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  1. #1
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    Default Breaking the cycle of pain - small animal vs. large animal

    I work very part-time at a small animal vet practice. I started doing phones and invoicing but now assist and do a lot of post-op care.

    What has startled me is the fact that when behavior goes awry in dogs and cats, owners-- and the vet I work for-- immediately start looking for physical causes.

    Also surprising is the fact that there are so many pain management options for small animals, and the the vet I work for (though I'd say he is incredibly conservative by most standards) is quick to try different things in an effort to find the best pain management solution for a particular animal.

    Equine medicine seems so archaic in comparison. A lot of people are still quick to chalk training issues up to pure bad behavior. There also seems very few options for pain management, especially longterm.

    I know the sheer fact that a lot of equine medicine takes place "in the field" means that many diagnostics, procedures, etc. are just not possible unless you haul into a clinic or university. But it still seems like large animal medicine is way behind the eight ball in a lot of ways.

    I suppose things like a horse's size and fragile digestive system are stumbling blocks when it comes to medicating. Pain patches, longterm oral meds, and even IV or IM administration are perhaps not realistic.

    Just wondered what people's thoughts are on this.
    We couldn't all be cowboys, so some of us are clowns.



  2. #2
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    Well, you know that I think that equine medicine really needs to get on the ball in regards to pain management.

    If you think about it, the most recent news is that our current pain management options cause ulcers.
    "Kindness is free" ~ Eurofoal
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    The CoTH CYA - please consult w/your veterinarian under any and all circumstances.



  3. #3
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    Quote Originally Posted by EqTrainer View Post
    Well, you know that I think that equine medicine really needs to get on the ball in regards to pain management.

    If you think about it, the most recent news is that our current pain management options cause ulcers.
    Yeah that's kind of my guess as to why there is not better pain management. But then why don't we have options for meds or administration techniques that aren't as likely to compromise the gut?

    Like seriously what do we use for horses? Bute and Banamine. How is that it?
    We couldn't all be cowboys, so some of us are clowns.



  4. #4
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    what about Equioxx and Surpass?

    I've put my horse on daily Previcox and it, (or the work load or the oral HA {giggle}) has done wonders.

    Equioxx I believe is not known to cause ulcers.
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  5. #5
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    I'm using gabapentin for my horse's neuropathic pain, which I think is pretty new and novel.

    I also use Surpass to target diclofenac to one joint.

    We also have Equioxx/Previcox.

    So it's not so bad as JUST bute and banamine.



  6. #6
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    Quote Originally Posted by EqTrainer View Post
    Well, you know that I think that equine medicine really needs to get on the ball in regards to pain management.
    What seems to big a big issue is, horse owner's don't want to pay.

    They'll keep a horse in pro training forever, but doing a full lameness workup... with x rays... or paying for therapeutic shoeing, for example, may get put off

    The research to see how these drugs work and how safe they are isn't free, either.

    Surpass is "expensive" at $50/tube last time I checked. Adequan at around $290 for the series of 7 is "outrageous" for some....



  7. #7
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    Gabapentin is one I've wondered about as I've seen it mentioned here a few times. We do utilize that quite a bit in the clinic.

    Previcox is one I had forgotten about...

    I suppose we also use Methocarbamol/Robaxin...

    What about transdermal Fentanyl?

    Maybe I've just been lucky in that I've never had to deal with a longterm injury/illness/severe pain issue, and so my experience in equine pain management is limited? Maybe pain meds are utilized more often than I realize?
    We couldn't all be cowboys, so some of us are clowns.



  8. #8
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    Quote Originally Posted by Simkie View Post
    I'm using gabapentin for my horse's neuropathic pain, which I think is pretty new and novel.

    I also use Surpass to target diclofenac to one joint.

    We also have Equioxx/Previcox.
    As I am sure you know, all of these cost more than bute Gabapentin is pretty costly in itself, at least it was when I used it on my Great Dane!



  9. #9
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    FP, I am sure you are correct. Bute and Banamine are cheap. And I think that because horses are prey animals, they show pain less, and so people are somewhat fooled into thinking maybe their horse really is not in pain.

    Equioxx still has the potential for causing ulcers and so does Surpass. Not to say they are not wonderful, just pointing that out. And the one that people do not always realize can contribute to them is IA injections using corticosteroids. Durn horses are just really prone to gastic ulcers!

    Gabapentin is not widely used or known about IME. We live in the same state as the school who released the paper on it and my vet had no idea about it. I told her about it, emailed the info and she is game to try it as soon as we have a need for it.

    I have always wondered, if it would be helpful to have some sort of service now that we have email - where a vet or someone qualified scanned new studies/info and if they were relevant to modern veterinarian medicine, they were emailed to the vets ? Or done in a bi-weekly newsletter? I think that maybe part of the issue is there is so much info out there that no one can sort thru it. Maybe a good idea for someone to turn into a small business
    "Kindness is free" ~ Eurofoal
    ---
    The CoTH CYA - please consult w/your veterinarian under any and all circumstances.



  10. #10
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    I have a close friend who's had a stroke and is suffering severe central post-stroke pain. This is compounded by normal muscular-skeletal pain from getting her body working again.

    The neuropathic pain is so bad it has reduced to her begging to be put out of her misery. As any human doctor will confirm pain management is a difficult area and there is always a balance between the positive benefits of pain reduction and the negative side effects of the drug.

    My friend had gabapentin which didn't work and various combinations of opiates and anti-depressants. At one point she suffered a severe adverse drug reaction which almost killed her.

    She is still on a cocktail of about 12 different drugs - some to reduce the perception of pain, others to deal with inflammation, some to counter further stroke and some to counter the side effects of other drugs.

    But she knows that unless she finds ways of coping with her neuropathic pain and gets moving, she'll not improve and the longer she is on the drugs the more habituated she will become to them, physically and mentally - and the greater the risk of gastric ulcers and liver and kidney damage etc.

    Interestingly what has helped her most are massage (never underestimate the power of touch), people just spending time with her, regaining the power to make some decisions, and being taken out of the hospital environment. The more distracted from her pain she is and the more power she is able to take back the better able she is to cope.

    Seems to me that we can apply that to animals.

    I've found that touch (massage, stroking, grooming etc), the company of other compatible animals, distraction and gentle exercise help animals that are in pain - and there aren't any adverse side effects.

    It never ceases to amaze me how a horse in severe pain will perk up when you take it for a walk with another friendly horse and allow it to mooch and graze in a fresh paddock - especially when the grass is still dewy. I've seen horses that were unwilling to take a step, walk almost normally in that situation.



  11. #11
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    Quote Originally Posted by George Myers View Post
    I have a close friend who's had a stroke and is suffering severe central post-stroke pain. This is compounded by normal muscular-skeletal pain from getting her body working again.

    The neuropathic pain is so bad it has reduced to her begging to be put out of her misery. As any human doctor will confirm pain management is a difficult area and there is always a balance between the positive benefits of pain reduction and the negative side effects of the drug.

    My friend had gabapentin which didn't work and various combinations of opiates and anti-depressants. At one point she suffered a severe adverse drug reaction which almost killed her.

    She is still on a cocktail of about 12 different drugs - some to reduce the perception of pain, others to deal with inflammation, some to counter further stroke and some to counter the side effects of other drugs.

    But she knows that unless she finds ways of coping with her neuropathic pain and gets moving, she'll not improve and the longer she is on the drugs the more habituated she will become to them, physically and mentally - and the greater the risk of gastric ulcers and liver and kidney damage etc.

    Interestingly what has helped her most are massage (never underestimate the power of touch), people just spending time with her, regaining the power to make some decisions, and being taken out of the hospital environment. The more distracted from her pain she is and the more power she is able to take back the better able she is to cope.

    Seems to me that we can apply that to animals.

    I've found that touch (massage, stroking, grooming etc), the company of other compatible animals, distraction and gentle exercise help animals that are in pain - and there aren't any adverse side effects.

    It never ceases to amaze me how a horse in severe pain will perk up when you take it for a walk with another friendly horse and allow it to mooch and graze in a fresh paddock - especially when the grass is still dewy. I've seen horses that were unwilling to take a step, walk almost normally in that situation.
    First George, I am very sorry for your friend, but also glad she is improving.

    I do think you are right in that there are things beyond pain meds that can aid in "pain control" and general recovery. Distraction, purpose, routine, etc. are all strong contributing factors.

    Ironically for myself, horses have been that distraction. One horse in particular really drove me to overcome some serious health obstacles, and encouraged me to get myself better... FOR MYSELF. And that is just what I needed to get over the hump.

    In turn I've spent the last 6 months helping another equine recover from severe neglect. There are times where I have been certain he was painful, and suffering, and still days now where I suspect there is a low level of chronic pain. Maybe more than I even know, as he is quite stoic.

    For the most part I've done what I could-- groomed him, hand walked him, hand grazed him, given him appropriate turnout buddies, clean stall, food, etc. and now slowly, a bit of light work. I think those things have helped him regain his health.

    There is much to pain management that goes beyond pharmaceuticals, and I'm glad you posted to remind me of that.
    We couldn't all be cowboys, so some of us are clowns.



  12. #12
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    Quote Originally Posted by FatPalomino View Post
    As I am sure you know, all of these cost more than bute Gabapentin is pretty costly in itself, at least it was when I used it on my Great Dane!
    Blush is on 2000 mg gabapentin bid and it costs me about $40 a month. Walgreens includes the 100 mg capsules on their prescription card, which I purchased for Blush for something like $20.

    I'm able to make a tube of Surpass last about a month if I'm putting it on one joint. I use about 4" once a day on clipped skin. More feels wasted.

    Previcoxx is about 50 cents a day, if you can get your large animal vet to write the script for your horse.

    So, yeah...not as cheap as bute. But not THAT costly, either

    If anyone would like a contact for their vet to discuss gabapentin use in equines, feel free to shoot me a PT. I have two vets who would probably be willing to discuss it.



  13. #13
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    Quote Originally Posted by EqTrainer View Post
    I have always wondered, if it would be helpful to have some sort of service now that we have email - where a vet or someone qualified scanned new studies/info and if they were relevant to modern veterinarian medicine, they were emailed to the vets ? Or done in a bi-weekly newsletter? I think that maybe part of the issue is there is so much info out there that no one can sort thru it. Maybe a good idea for someone to turn into a small business
    It's called continueing education

    Really, most vets subscribe to the services they think will help them in practice and it's hard to have time to look at more. We have on-line journals and CE, real life CE, and site like VIN (VEterinary Information Network) to keep updated on the latest medicine.

    So good idea, but there's lots of competition.....
    Turn off the computer and go ride!



  14. #14
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    Quote Originally Posted by FlashGordon View Post

    What about transdermal Fentanyl?
    It's used in clinical settings.
    High abuse potential, so I doubt too many folks would be dispensing it.

    Epidural analgesia is also used in clinical settings.

    As mentioned above, pony up the research money, and you'll get more options.
    "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

    ...just settin' on the Group W bench.



  15. #15
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    Quote Originally Posted by EqTrainer View Post
    We live in the same state as the school who released the paper on it and my vet had no idea about it. I told her about it, emailed the info and she is game to try it as soon as we have a need for it.
    Me too, mine too had never heard of the drug, much less what it was used for. She researched it for me though, 'cause that's what she likes to do, though it ended up not being something appropriate for my horse at this time. She does a lot of CE, and still was not aware of it. I don't know if that means there is partially an issue with the information that IS out there just not being properly dispersed?

    Drug companies are willing to put lots and lots of $$ into research for companion animals, ie our dogs and cats, because people spend insane amounts of $$ on those animals, largely because so many households have 1 dog or 2+ cats. Horses aren't classed that way, it seems, so companies with the $$ to spend aren't willing to put it into researching products that don't get as much return
    ______________________________
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  16. #16
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    It can be pain, but it can be diet as well. That's why Cesar Milan tends to run some of the dogs first to get all this excessively stored energy out so they can actually start to focus on the handler.



  17. #17
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    what an interesting thread, and thought provoking responses.

    I have a 22yo mare who cracked her pelvis at age 7. While she has a hitch in her giddyup, and will never trot evenly, she has not shown pain or hard keeping that I'd associate with it, until this past winter. This was also the first winter pretty much since the injury that she has not been either pregnant or with foal-at-side.

    She has quite a bit more muscle wastage and loss of topine, and was showing some discomfort, as well as impossible to keep weight on...

    Could certainly partially be hormones, but I think probably has much to do with distraction and 'purpose.'

    It's something to think about as I ponder decisions before another winter.

    And I don't know... I think the cost, vs. the quality of life issues is muddier than appears at first glance. I won't go into debt that would leave the farm at risk (or myself) over a horse. Which sounds incredibly cold, and it's not. I just know where my limits are. I try very hard to set those limits when there is no crisis, and tell people who care about me to remind me of them when there IS crisis.

    I will spend as much TIME and PHYSICAL EFFORT as humanly possible. Nursing, rehab, whatever it takes. But there are limits to how far I'll go financially. The needs of the many outweigh the needs of the one. In this case the 'many' include myself, the dogs, the mortgage, the vehicle, and the rest of the farm. If I can work a couple more hours or a few extra shifts for a reasonable Rx, of COURSE I will. But I'm not going to pin my hopes on a nuclear scan or a brand new Rx for a 22yo with a known cracked pelvis... ya know?

    Boy, reading over that, it sounds awful. I hope that people get what I'm saying. If it's about time and effort--there is absolutely no limit. But when it comes down to concrete matters of extraordinary expense vs. quality of life... I think you really, really have to make those decisions when times are good. So when they're not so good, you have at least a yardstick to measure by.
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  18. #18
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    Quote Originally Posted by pintopiaffe View Post

    And I don't know... I think the cost, vs. the quality of life issues is muddier than appears at first glance. I won't go into debt that would leave the farm at risk (or myself) over a horse. Which sounds incredibly cold, and it's not. I just know where my limits are. I try very hard to set those limits when there is no crisis, and tell people who care about me to remind me of them when there IS crisis.

    I will spend as much TIME and PHYSICAL EFFORT as humanly possible. Nursing, rehab, whatever it takes. But there are limits to how far I'll go financially. The needs of the many outweigh the needs of the one. In this case the 'many' include myself, the dogs, the mortgage, the vehicle, and the rest of the farm. If I can work a couple more hours or a few extra shifts for a reasonable Rx, of COURSE I will. But I'm not going to pin my hopes on a nuclear scan or a brand new Rx for a 22yo with a known cracked pelvis... ya know?

    Boy, reading over that, it sounds awful. I hope that people get what I'm saying. If it's about time and effort--there is absolutely no limit. But when it comes down to concrete matters of extraordinary expense vs. quality of life... I think you really, really have to make those decisions when times are good. So when they're not so good, you have at least a yardstick to measure by.
    PP I don't think that is awful at all, instead both realistic and thoughtful.

    There are two sides to everything.... while many cat/dog owners seem much quicker to realize that behavior changes often have a physical root, they also go to lengths that are, at times, a bit extreme IMO.

    Myself and the other horse owner on staff often have different views than the rest of the small animal staff when it comes to quality of life and euthanasia. By no means are we "euth happy," but at the same time, doing a cruciate repair on a dog with congestive heart failure, or chemo on a dog just to *maybe* give it 3 more months, seems a bit.... dysfunctional?

    With the horses, you are forced to think about quality of life.... because if they cannot stand, move, eat, poop, etc. where does that leave such a big animal? So the first thing I seem to think of when I see a sick dog/cat is, what's going to be their quality of life AFTER the surgery, treatment, etc. I would say a lot of pet owners are just thinking about quantity, and less about quality.

    On the flip side, of course, we do see small animals with issues that are easily addressed, and owners that are often unwilling to treat, which is unfortunate. My boss has a habit of offering services like obstruction surgery or ligament repair, etc. even if an owner cannot pay... because the animal will live a "normal" life if we treat it and he hates finances to be the roadblock. There is a special place in heaven for that man!

    I guess the contrast between small/large animal medicine has been intriguing to me, to see the differences in both treatment and diagnostics, and also client attitudes. Perhaps neither one is better, they are just different.
    We couldn't all be cowboys, so some of us are clowns.



  19. #19
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    I think that it's a least partly because horses fall into an area that is between pets and livestock. Horses are also more costly to keep, even when they're completely healthy, than is the average cat or dog. So owners are frequently unwilling (or in some cases financially unable) to spend the money on newer pain medications.

    Owners also don't really think about what riding a horse may do physically to the animal. Just the stress and wear and tear on the joints causes all kinds of soreness (both muscle soreness and joint problems) that most riders don't really think about. And because horses tend to be stoic, when a horse suddenly erupts--probably because of pain issues--the owner is disinclined to believe that the horse has been in pain for a long time without showing it. Thus, by that reasoning, it must be because the horse is "nappy" or "mareish" or a "spaz" or has a bad attitude.

    Easier to get another horse than to spend the money finding out what the issue is and then treating what may amount to long-term maintenance.

    JMHO.
    "The formula 'Two and two make five' is not without its attractions." --Dostoevsky



  20. #20
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    Quote Originally Posted by FlashGordon View Post
    Equine medicine seems so archaic in comparison. A lot of people are still quick to chalk training issues up to pure bad behavior. There also seems very few options for pain management, especially longterm.

    Just wondered what people's thoughts are on this.
    Beg to differ. I bought my first horse in, like maybe, 1968 and can say that the single biggest change I have seen is in the way we can treat and diagnose horses today. We used to blame the training or bad behavior where we now know to look for pain first and there ARE things we can do to ease pain.

    The issue, IMO, is the affordability of doing so. Many, if not the majority, of owners lack the financial resources for the diagnostics and continuing treatment or are unwilling to spend it. Sorry, but a huge truth is that this large animal costs more then a Dachsund to treat and even the dog's owner may not have or want to spend the money to diagnose and treat.

    Such is the fate of the animals we choose to be responsible for.

    And, ya' know, some of them are victims of bad handling, training, riding and you cannot say it is ALL because of pain in either the small animal or a horse.
    When opportunity knocks it's wearing overalls and looks like work.

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