Pain: From Diagnosis to Effective Treatment

Managing pain effectively is one of the most important tasks that clinical veterinarians perform on a daily basis. This requires accurate assessing and grading of perioperative or posttraumatic pain followed by effective treatment. Commonly, veterinarians rely on the interpretation of physiological indices such as heart and respiratory rates, and, in case of musculoskeletal pain, on lameness evaluation. However, accurate assessment of pain in horses is complicated, not only because there are as many types of pain as there are responses to injuries, but also because criteria used to assess pain are often confounded by other factors. More recent studies suggest that subjective and objective assessment of species-specific pain behaviors should become an integral part of pain evaluation also in the horse, and that physiological and behavioral data combined are more useful than physiological measures alone to assess pain and the response to treatment in an individual animal. Pain scoring systems have recently been adapted to the horse and may prove useful in judging progress and response to treatment during the perioperative period. Effective pain therapy is best accomplished by applying a multi-modal or balanced analgesia concept that involves the combination of drugs with different pharmacological mechanisms of action and different target sites within the nociceptive system. Balanced analgesia may also include complementary modalities of pain treatment, such as acupuncture or chiropractic manipulations, especially when dealing with conditions of chronic pain.