Pain Management. Dr. J.M. Roesner, DVM, DABVP Dr. Vanessa Lee, DVM. Ethics and Economics of Pain Management Pain Pathway and Strategies for Pain Reduction NSAIDS Tepoxalin Parting Thoughts. AVMA Position.
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Dr. J.M. Roesner, DVM, DABVP
Dr. Vanessa Lee, DVM
“Animal pain and suffering are clinically important conditions that adversely affect an animals quality of life. Drugs, technique or husbandry methods used to prevent and control pain must be tailored to individual animals.”
60% or more of DJD dogs are not treated or managed by a DVM.
(Tranquilly, Teton Press)
“First Pain” – A-delta, fast
“Second Pain” - C fibers, slow
Dorsal Root Ganglia – contains afferent cell bodies
Dorsal Horn of Spinal Cord (2nd order Neurons)
Site of Synapse of First Order Neurons:
A: excitatory and inhibitory interneurons
B: propriospinal neurons (segmental reflex activity)
C: projecting neurons to supraspinal centers (midbrain, cortex)
Spinothalamic, Spinocervical, Spinomesencephalic
3rd order neurons are within:
Descending inhibitory influences occur within cortex, thalamus, midbrain, rostral medulla and brain stem.
A: Transduction: receptor translates physical energy into electrical energy
B: Transmission: A delta and C fibers propagate impulses
C: Modulation: endogenous descending analgesic systems (opiod, serotonergic and noradrenergic) inhibit stimuli processing in spinal dorsal horn cells.
Chemotaxins C5a LT ect help direct emigration
LOX / \ COX
12HETE, 15HETE, LTA2 PGH2
/\ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯
LTB4 LTC4, LTD4, LTE4 PGE2 PGD2 PGF2α PGI2 TXAα
INFORMATION TO CONSIDER:(Papich NAVC, 2004)
Invitro data for COX1:COX2 does not always reflect in vivo, species
Both COX1 and COX2 must be inhibited in man to produce analgesia.
COX2 selective drugs have similar rates of GI side effects as non selective.
Concentration at site of action may be different than that of in vitro systems and drug may reflect different selectivity at that concentration.
COX2 products are essential for GI ulcer healing.
LT when block COX
(Gilroy et al EurJ Pharmacol, 1998)
Stimulus Cell Membrane
Transcription Factor 1kB
Nuclear Factor Kappa B
PGE2 levels in gastric mucosa, liver & blood of rats was not decreased.
PGE2 levels at sites of inflammation were decreased.
More significant joint lesions in humans on chronic high dose COX inhibitors.
n=62, % improved n=60, % improved
Ambulation 92 81
Weight Bearing 84 80
Pain on palpation 86 87
Pain on movement 82 81
General attitude 88 80
Owner evaluation 94 92
DVM evaluation 95 90
Similar results with Meloxicam Multicenter european studies. (World Wide Symposium, Technical Monograph)
(Technical Monograph Worldwide Symposium)
(Rossa et all, 1999)
Tepoxalin vs CarprofenZubrin vs Meloxicam
% dogs with 5.4 7.5 10.3 19.2
n=82 n=77 n=107 n=99
(World Wide Symposium)