain) 243
9.8.2 Lidocaine Use in ECC 243
9.8.3 Opioid Analgesia for Emergency and Critical Care Patients 244
9.8.4 Local/Regional Analgesia in ECC 244
9.8.5 Nsaids 245
9.8.6 Maropitant 245
9.8.7 Physical Rehabilitation Methods in ECC 245
9.9 Common Painful Conditions in the ER/ICU Setting 246
9.9.1 Fractures 246
9.9.2 Acute Soft Tissue Injuries 247
9.9.3 Feline Lower Urinary Tract Obstruction 247
9.9.4 Trauma Patients 247
9.9.5 Abdominal Pain in ECC Patients 247
9.9.6 Acute Swelling and Edema 248
9.10 Conclusion 248
References 249
10 Chronic Pain Management for the Companion Animal 253 Taly Reyes, Jessica Birdwell, and Stephen Niño Cital
10.1 Introduction 253
10.2 The Complexity of Chronic Pain 253
10.3 Neuropathic Pain 255
10.4 Common Chronic Pain Conditions 255
10.4.1 Chronic Joint Pain- Osteoarthritis (OA) 255
10.4.2 Oncologic/Malignant Pain 257
10.4.3 Chiari Malformation Pain 257
10.4.4 Headaches and Migraines in Animals 259
10.4.5 Meningitis 259
10.4.6 Chronic Wounds 260
10.5 Assessing Chronic Pain 261
10.6 Goals and Modalities for Treating Chronic Pain 261
10.7 Pharmacological Interventions 261
10.7.1 Pain Vacation (Chronic Pain) 262
10.7.2 Mesotherapy 262
10.7.3 Transdermal Medications 263
10.7.4 Non- steroidal Anti- Inflammatory Drugs (NSAIDs) 264
10.7.5 Acetaminophen 265
10.7.6 Corticosteroids 265
10.7.7 Opioids 266
10.7.8 Atypical Opioids: Tramadol and Tapentadol 266
10.7.9 Tricyclic Antidepressants (TCAs), Selective Serotonin Reuptake Inhibitors (SSRIs), and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) 267
10.7.10 Gabapentinoids: Gabapentin and Pregabalin 268
10.7.11 N- Methyl- D- Aspartate Antagonists 269
10.7.12 Neurokinin- 1 Inhibitors 269
10.7.13 Bisphosphonates 270
10.7.14 Anti- NGF, Monoclonal Antibodies 270
10.7.15 Nutraceuticals and Animal Health Supplements 270
10.8 Lifestyle Modifications 271
10.8.1 Weight Loss and Appropriate Nutrition 271
10.8.2 Routine Exercise and Physical Therapy 271
10.8.3 Thinking "Out of the Box" through Environment Modifications 271
10.9 Conclusion 271
References 272
11 Analgesia for Shelter Medicine and Trap-Neuter-Return Programs 277 Anne Marie McPartlin and Erin Spencer
11.1 Introduction 277
11.2 Multimodal Analgesia 277
11.2.1 Opioids 279
11.2.2 Nonsteroidal Anti- inflammatory Drugs (NSAIDs) 279
11.2.3 NMDA Antagonists 281
11.2.4 Alpha- 2 Adrenoceptor Agonists 282
11.2.5 Local Anesthetics 282
11.2.6 Adjunct Therapies 283
11.3 HQHVSN and TNR Programs 283
11.4 Rabbits 285
11.5 Conclusion 286
References 286
12 Pain Management in Equids 289 Molly Cripe Birt, Rebecca Johnston, Rachael Hall, and Janel Holden
12.1 Introduction 289
12.2 Pain Assessment in Horses 289
12.3 Common Analgesics and Strategies in Horses 289
12.3.1 Butorphanol 290
12.3.2 Buprenorphine 291
12.3.3 Meperidine 291
12.3.4 Tramadol 291
12.3.5 Pure Opioid Agonists 291
12.3.6 Non- steroidal Anti- inflammatories 292
12.3.7 NMDA Receptor Antagonists 293
12.3.8 Alpha- 2 Agonists 293
12.3.9 N- butylscopolammonium Bromide (NBB) 294
12.3.10 Dimethylsulfoxide (DMSO) 294
12.3.11 Prokinetics and Antispasmodics 294
12.3.12 Locoregional Anesthetics and Techniques 294
12.4 Lidocaine Use in Horses 295
12.4.1 Postoperative Period Lidocaine Use 295
12.5 Common Painful Conditions and Procedures in Horses 296
12.5.1 Surgical Pain 296
12.5.2 Gastrointestinal (Colic and Ulcers) Pain 296
12.5.3 Lameness 297
12.5.3.1 Acute Lameness 297
12.5.3.2 Chronic Lameness 298
12.5.4 Osteoarthritis 298
12.5.5 Laminitis 299
12.5.6 Pleuropneumonia 300
12.5.7 Dystocia 301
12.6 Analgesia in Foals 302
12.7 Pain Management in the Donkey 304
12.7.1 Common Painful Conditions 304
12.7.2 Pain Scoring and Behaviors 304
12.7.3 Anatomic and Physiologic Distinctions from the Horse 306
12.7.4 Analgesics in Donkeys 306
12.7.4.1 Nonsteroidal Anti- inflammatory Agents 306
12.7.4.2 Alpha- 2 Adrenoceptor Agonists 307
12.7.4.3 Opioids 307
12.7.4.4 Local Anesthesia/Analgesia Methods 307
12.8 Nonpharmacologic Approaches to Pain 308
12.9 Conclusion 308
References 308
13 Food and Fiber Species 315 Janel Holden, Rachael Hall, MegAnn Harrington, and Mary Ellen Goldberg
13.1 Introduction 315
13.2 Cattle 318
13.2.1 Bovine or Cattle Medications 318
13.2.1.1 Opioids 318
13.2.1.2 Nsaids 318
13.2.1.3 Alpha- 2- Adrenergic Agonists 319
13.2.1.4 NMDA Antagonists 319
13.2.2 Regional Anesthesia and Analgesia 319
13.2.2.1 Local Anesthetic Agents 319
13.2.2.2 Intravenous Regional Anesthesia 320
13.2.2.3 Teat Block 321
13.2.2.4 Infusion of the Teat Cistern 321
13.2.2.5 Epidural Analgesia 321
13.2.2.6 Analgesia for Dehorning 322
13.2.2.7 Spermatic Cord Block 322
13.2.3 Analgesic Adjuvants 322
13.2.3.1 Gabapentin 322
13.2.3.2 Continuous Infusion Analgesia 322
13.2.4 Withdrawal Period 324
13.3 Sheep (Ovine) and Goat (Caprine) Medications 326
13.3.1.1 Opioids 326
13.3.1.2 NSAIDs 327
13.3.1.3 Alpha- 2- Adrenergic Agonists 327
13.3.1.4 NMDA Antagonists 327
13.3.2 Regional and Local Anesthesia 327
13.3.2.1 Cornual Block 327
13.3.2.2 The Inverted L- Block or 7- Block 328
13.3.2.3 Paravertebral Nerve Block 328
13.3.2.4 Caudal Epidural 329
13.3.3 Intravenous Regional Anesthesia 329
13.3.3.1 Bier Block 329
13.3.3.2 Intratesticular Block 330
13.3.3.3 Continuous Rate Infusions 330
13.3.4 Pain Management for Pigs (Swine) 330
13.3.4.1 Opioids 332
13.3.4.2 NSAIDs 332
13.3.4.3 Alpha- 2 Adrenergic Agonists 334
13.3.4.4 NMDA Antagonists 334
13.3.4.5 Lumbosacral Epidural Block 334
13.3.4.6 Continuous Rate Infusions 335
13.4 Pain Management for Camelids 335
13.4.1 Camelid Medications 337
13.4.1.1 Opioids 337
13.4.1.2 Nsaids 338
13.4.1.3 Alpha- 2 Agonists 339
13.4.1.4 Local Anesthetics 339
13.4.1.5 NMDA Antagonists 340
13.4.1.6 CRI Techniques 340
13.4.1.7 Tramadol 342
13.4.1.8 Gabapentin 342
13.5 Conclusion 342
References 342
14 Exotic Companion Animals 347 Katrina Lafferty, Elizabeth Vetrano, Mary Ellen Goldberg, and Stephen Niño Cital
14.1 Introduction 347
14.2 Why Treat Pain? 348
14.3 Rabbits 349
14.3.1 Painful Behaviors: Rabbits 349
14.3.2 Pain Scoring: Rabbits 350
14.3.3 Nursing Care and Environmental Management: Rabbits 350
14.3.4 Common Analgesics in Rabbits 351
14.3.4.1 Opioids 352
14.3.4.2 NSAIDs 352
14.3.4.3 Regional and Local Anesthesia 352
14.3.4.4 Continuous Rate Infusions 353
14.4 Rodents and Ferrets 353
14.4.1 Mice 354
14.4.1.1 Pain Scoring: Mice 354
14.4.2 Rats and Ferrets 355
14.4.2.1 Pain Scoring: Rats and Ferrets 355
14.4.3 Gerbils 355
14.4.4 Hamsters 355
14.4.5 Guinea Pigs 356
14.4.5.1 Pain Scoring: Gerbils, Hamsters, Guinea Pigs, and Ferrets 356
14.4.5.2 Common Analgesics in Rodents 356
14.4.5.3 Opioids 356
14.4.5.4 NSAIDs 358
14.4.5.5 Regional and Local Anesthesia 358
14.5 Multimodal Analgesia: All Species 359
14.6 Avian Analgesia 359
14.6.1 Recognizing Relevant Behaviors for Each Species 360
14.6.2 Avian Pain Scoring and Management 361
14.6.3 Avian Drug Delivery 362
14.6.4 Common Analgesics in Birds 365
14.6.4.1 Nsaids 365
14.6.4.2 Opioids 365
14.6.4.3 Regional and Local Analgesia 366
14.6.4.4 Adjunctive Analgesics 366
14.7 Reptile Analgesia 367
14.7.1 Causes of Pain in Reptiles 368
14.7.2 Analgesic Med
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