Inflammatory pain in cattle Stine Jacobsen Professor of Large Animal Surgery Dept. of Veterinary Clinical Sciences 2 Inflammation an everyday occurrence 1
3 Inflammation an everyday occurrence 4 Inflammation an everyday occurrence 2
5 Inflammation an everyday occurrence 6 Pathophysiology of inflammation and pain 3
7 Rubor et tumor cum calore et dolor Aulus Cornelius Celsus (c. 25 BC c. 50 AD) 8 Pain is a cardinal part of inflammation 4
9 Inflammation 10 Inflammatory pain is a complex and intricate process 5
11 Important concepts in pain physiology Gottschalk et al., Am. Fam. Phys. 2001 12 Allodynia 6
13 If left untreated, inflammatory pain becomes chronic 14 7
15 Effective treatment of inflammatory pain 16 Ineffective treatment of inflammatory pain 8
17 Acute inflammatory pain is easy to treat 18 Acute inflammatory pain is easy to treat 9
19 Obstacles for treatment of inflammatory pain 20 Obstacles for appropriate treatment of pain Reasons for not using analgetics Newton & 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) 10
21 Diagnosing pain Physical Increased heart and respiratory rate Increased rectal temperature Reduced appetite and weight loss Reduced milk production Behavioural 22 Subtle differences in resting behaviour after castration No castration Castration Musk et al., Animals 2017 11
23 Cesarean section Barrier et al., Appl. Anim. Behav. Sci. 2014 24 Diagnosing pain changes in behaviour Gleerup et al., Appl. Anim. Behav. Sci. 2015 12
25 Diagnosing pain the pain face 26 13
27 Obstacles for appropriate treatment of pain Reasons for not using analgetics Newton & 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) 28 Inadequate knowledge about available analgetics 14
29 Very few studies compare efficacy of different NSAIDs Treatment Ceftiofur 15.3 Ceftiofur + carprofen 5.5 Ceftiofur + ketoprofen 6.3 Ceftiofur + flunixin 1.7* Lung consolidation (median %) Lockwood et al., Vet. Rec. 2003 30 Obstacles for appropriate treatment of pain Reasons for not using analgetics Newton & 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) 15
31 Use of analgetics is not cost-effective Musk et al., Animals 2017 32 Use of analgetics is not cost-effective Newton & O Conner, Vet. Clin. North Am. Food Anim. 2013 16
33 Mastitis Sulfa-TMP Sulfa-TMP + Ketoprofen Shpigelet al., Res. Vet. Sci. 1994 34 Mastitis AB AB + meloxicam McDougall, J. Dairy Sci. 2009 17
35 36 Ways to obtain analgesia 18
37 NSAIDs registered for cattle NSAID Dose Half-life Administration Flunixin meglumin 2.2 mg/kg 3-8 hours IV q 24 hours Ketoprofen 3 mg/kg 30 minutes IV(IM) q 12-24 hours Carprofen 1.4 mg/kg 30 hours(longer for calves) IVor SC Meloxicam 0.5 mg/kg 20-40 hours IV or SC, (PO) q 24-72 hours 38 Transdermal flunixin 19
40 Other analgetics Local analgetics Procain Alfa2-agonists Xylazin Detomidin Ketamin Opioids Butorphanol 20
41 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 42 Epidural administration Local analgetics Alfa2-agonists Ketamin Opioids? 21
43 Epidural analgesia w/ xylazine - Master s thesis by Sidsel Sten Andersen 44 Epidural analgesia w/ xylazine 22
45 Nerve blocks 46 Nerve blocks 23
47 Regional perfusion (Bier block) 48 Infiltration analgesia 24
49 Infiltrationsanalgesi 50 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 25