Table of Contents

• 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™ 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 Medications 368
• 14.7.2.1 Opioids 369
• 14.7.2.2 NSAIDs 369
• 14.7.2.3 Local Anesthetics 369
• 14.7.2.4 Adjunctive Analgesics in Reptiles 371
• 14.8 Analgesia in Fish and Amphibians 371
• 14.8.1 Fish and Amphibian Treatment Strategies 372
• 14.9 Analgesia in Invertebrates 372
• 14.9.1 Invertebrate Analgesia Strategies 375
• 14.10 Conclusion 375
• References 375
• 15 Analgesia in Zoo Animals 381
• Lindsay Wesselmann, Mark Romanoski, Alison Mott, and Margot Monti
• 15.1 Veterinary Technicians in a Zoological Setting 381
• 15.1.1 Types of Questions to Ask Keepers Include 381
• 15.2 Recognizing Pain in Non- domestic Animals 382
• 15.2.1 Scoring Pain and Discomfort 384
• 15.3 Treatment 385
• 15.4 Medication Administration 385
• 15.5 Adjunctive Therapies 388
• 15.6 Choosing a Pain Regimen 389
• 15.7 Taxon- specific Considerations 389
• 15.7.1 Elephants 389
• 15.7.1.1 Pain Interpretation 394
• 15.7.1.2 Treatment 395
• 15.7.2 Great Apes 398
• 15.7.3 Old World and New World Non- human Primates (NHP) 399
• 15.7.3.1 Signs of Pain or Distress in Nonhuman Primates 401
• 15.7.3.2 Local and Regional Anesthetics 401
• 15.7.4 Exotic Ungulates 402
• 15.7.4.1 Nonruminant Ungulates 403
• 15.7.4.2 Ruminant Ungulates 404
• 15.7.5 Swine 405
• 15.7.6 Wildlife 406
• 15.8 Conclusion 407
• References 407
• 16 Physical Rehabilitation 411
• Kristen Hagler, Wendy Davies, and Lis Conarton
• 16.1 Scope of Training for the Team 411
• 16.1.1 Team Approach to Care 413
• 16.1.2 Applications in Veterinary Medicine 413
• 16.2 The Veterinary Technician and Physical Rehabilitation 413
• 16.2.1 Common Conditions and Therapeutic Modalities 413
• 16.2.2 General Wound Healing 415
• 16.2.3 Bone 415
• 16.2.4 Muscle 415
• 16.2.5 Tendons and Ligaments 416
• 16.2.6 Articular Cartilage 417
• 16.3 Client Communication and Activity Modification 417
• 16.4 Patient Assessment 418
• 16.4.1 Veterinary Diagnosis - The Rehabilitation Team 418
• 16.4.2 Objective Outcomes: Goniometry and Muscle Girth 419
• 16.4.3 Pain and Disability Scoring - Methodology in Pain Scoring and Assessment 420
• 16.4.4 The Musculoskeletal System 422
• 16.4.5 Structural and Postural Evaluation 424
• 16.4.6 Gait Analysis and Movement 425
• 16.4.7 Lameness 425
• 16.4.8 The Aging Patient 427
• 16.5 Patient Management 427
• 16.5.1 Assistive Devices: Mobility Wheelchairs, Harnesses, and Footwear 427
• 16.5.2 Bracing, Splinting, and Prosthesis 429
• 16.5.3 Kinesio Taping 430
• 16.5.4 Environmental Modifications 430
• 16.6 Therapeutic Modalities and Emerging Treatments 431
• 16.6.1 Superficial Thermal Therapies 431
• 16.6.2 Photobiomodulation (Therapeutic Laser) 433
• 16.6.3 Electrical Stimulation 434
• 16.6.4 Extracorporeal Shock Wave Therapy (ESWT) 435
• 16.6.5 Therapeutic Ultrasound (ThUS) 435
• 16.6.6 Electro- Magnetic Therapy 436
• 16.7 Manual Therapy and Myofascial Trigger Points 436
• 16.7.1 Myofascial Trigger Points 436
• 16.7.2 Joint Mobilizations and Chiropractic 437
• 16.7.3 Joint Range of Motion - Passive 438
• 16.7.4 Therapeutic Massage 438
• 16.8 Emerging Therapeutic Medical Interventions 439
• 16.8.1 Regenerative Medicine and Biological Treatments 439
• 16.8.2 Corticosteroids and Hyaluronic Acid 440
• 16.8.3 Stem Cells 440
• 16.8.4 Platelet Rich Plasma (PRP) 440
• 16.8.5 Interleukin- 1 Receptor Antagonist Protein (IRAP) 440
• 16.8.6 Prolotherapy 441
• 16.8.7 Emerging Technologies: Radiosynoviorthesis (Conversion Electron Therapy) 441
• 16.8.8 Emerging Technologies: Viscoelastic Therapies - Injectable Hydrogel Microparticles and Polyacrylamide Gels 441
• 16.9 Therapeutic Exercise and Aquatic Therapy 442
• 16.9.1 Therapeutic Exercise Principles and Application 442
• 16.9.2 Land Treadmills 443
• 16.9.3 Hydrotherapy or Aquatic Therapy 444
• Appendix 16.A Obtaining Goniometric Measurements in the Canine Patient 446
• Appendix 16.B Limb Circumference 447
• Appendix 16.C Postural Compensations and Associated Medical Conditions 447
• Appendix 16.D Photobiomodulation Example Protocols Adapted from (Monici et al. 2019) 448
• Appendix 16.E Electrical Stimulation Example Protocols (Armitage 2019) 448
• Appendix 16.F Myofascial Trigger Point (MTrP) and Myofascial Pain Syndrome (MPS) Terminology 449
• Appendix 16.G Myofascial Trigger Point Examination Techniques 449
• Appendix 16.H Techniques Addressing Myofascial Trigger Points 450
• Appendix 16.I Joint Mobilizations 450
• Appendix 16.J Passive Range of Motion 451
• Appendix 16.K Therapeutic Massage Techniques 452
• Appendix 16.L Therapeutic Exercises for Early Rehabilitation 453
• Appendix 16.M Sample Guidelines 454
• References 459
• 17 Nutrition and Integrative Medicine 465
• Robin Saar, Jaime Brassard, and Stephen Niño Cital
• 17.1 Nutrition - The 5th Vital Assessment 465
• 17.1.1 Components of a Nutrition Assessment 466
• 17.1.1.1 Pet- Related Components 466
• 17.1.1.2 Diet- Related Components 466
• 17.1.1.3 Feeding Management 466
• 17.1.2 Nutrition Plan 467
• 17.1.3 Complete and Balanced Nutrition 467
• 17.1.4 Obesity's Role in Inflammation and Pain 468
• 17.1.5 Key Nutritional Factors 468
• 17.1.6 Macronutrients and Micronutrients 470
• 17.1.7 Antioxidants 471
• 17.1.8 Nutrient- Focused Diets 471
• 17.2 Microbiota Health 471
• 17.2.1 Prebiotics 471
• 17.2.2 Probiotics 471
• 17.2.3 Fecal Microbial Transplant (FMT) 472
• 17.2.4 Postbiotics 472
• 17.3 Cannabinoid Medicine 473
• 17.3.1 History of Cannabis 473
• 17.3.2 Cannabis Potential in Veterinary Medicine 474
• 17.4 The Endocannabinoid System (ECS) and Endocannabinoidome (eCBome) 475
• 17.4.1 Primary Cannabinoid Receptors 475
• 17.4.2 Endocannabinoids 476
• 17.4.3 Retrograde Signaling 477
• 17.4.4 Exogenous Cannabinoids 477
• 17.4.5 Major Cannabinoids 478
• 17.4.6 Minor Cannabinoids 478
• 17.4.7 Terpenoids and Flavonoids 479
• 17.4.8 Entourage Effect and Synergy 480
• 17.5 Cannabinoid Role in Pain Management 480
• 17.5.1 Acute Pain 480
• 17.5.2 Chronic Pain 481
• 17.5.3 G- Coupled Protein Receptors (GPR) 481
• 17.5.4 Glycine Receptors (GlyR) 481
• 17.5.5 N- Methyl- d- Aspartate (NMDA) Receptor 481
• 17.5.6 Peroxisome Proliferator- activated Receptors (PPAR) 482
• 17.5.7 Serotonin Receptors (5- HT) 482
• 17.5.8 Transient Receptor Potential (TRP) Cation Channel Superfamily 482
• 17.5.9 Opioids and Opioid Receptors (OPD1, OPK1, OPM1) 482
• 17.5.10 Acetaminophen and the ECS 483
• 17.5.11 Gabapentinoids 483
• 17.6 Cannabis Safety and the Veterinary Technicians Role in Client Education 483
• 17.7 Harm Reduction Education (HRE) 485
• 17.7.1 THC Intoxication 485
• 17.7.2 Cognitive Perception Modulation 486
• 17.7.3 Product Guidance 486
• 17.7.4 Dosing 487
• 17.7.5 Monitoring 488
• 17.8 Acupuncture 488
• 17.9 Supplements for Pain Management 489
• 17.9.1 Omega- 3 Fatty Acids 489
• 17.9.2 Palmitoylethanolamide (PEA) 490
• 17.9.3 Turmeric (Curcumin) 490
• 17.9.4 Glucosamine/Chondroitin and Undenatured Collagen- based Supplements 491
• 17.9.5 Kratum 491
• 17.9.6 Magnesium 491
• 17.9.7 Green Lipped Mussel Extract 492
• 17.9.8 Passion Fruit Peel Extract 492
• 17.9.9 Avocado/Soybean Unsaponifiables (ASU) 492
• 17.9.10 Yucca Schidigera 493
• 17.9.11 Melatonin 493
• 17.10 Conclusion 493
• References 494
• 18 Pain Management for End- of- Life Care 507
• Brooke Quesnell and Danielle DeCormier
• 18.1 Hospice and Palliative Care 507
• 18.1.1 Veterinary Staff in the Hospice and Palliative Care Environment 508
• 18.1.2 Work Areas 508
• 18.2 Technicians' Roles in a Hospice and Palliative Care Practice 509
• 18.2.1 Patient Presentation and Evaluation 509
• 18.2.2 Planning of Care 509
• 18.2.3 Delivery of Care 509
• 18.2.4 Caregiver Education and Training 510
• 18.2.5 Setting Up the Physical Environment 510
• 18.2.6 Social Environment 510
• 18.2.7 Support for the Family 510
• 18.2.8 Pain Recognition and Management 511
• 18.2.8.1 Neoplasia 511
• 18.2.8.2 Osteoarthritis 511
• 18.2.8.3 Analgesia for Specific Procedures and Special Problems 511
• 18.2.9 Advocacy 512
• 18.3 Euthanasia and Analgesia for the Dying Patient 512
• 18.3.1 Euthanasia 513
• 18.3.2 Natural Death 514
• 18.3.3 Pain Management for the Dying Animal 514
• 18.4 Support for the Family of the Dying Patient 515
• 18.5 Conclusion 515
• References 516
• 19 Selected Case Studies in Analgesia 517
• Tasha McNerney, Darci Palmer, and Stephen Niño Cital
• Index 529