Pain Management
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Dr. Monique Pairis-Garcia, Iowa State University, Dr. Anna Johnson Butters, Iowa State University, from the 2014 World Pork Expo, June 4 - 6, 2014, Des Moines, IA, USA.
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Pain Management
- 1. Pain Management For Piglets During Castration and Tail Docking Monique Pairis-Garcia BS, DVM, PhD, mdpairis@iastate.edu Anna Johnson BSc, MSc, PhD, johnsona@iastate.edu Department of Animal Science, Iowa State University Ames, IA 1
- 2. Objectives • Defining pain • How to measure pain? • Regulatory concerns for using pain relieving drugs in the United States • Case Study: Drug efficacy for pain management during castration 2
- 3. Defining Pain Pain: “Unpleasant sensory and emotional experience associated with actual or potential tissue damage”1 Pain and suffering are clinically important conditions adversely affecting an animal’s quality of life (short-term or long-term) Prevention and alleviation of animal pain and suffering (i.e., management) are important goals 1IASP, 2004 3
- 4. Procedures Management Procedures Disease Painful Events 4 • Castration • Tail docking • Teeth clipping • Reproductive surgery • Repairs • Lameness • Shoulder ulcers • Heal erosions • Fractures • Tail/vulva bites • Injuries • Lameness • Mastitis • Farrowing difficulties • Respiratory disease • GI disease
- 5. Procedures Management Procedures Disease Painful Events 5 • Castration • Tail docking • Teeth clipping • Reproductive surgery • Repairs • Lameness • Shoulder ulcers • Heal erosions • Fractures • Tail/vulva bites • Injuries • Lameness • Mastitis • Farrowing difficulties • Respiratory disease • GI disease Castration Tail Docking
- 6. Castration • Removal of testicles or destruction of testicular formation2 – Prevention of unwanted breeding – Reduced fighting and aggression – Meat quality improvement • Pain associated with scrotal incision, extraction of the testes and severing of the spermatic cords 62Petherick , 2010 Mcglone, 2014
- 7. Tail Docking • Portion of tail removed – Prevent/Decrease tail biting – Decrease economic loss associated with reduction in growth performance and increased incidence of infection • Pain associated with physical removal3 7 Liat Romme Thomsen, 2013 3Sutherland et al, 2011
- 8. How to measure pain • Physiological measures – Hormones, Catecholamines, Immune response • Behavioral measures – Locomotion, postures, maintenance behaviors • Performance measures 8
- 9. Physiological Measures • Hormones – ACTH (Adrenocorticotropic hormone)4 – Cortisol • Catecholamines – Norepinephrine/Epinephrine5 effects on: • Heart rate • Glucose levels • Lactate levels **Physiological measures can also increase due to general arousal and handling** 94Prunier et al, 2005; 5Hay et al 2003
- 10. Physiological Measures • Immune function6 – Acute phase proteins – Pro-inflammatory cytokines – Antibody response **May result in greater welfare concerns if animal’s health is compromised** 10 Wikipedia, 2014 6Moya et al, 2008
- 11. Behavioral Measures • Behavioral changes – Locomotion and Posture7 • Head turning toward hindquarters • Hind leg lifting • Slow twitching tail – Maintenance behaviors8 • Reduced feeding • Reduced drinking • Reduced activity 117Wemelsfeder and van Putten, 1985; 8McGlone and Hellman, 1988
- 12. Vocalization • Behavioral indicator of pain9 – Immediate vocal response – High frequency calling – Increased calling rate 129Xin et al, 1989
- 13. Performance Measures • Average daily gain • Feed intake • Market weight • Carcass quality • Mortality 13 Iowa State University, 2011
- 15. Regulatory Concerns in the U.S. • Animal drugs intended for use in the U.S are regulated by Food and Drug Administration (FDA) Center for Veterinary Medicine (CVM)10 • There are no pain relieving drugs specifically approved by FDA for use in livestock in the U.S.11 • Extra-label drug use (ELDU) is regulated under the Animal Medicinal Drug Use Clarification Act of 1994 (AMDUCA) 1510Smith and Modric, 2013 11Coetzee, 2011
- 16. AMDUCA requirements • Valid Veterinary-Client-Patient Relationship (VCPR) • Extra-label use limited to circumstances when a threat is posed to the health of an animal, or when failure to treat results in suffering or death • FDA approved animal and human drugs • There is no approved product to address the issue • Product administered under the direction of a licensed veterinarian and assigned an extended withdrawal time to avoid residues. 16
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- 18. Pharmacological • Local Anesthetics – Lidocaine • General Anesthetics –CO2 Gas –Isoflurane • Analgesics –NSAIDs 18
- 19. Local anesthetics Local • Most commonly used pain relieving drug in food animal medicine12 • Produces loss of sensation without loss of consciousness by preventing and blocking nerve impulses – Lidocaine/Prilocaine **Short Acting** 1912Muir et al, 1995
- 20. Lidocaine • Lidocaine is commonly suggested as a drug for pain relief during castration and tail docking. • Lidocaine is NOT APPROVED for veterinary use • Only Lidocaine approved for humans can legally be prescribed under AMDUCA and used in an extra-label manner 20
- 21. General Anesthetics • Loss of feeling or sensation • State of unconsciousness with absence of pain sensation • Suppresses cerebral activity – Co2 – Isoflurane – Sevoflurane **Short Acting** 21
- 22. Analgesics Non-steroidal anti- inflammatory drugs (NSAIDs) Flunixin meglumine Meloxicam Ketoprofen **Longer acting but take time to have an effect** 22
- 23. Case Study: Pain relief for castration 23
- 24. Materials and Methods • 141 litters • Four male piglets/ litter • Four treatments – Castration alone (C) – Castration + Meloxicam (M) – Castration + Lidocaine (L) – Castration + Lidocaine + Meloxicam (LM) 24
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- 28. Production Measures • Mean weight on castration day was not different. • No difference in weight gain • 11% morbidity with no treatment effect • 5% mortality with no treatment effect 28
- 29. Case Summary • Lidocaine reduced pain during castration • Meloxicam reduced pain after castration • No treatment effects on: – Skin temperature, weight gain, morbidity or mortality • Herdsmen effectively administered local anesthesia 29
- 30. Take home points • Pain associated with castration and tail docking is a current welfare issue on farm • Pain relief may be conducted using either anesthetics, analgesics or a combination of both • Use of these drugs in an extra label manner is approved under AMDUCA • Multi-modal drug approach is most effective for pain relief 30
- 31. THANK YOU VERY MUCH FOR YOUR ATTENTION QUESTIONS? 31
Editor's Notes
- IASP: International Association for the Study of Pain Pain typically involves a noxious stimulus or event that activates nociceptors in the body’s tissues that convey signals to the central nervous system, where they are processed and generate multiple responses, including the “unpleasant sensory and emotional experience” central to the IASP definition
- Procedures: defined as elective events performed on the animal by a veterinarian or caregiver specific to sows and boars that may result in the animal experiencing pain. Management: Defined as facilities or environments that predispose or increase the likelihood of conditions that may cause pain Disease: Defined as non-elective medical conditions that may cause the animal pain
- Procedures: defined as elective events performed on the animal by a veterinarian or caregiver specific to sows and boars that may result in the animal experiencing pain. Management: Defined as facilities or environments that predispose or increase the likelihood of conditions that may cause pain Disease: Defined as non-elective medical conditions that may cause the animal pain
- Petherick, J.Carol (2010). Castration. In Daniel S. Mills, Jeremy N. Marchant-Forde, Paul D. McGreevy, David B. Morton, Christine J. Nicol, Clive J. C. Phillips, Peter Sandoe and Ronald R. Swaisgood (Ed.), The Encyclopedia of Applied Animal Behaviour and Welfare (pp. 82-83) Wallingford, England: CAB Internarional. In other parts of the world, for example the United States, no such legislation exists and pigs may be castrated at any age without proviso other than non-legally binding recommendation (e.g. AVMA, 2010 which recommends castrating within the first 14 days of age).
- The sympathetic nervous system is activated during different kinds of stress (pain, anger and fear) and several changes are noted in the body, for example: dilated pupils, increased heart rate and blood pressure, redirected blood from the skin, decreased digestion and dilated bronchioles. During activation adrenocorticotropic hormone is released and induces secretion of cortisol [9]. These changes can be used as possible indicators of pain and several of these changes have been shown in piglets during and after castration [2,10,11]. Stress, trauma, infection or inflammation also triggers the acute phase protein response, which is a part of the body’s early defence. Serum amyloid A (SAA) is a major acute phase protein in pigs that can increase quickly and with large amplitude, and SAA level can therefore be used for defining the health and welfare status of pigs [12].
- Stress, trauma, infection or inflammation also triggers the acute phase protein response, which is a part of the body’s early defence. Serum amyloid A (SAA) is a major acute phase protein in pigs that can increase quickly and with large amplitude, and SAA level can therefore be used for defining the health and welfare status of pigs [12].
- http://isuag450farm.blogspot.com/2011/04/450-farm-students-gets-pqa-certified.html
- The Food and Drug Administration’s Center for Veterinary Medicine (CVM) ensures that safe and effective approved animal drugs are available for use in the United States. Although no drugs are currently approved for analgesic use in swine, CVM supports the ethical treatment and management of swine and aims to improve the availability of safe and effective drugs for the control of pain. CVM encourages drug companies to use innovative approaches to demonstrate the effectiveness of drugs for analgesic use in swine. There is an obvious need for continued research into the development of adequate behavioral and physiologic measures that can be used to reliably demonstrate the effectiveness of new animal drugs for the control of pain in swine (Smith and Modric, 2013)
- Treatment of pain falls into three major categories 1. Anesthetics 2. Sedative/tranquilizers and 3.analgesics. Among the analgesic categories includes: opioids, nonsteroidal antiinflammatory drugs (NSAIDs) and α2-agonists.
- Lidocaine withdrawal: 5 days Epidural for rectal/vaginal prolapse or dystocia, hernia repair, surgery on prepuce, penis or rear legs
- Anesthesia can be defi ned as the loss of feeling or sensation (Blood and Studdert, 1995), and general anesthetic agents achieve this by causing a state of unconsciousness, which results in an absence of pain sensation over the entire body. Inhalation of CO2 causes anesthesia by suppressing nerve cell function and cerebral electrical activity (Martoft et al., 2003). The advantages of using CO2 as a form of anesthesia include the speed at which CO2 can be administered, the speed at which animals return to consciousness, the fact that CO2 is not a restricted drug requiring administration by a veterinarian, and lastly, that there are no issues with drug residues (Gerritzen et al., 2008). http://secure.swissinfo.ch/eng/archive/Parliament_moves_to_improve_animal_rights.html?cid=4569378
- Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most common categories of drugs used to manage pain in animals. NSAIDS have several action modes including anti-inflammatory, antipyretic and analgesic properties. The biochemical action of NSAID’s is the inhibition of cyclooxygenase enzymes (COX) which are responsible for the production of prostaglandins, thromboxane A2, and conversion of arachidonic acid via lipoxygenase catalase pathway. Flunixin meglumine labeled in swine at 2.2 mg/kg IM for pyrexia associated with respiratory disease Aspirin is commonly used for pyrexia control and analgesic but are not approved by the FDA for use in animals.
- Collected vocalization, resistant movements, wounds, ear and skin temperature, acute phsae protein sickness treatment and mortality
- A total of 63 piglets (11%) were treated for health problems between the castration day and three weeks of age. The piglets were equally distributed over the treatments (C:17, M:11, L:17 and LM:18). During the same period, 26 piglets (5%) died but no significant effect of treatment on mortality was found (C:6, M:6, L:4 and LM:10). The mean weight on the castration day was 2.2 kg (SD = 0.5 kg) for all treatments. There was no significant difference between treatments in weight gain (kg) between the castration day and three weeks of age.