Post on 11-Apr-2019
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Stine JacobsenProfessor of Large Animal SurgeryDept. of Veterinary Clinical Sciences
Inflammatory pain in cattle
Inflammation – an everyday occurrence
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Inflammation – an everyday occurrence
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Inflammation – an everyday occurrence
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Inflammation – an everyday occurrence
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Pathophysiology of inflammation and pain
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Rubor et tumor cum calore et dolor
Aulus Cornelius Celsus (c. 25 BC – c. 50 AD)
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Pain is a cardinal part of inflammation
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Inflammation
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Inflammatory pain is a complex and intricate process
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Important concepts in pain physiology
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Gottschalk et al., Am. Fam. Phys. 2001
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Allodynia
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Effective treatment of inflammatory pain
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Ineffective treatment of inflammatory pain
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Acute inflammatory pain is easy to treat
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Acute inflammatory pain is easy to treat
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Obstacles for treatment of inflammatory pain
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Obstacles for appropriate treatment of pain
Reasons for not using analgeticsNewton & O’Conner, Vet. Clin. North Am. Food Anim. 2013
Financial reasons: only 25-45 % of farmers are willing to pay for analgetics(studies from USA, Canada, Italy)
Farmers cannot diagnose pain
Farmers have inadequate knowledge of available analgetics
It is generally not cost-effective to provide analgesia (limited effect on production outcomes such as average daily gain, feed intake, or feed to gain)
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Diagnosing pain
• Physical• Increased heart and respiratory rate
• Increased rectal temperature
• Reduced appetite and weight loss
• Reduced milk production
• Behavioural
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Subtle differences in resting behaviour after castration
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Musk et al., Animals 2017
CastrationNo castration
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Barrier et al., Appl. Anim. Behav. Sci. 2014
Cesarean section
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Diagnosing pain – changes in behaviour
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Gleerup et al., Appl. Anim. Behav. Sci. 2015
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Obstacles for appropriate treatment of pain
Reasons for not using analgeticsNewton & O’Conner, Vet. Clin. North Am. Food Anim. 2013
Financial reasons: only 25-45 % of farmers are willing to pay for analgetics(studies from USA, Canada, Italy)
Farmers cannot diagnose pain
Farmers have inadequate knowledge of available analgetics
It is generally not cost-effective to provide analgesia (limited effect on production outcomes such as average daily gain, feed intake, or feed to gain)
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Inadequate knowledge about available analgetics
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Very few studies compare efficacy of different NSAIDs
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TreatmentLung consolidation
(median %)
Ceftiofur 15.3
Ceftiofur + carprofen 5.5
Ceftiofur + ketoprofen 6.3
Ceftiofur + flunixin 1.7*
Lockwood et al., Vet. Rec. 2003
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Obstacles for appropriate treatment of pain
Reasons for not using analgeticsNewton & O’Conner, Vet. Clin. North Am. Food Anim. 2013
Financial reasons: only 25-45 % of farmers are willing to pay for analgetics(studies from USA, Canada, Italy)
Farmers cannot diagnose pain
Farmers have inadequate knowledge of available analgetics
It is generally not cost-effective to provide analgesia (limited effect on production outcomes such as average daily gain, feed intake, or feed to gain)
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Use of analgetics is not cost-effective
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Musk et al., Animals 2017
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Use of analgetics is not cost-effective
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Newton & O’Conner, Vet. Clin. North Am. Food Anim. 2013
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Mastitis
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Shpigel et al., Res. Vet. Sci. 1994
Sulfa-TMP Sulfa-TMP + Ketoprofen
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Mastitis
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AB
AB + meloxicam
McDougall, J. Dairy Sci. 2009
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NSAIDs registered for cattle
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NSAID Dose Half-life Administration
Flunixinmeglumin
2.2 mg/kg 3-8 hours IVq 24 hours
Ketoprofen 3 mg/kg 30 minutes IV (IM)q 12-24 hours
Carprofen 1.4 mg/kg 30 hours (longer for calves)
IV or SC
Meloxicam 0.5 mg/kg 20-40 hours IV or SC, (PO)q 24-72 hours
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Transdermal flunixin
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Other analgetics
• Local analgetics• Procain
• Alfa2-agonists• Xylazin
• Detomidin
• Ketamin
• Opioids• Butorphanol
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Systemic administration
• Alfa2-agonists• Xylazin: 0.05-0.3 mg/kg
• Detomidin: op til 0.08 mg/kg
• Opioids• Butorphanol: 0.05 mg/kg
• Ketamin• Up to 1 mg/kg
• Drawbacks• Sedation
• Short action• Repeated IM injections
• Constant rate infusion
• Can become expensive
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Epidural administration
• Local analgetics
• Alfa2-agonists
• Ketamin
• Opioids?
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Epidural analgesia w/ xylazine- Master’s thesis by Sidsel Sten Andersen
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Epidural analgesia w/ xylazine
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Infiltrationsanalgesi
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Take-home messages
• Inflammation causes pain
• Acute inflammatory pain is easy to treat • NSAIDs
• Chronic pain with sensitization/wind-up is more difficult to treat• Multimodal approach
• Analgetics can be administered in many ways
• Limited knowledge and limited availability of drugs impedes treatment of pain in cattle• Pain recognition tools
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