The Fourth Vital Sign in All Creatures Great and Small With TG - RD Ideas

8/2/2019 The Fourth Vital Sign in All Creatures Great and Small With TG - RD Ideas

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The Fourth Vital Sign in All Creatures Great and Small

All things bright and beautiful,All creatures great and small,

All things wise and wonderful,

The Lord God made them all.

Cecil Frances Alexander (1818-1895 / England)

During this past year, members from the International Veterinary Academy of Pain Management have been

providing articles about techniques and modalities to enhance the level of analgesia your practice provides. Today,

we will discuss the fact that pain management needs to be applied to All Creatures Great and Small, includingLaboratory Animals. Lets first name what species can be included in laboratory animals. Certainly, rats and mice

would be recognized, as would rabbits. But, did you know laboratory animals includes, dogs, cats, ferrets, primates,

guinea pigs, hamsters, gerbils, sheep, goats, cows, horses, pigs, birds, reptiles, amphibians, fish, and invertebrates?

Not only these species, but others are classified as non-traditional laboratory animals. So, as you can see providing

analgesia for laboratory animals is a large task. While this article will briefly touch on certain topics involved in

laboratory animal analgesia, it is not meant as an in-depth piece. Careful study of specifics for each species must be

taken into account before proceeding with any analgesic therapy.

Pain has been called the fourth vital sign after body temperature, heart rate, and respiratory rate, and its potential

presence should be evaluated in patients just as the other vital signs are.Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or

described in terms of such damage.1 Pain motivates us to withdraw from potentially damaging situations, protect a

damaged body part while it heals, and avoid those situations in the future.2 It is initiated by stimulation of

nociceptors in the peripheral nervous system, or by damage to or malfunction of the peripheral or central nervous

systems.3 Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes

pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the

absence of any detectable stimulus, damage or pathology.4 For the purpose of this article we will describe pain as

acute, chronic or neuropathic (maladaptive).Acute pain is a normal physiologic and usually time-limited response to an adverse (noxious) chemical, thermal or

mechanical stimulus, associated with surgery, trauma, and acute illness and historically responsive to opioid

therapy.5

Chronic pain is defined by the IASP (International Association for the Study of Pain) as pain without apparent

biological value that has persisted beyond the normal tissue healing time usually taken to be 3 months.6 The classic

example of chronic pain is osteoarthritis.Neuropathic pain is a type ofpain which is caused by damage to or dysfunction of the nervous system.7

Neuropathic pain cannot be explained by a single disease process or a single specific location of damage. Examplesof neuropathic pain are phantom limb pain (e.g., onychectomy complications), complex regional pain syndrome,

prolonged intervertebral disc disease, cancer, and chronic ear pain.

Pain scoring for laboratory animals has evolved since 1985 when a behavioral paper was published by Morton and

Griffiths.8 Pain rating scales should include at least three requirements9:

1. Minimal Interobserver variability and observer bias.

2. Ability to distinguish varying levels of pain intensity in a particular species and situation

3. Ability to detect the degree of importance of pain to the subject.

Pain Scales can be visual analog scales (VAS); numerical rating scales (NRS) and simple descriptive scales (SDS).

VAS a line with no markings is used, numbers are at each end 0 being no pain and 100 being worst.

NRS a number line with individual numerical markings (1-10) which are chosen as the score.

SDS numbers used to assign to descriptions that categorize different levels of pain intensity.
http://en.wikipedia.org/wiki/Nociceptorshttp://en.wikipedia.org/wiki/Peripheral_nervous_systemhttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Pain#Etiology_.28cause.29http://en.wikipedia.org/wiki/Nociceptorshttp://en.wikipedia.org/wiki/Peripheral_nervous_systemhttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Pain#Etiology_.28cause.29


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Assessment of pain or distress may be based on many different criteria including:

Decreased activity

Abnormal postures, hunched back, muscle flaccidity or rigidity

Poor grooming

Decreased food or water consumption

Decreased fecal or urine output

Weight loss (generally 20-25% of baseline), failure to grow, or loss of body condition (cachexia) Dehydration

Decrease or increase in body temperature

Decrease or increase in pulse or respiratory rate

Physical response to touch (withdrawal, lameness, abnormal aggression, vocalizing, abdominal splinting,

increase in pulse or respiration)

Teeth grinding (seen in rabbits and farm animals)

Self-aggression

Inflammation

Photophobia

Vomiting or diarrhea

Objective criteria of organ failure demonstrated by hematological or blood chemistry values, imaging,

biopsy, or gross dysfunction

SPECIES-SPECIFIC BEHAVIORAL SIGNS OF PAINSpecies Vocalizing Posture Locomotion Temperament

Dog Whimpers,

howls, growls

Cowers, Crouches;

Recumbent

Reluctant to move;

awkward, shuffles

Varies from chronic to

acute; can be subdued or

vicious; quiet or restless

Cat Generally silent;

may growl or

hiss

Stiff, hunched in

sternal recumbency;

limbs tucked under

body

Reluctant to move

limb, carry limb

Reclusive

Primate Screams, grunts,

moans

Head forward, arms

across body; huddled

crouching

Favors area in pain Docile to aggressive

Mice, rats,

hamsters

Squeaks,

squeals

Dormouse posture;

rounded back; headtilted; back rigid

Ataxia; running in

circles

Docile or aggressive

depending on severity ofpain, eats neonates

Rabbits Piercing squeal

on acute pain

Hunched; faces back

of cage

Inactive; drags hind

legs

Apprehensive, dull,

sometimes aggressive

depending on severity of

pain; eats neonates

Guinea Pig Urgentrepetitive

squeals

Hunched Drags hind legs Docile, quiet, terrified,agitated

Horses Grunting, nicker Rigid; head lowered Reluctant to move;

walk in circles "up &down" movement

Restless, depressed

Chickens Gasping Stand on one foot,

hunched huddled

None Lethargic, allows handling

Cows,

calves, goats

Grunting;

grinding teeth

Rigid; head lowered;

back humped

Limp; reluctant to

move the painful area

Dull, depressed; act violent

when handled

Sheep Grunting; teeth

grinding

Rigid; head down Limp; reluctant to

move the painful area

Disinterested in

surroundings; dull,

depressed


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Pigs From excessivesquealing to no

sound at all

All four feet closetogether under body

Unwilling to move;unable to stand

From passive to aggressivedepending on severity of

pain

Birds Chirping Huddled, hunched From excessive

movement to tonic

immobility depending

on severity of pain

Inactive; drooping,

miserable appearance

Fish None Clamped fins; pale

color; hiding;

anorexia

None unless forced; if a

schooling fish; will

separate itself from

others

First sign to occur is

anorexia; lethargic; stressed

easily

Amphibians None Closed eyes; color

changes; rapid

respirations

Immobility; lameness Anorexia; aggressive;

Reptiles Hiss; grunting Hunched; hiding;

color change

immobility unless

forced

Anorexia; aggressive;

lethargic; avoidanceThis chart is meant to display some of the different signs species may exhibit if in pain. Individuals may not show any of these signs or they show

signs not listed. This is meant as a general guide.

When determining which analgesics should be used several factors need to be considered

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:

What is the likely severity of pain, and what is its anticipated duration?

Which drug or drugs should be administered, and at what dose rates?

Are there any special factors that will influence the choice of analgesic, for example, the species of animal,

any potential interactions with the particular research project, or any particular features of the current

condition and the type of pain?

What facilities are available for management of the animal? What level of nursing care and monitoring of

the animal is available? Can staff attend throughout a 24 hour period? Are there facilities for continuous

infusion of analgesics?

Mechanism-Specific Definitions11

Clifford Woolf has proposed a clinically useful method of classifying pain that is based on the

underlying physiology and pathophysiology of the specific type of pain:Nociceptive pain: transient pain in response to a noxious stimulus.Inflammatory pain: spontaneous pain and hypersensitivity to pain in response to tissue damageand inflammation.Neuropathic pain: spontaneous pain and hypersensitivity to pain in association with damage toor a lesion in the nervous system.Functional pain: hypersensitivity to pain resulting from abnormal processing of normal input.

The mechanism-specific definitions of pain highlight the fact that the sensation of pain can represent normal

protective mechanisms (nociceptive, inflammatory) to abnormal sensory processing (neuropathic, functional) in

which pain itself becomes a disease. In veterinary medicine, inflammatory pain is routinely observed acutely

(surgery, trauma) and chronically (osteoarthritis, cancer). Severe acute and chronic pains have components of

neuropathic pain. The role of functional (central) pain in veterinary patients is less clear.

Dr. Woolf further classified pain as Adaptive pain, which is defined as an appropriate hypersensitive response to a

potentially damaging stimulus that is responsive to medication orMaladaptive pain (commonly referred to as wind-

up pain), defined as spontaneous hypersensitivity resulting from abnormal processing of a stimulus by the central

nervous system (CNS), does not respond to treatment.12

Multimodal Analgesia

Multimodal analgesia uses more than one method of pain management. Multiple methods can actually reduce theamount of medications necessary to relieve pain, and can minimize uncomfortable side-effects. Benefits include13

1. More effective analgesia


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2. Possible reduction of doses of one or more individual drugs

3. Fewer incidences of breakthrough pain

Using combinations of different classes of analgesics may override some of the problems that can occur from

differences in the speed of onset of action or duration of analgesia from various agents. Medications like opioids,NSAIDS, local anesthetics, alpha-2-agonists, ketamine, tramadol, gabapentin, amantadine and amitriptyline have

shown synergistic effects when used in combinations. The following tables are to be used as guidelines. It is alwaysbest to begin a medication at the lowest dose possible unless you have proven knowledge of how a certain species

will react.

Multimodal Analgesic Drugs for Dogs and Cats

Drug Dose Species Route Dose

Interval

Comments

Morphine 0.5-1.0 mg/kg

0.05-0.1 mg/kg

0.2 mg/kg: loading,IM

0.1-0.5 mg/kg/hr

0.05-0.1 mg/kg/hr

0.1 mg/kg

preservative free

1-5 mg in 5-10 mlsaline

Canine

(K-9)

Feline

Canine:

Feline:

K-9/feline

Canine

IM, SC,

IV

IM, SC

IM thencontinuous

rate

infusion

(CRI) IV

Epidural

Intra-

articular

q3-4 hr

q3-4 hr

q12-24 hr

Caution with IV

administration: histamine

release-give slowly

Meperidine 3-5 mg/kg K-9/feline IM,SC q1-2 hr DO NOT GIVE IV

(Histamine release)

Methadone 0.1-0.5 mg/kg K-9/feline IM,SC,IV q2-4 hr NMDA antagonist activity

Oxymorphone 0.05-0.2 mg/kg

0.03-0.05 mg/kg

K-9

Feline

IM,IV,SC

IM,SC

q3-4 hr

q3-4 hr

Minimal histamine release

Hydromorphone 0.1-0.2 mg/kg K-9/feline IM,IV,SC q2-4 hr Minimal histamine release.

Hyperthermia may occur in

cats

Fentanyl 5g/kg +

3-6 g/kg/hr

2-3 g/kg +

2-3 g/kg/hr

K-9

Feline

IV

IV

Infusion

Infusion

Fentanyl Patch 25 g/hr

50g/hr

75 g/hr

100g/hr

25-50 g/hr

K-9: 3-10

kg

K-9: 10-20

kg

K-9:20-30kg

K-9:> 30kg

Feline

q1-3 days

q1-3 days

q1-3 days

q1-3 days

6 days

12-24 hr to reach peak

concentrations. Must

supplement analgesia until

blood levels are reached

6 hr to reach peak

concentrations

Butorphanol

10 mg/ml

0.1-0.2 mg/kg

0.2-0.4 mg/kg IV;

then 0.1-0.2 mg/kg/hr

K-9/feline

K-9/feline

IM,IV,SC

CRI

K-9: q1 hr

Feline:

q2-4 hr

Low oral bioavailability


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Pentazocine 1-3 mg/kg K-9/feline IM,IV,SC q2-4 hr

Nalbuphine 0.03-0.1 mg/kg K-9/feline IM,IV,SC q2-4 hr

Buprenorphine 10-30g/kg k-9/feline IM,IV,SC q4-10 hr 15-30 minute onset.

Excellent buccal mucosa

absorption in cats and dogs

Tramadol 2-10 mg/kg

start at 2-3mg/kg

K-9

feline

PO q4-6hr Nonscheduled agonist activity.Serotonin and norepinephrine

reuptake inhibitor. NMDAantagonist at lower doses, GABA

receptor inhibitor at high

concentrations.

Codeine 1-2 mg/kg K-9 PO

MedetomidineDexmedetomidine

1.0 mg/ml

2-15 g/kg

5-20 g/kg

1 g/kg IV, then 1-2

g/kg/hr

1-5 g/kg

2-5 g/kg

K-9

Feline

K-9/feline

K-9/feline

K-9/feline

IM,IV

IM,IV

CRI

Epidural

Intra-

articular

q0.5-1.5hr

q0.5-1.5

hr

Sedation, mild analgesia,bradycardia, vomition

Xylazine 0.1-0.5 g/kg K-9/feline IM,IV q0.5-1.0

hr

Yohimbine

(Antagonist)

0.1 mg/kg IV; 0.3-0.5

mg/kg IM

K-9/feline IM,IV

Atipamezol

(Antagonist)

0.05-0.2 mg/kg IV K-9/feline 2-4 times the

medetomidine-

dexmedetomidine dose

Ketamine 0.5 mg/kg; IV then

0.1-0.5 mg/kg/hr

K-9/feline CRI Excellent for intraoperative

CRI analgesia

Amantadine 3-5 mg/kg K-9/feline PO q24 hr Neuropathic pain

Amitriptyline 1.0 mg/kg

0.5-1.0 mg/kg

K-9

Feline

PO

PO

q12-24 hr

q12-24 hr

Enhanced noradrenergic

activity

Gabapentin 5-10 mg/kg K-9/Feline PO q12-24 hr VDCC inhibitor; excellent

for neuropathic pain or in

addition as

preanesthetic/postoperative

analgesic

Acepromazine 0.025-0.05 mg/kg

0.05-0.2 mg/kg

K-9

Feline

IM,SC,IV

IM,SC

q8-12 hr

q8-12 hr

3 mg maximum total dose;

used to potentiate or

prolong analgesic drug

effect. No analgesic benefitalone.

Diazepam 0.1-0.2 mg/kg

0.25-1.0 mg/kg

K-9/feline

K-9/feline

IV

PO

q2-4 hr

q12-24 hr

Used to potentiate or

prolong analgesic drug

effect

Lidocaine (1-2%) 6.0 mg/kg

3.0 mg/kg

2-4 mg/kg IV, then

25-80 g/kg/min

K-9

Feline

K-9

Perineural

Perineural

IV: CRI

q1-2 hr

q1-2 hr

Onset: Onset: 10-15

minutes. Maximum dose:

12 mg/kg (K-9); 6 mg/kg

(feline)

Excellent intra-operative

CRI analgesia for both K-9


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0.25-0.75 mg/kg slow

IV, then 10-40

g/kg/min

Feline IV: CRI and feline

Bupivacaine (0.25-

0.5%)

2.0 mg/kg

1.0 mg/kg

K-9

Feline

Perineural

Perineural

q2-6 hr

q2-6 hr

Onset: 20-30 minutes.

Maximum dose: 2 mg/kg

(K-9 or feline)

Mepivacaine (1-

2%)

6.0 mg/kg

3.0 mg/kg

K-9

Feline

Perineural

Perineural

q2-2.5 hr

q2-2.5 hr

References

Fish RE, Brown MJ, Danneman PJ and Karas AZ.Anesthesia and Analgesia in Laboratory Animals, Academic

Press, London, UK, 2008

Gaynor, JS, Muir, WW.Handbook of Veterinary Pain Management, Mosby/Elsevier Publishing, St. Louis, MO.,

2009.

Short, C.E. (Ed),Principles and Practice of Veterinary Anesthesia, Williams and Wilkins, Baltimore, 1987.

Tranquilli, WJ, Thurmon, JC, Grimm, KA.Lumb and Jones Veterinary Anesthesia and Analgesia, Blackwell

Publishing, 4th Edition, Ames, Iowa, 2007.

Fox, SM. Chronic Pain in Small Animal Medicine, Manson Publishing LTD, London, UK. 2010.

Spelts, K and Gaynor, J. Pain Management Strategies in Anesthesia for veterinary Technicians Editor Susan

Bryant, Wiley-Blackwell Publishing, Ames, Iowa, 2010.

Mathews, KA. Veterinary Clinics of North America: Small Animal Practice Update on Pain Management 38(6)

Nov, Elsevier/Saunders Publishing, Philadelphia, PA. 2008.

Tranquilli, WJ, Grimm, KA, Lamont, LA. Pain Management for the Small Animal Practitioner2nd Edition Teton

NewMedia, Jackson, WY 2004.

Short, CE and Poznak, AV.Animal Pain Churchill Livingstone Inc. New York, NY, 1992

Hellebrekers, LJ.Animal Pain: A Practice-Oriented Approach to Effective Pain Control in Animals Van der Wees

Uitgeverij, Utrecht, The Netherlands. 2000.

Sawyer, DC. The Practice of Veterinary Anesthesia: Small Animals, Birds, Fish and Reptiles . Teton NewMedia,

Jackson, WY. 2008

Carroll, GL. Small Animal Anesthesia and Analgesia, Blackwell Publishing, Ames, Iowa. 2008

Multimodal Analgesia in Primates

Drug Dose (mg/kg) Route Dose Interval Comments

Morphine 1-2 IM, SC q4h

Fentanyl 1-2g/kg

2-10 g/kg

10-25 g/kg/h

50-70 g/kg/h to 70-

IV

IV

IV-CRI

IV-CRI

q30 min for analgesia

adjunct for inhalant

anesthesia

neurosurgical


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100 g/kg/h procedures

Fentanyl

Transdermal Patch

4g/kg/h or 25

g/kg/h times 2

patches

transdermal drug

delivery-topical

q72h

Alfentanil 3-32 g/kg IV q15 min

Remifentanil 3.2-5.6 g/kg IV Ultra short acting 4 hrED50 in leopard frog

(Rana pipiens)

Butorphanol 0.2-0.4

25

IM

Intracoelomic q12 hr

Fentanyl 0.5 SC > 4 hr ED50 in leopard frog

(Rana pipiens)

Morphine 30-100

38-42

IM, SC, topically

SC

60-90 minutes

> 4 hr

Little effect on

feeding behavior

Nalorphine 122 SC > 4 hr

Lidocaine 1-2% Local infiltration Local anesthetic; use

with caution

Ketorolac 26 Dorsal Lymph Sac

Dexmedetomidine 120 Dorsal Lymph Sac

Xylazine 10 Intracoelomic q12-24 hr

Sedation and depression of motor reflexes associated with administration of opioids and alpha-2-adrenergic agonists

in mammals has not been observed in amphibians.

References:

Stevens, CW., Maciver, DN, Newman, LC. (2001) Testing and comparison of non-opioid analgesics in amphibians.Contemporary Topics 40, 23.

Brenner, GM, Klopp, AJ, Keason, LL and Stevens, CW. (1994) Analgesic potency of alpha adrenergic agents after

systemic administration in amphibiansJournal of Pharmacological ExperimentalTtherapy 270 pg 540-545

Machin, KL. (2001) Fish, amphibian and reptile analgesia. In Analgesia and Anesthesia Veterinary Clinics of

North America Exotic Animal Practice 4, P19-33.

Terril-Robb, LA, Suckow, MA, Grigdesby, CF. (1996) Evaluation of the analgesic effects of butorphanol tartrate,

xylazine hydrochloride, and flunixin meglumine in leopard frogs (Rana pipiens) Contemporary Topics 35, 54.

Longley, L Amphibian Anaesthesia in Anaesthesia of Exotic Pets (2008) Saunders/Elsevier, Edinburgh, Scotland pg

257.

Multimodal Analgesia for Fish

Drug Dose (mg/kg) Route Comments

Butorphanol 0.1-0.4 IM

Carprofen 2-4 IM q3-5days

Flunixin meglumine 0.25-0.5 IM q3-5days

Ketoprofen 2 IM


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Meloxicam 0.1-0.2 IM

Morphine 0.3 IM

Lidocaine do not exceed 1-2 mg/kg

total dose

local anesthesia

References

Stoskopf, M and Posner, LP. Anesthesia and Analgesia of Laboratory Fish inAnesthesia and Analgesia in

Laboratory Animals 2nd Edition, (2008) Editors: Fish RE, Brown MJ, Danneman PJ and Karas AZ. Academic

Press/Elsevier San Diego, CA pg 531.

Longley, L Fish Anaesthesia in Anaesthesia of Exotic Pets, (2008) Saunders/Elsevier, Edinburgh, Scotland pg 276.

Roberts, HE. Anesthesia, Analgesia, and Euthanasia in Fundamentals of Ornamental Fish Health, (2010) Editor:

Roberts, HE. Wiley-Blackwell Publishing Ames, Iowa, 168-171.

Flecknell, PA Analgesia and Post-Operative Care inLaboratory Animal Anaesthesia 3rd Edition, (2009)Elsevier/Academic Press, London, UK pg. 240.

Multimodal Analgesia for Miscellaneous Species

Species Drug Dose (mg/kg) Route Dose Interval

Hamsters morphine 2-5 SC, IM, q2-4h

aspirin 100 PO q4-8h

buprenorphine 0.05-0.1 SC q6-12h

butorphanol 1-5 SC q4h

carprofen 5 SC q24h

flunixin 2.5 SC q12-24h

ketoprofen 5 SC q12-24h

nalbuphine 4-8 IM q3h

oxymorphone 0.2-0.5 SC, IM q6-12h

meperidine 20 SC, IM q2-4hGerbil aspirin 100 PO q4-8h

butorphanol 1-5 SC q4h

carprofen 5 SC q24h


ketoprofen 5 SC

morphine 2-5 SC, IM q2-4h

nalbuphine 4-8 IM q3h


meperidine 20 SC, IM q2-4h


Chinchilla aspirin 100 PO q4-8h


butorphanol 0.2-2.0 SC, IM, IP q2-4hcarprofen 4 SC Q24h

flunixin 1-3 SC q12-24h

ketoprofen 1 SC, IM q12-24h


meperidine 1-2 SC, IM q2-4h

Prairie Dog butorphanol 0.1-0.4 SC, IM q8h

carprofen 1 PO q12-24h

ketoprofen 1-3 SC, IM


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buprenorphine 0.01-0.05 SC, IP q6-12h

meperidine 10-20 SC q2-3h

morphine 2-5 SC q4h


meloxicam 0.1-0.2 PO q24h

Degus aspirin 50-100 PO q4h

butorphanol 0.2 IM q4hflunixin 2.5 SC q12-24h

meperidine 10-20 IM, SC q3-4h

Duprasi

(Fat-Tailed Gerbil)

aspirin 150 PO q4-6h

buprenorphine 0.1-0.2 SC q8h

butorphanol 1-5 SC q2-4h


meperidine 20 SC, IM q3-4h

Herbivorous

Marsupials

buprenorphine 0.01 SC, IM, slow IV q8-12h

butorphanol 0.1-0.5 SC, IM q4-6h

flunixin 1 SC, IM q12-24h

Woodchuck Use same dosages as prairie dogsGround squirrels Use same dosages as prairie dogs

Invertebrates

There is little literature to document the use of analgesics in invertebrate species such as:

Mollusks Gastropods, cephalopods, Bivalves

Annelids Ploychaetes, Oligochaetes, Hirudineans (leeches)

Arachnida Spiders, Scorpions, Horseshoe Crabs

Crustaceans crabs, crayfish, hermit crabs, lobsters, shrimp

Insects

Nematodes

Echinoderms

Nociceptive cells have been found in invertebrates and opioid systems are functional in invertebrate nociception.

Local anesthetics will block the nociceptive pathway and decrease stimulus. Opioids provide good analgesia. As of

this time, we are urged to carefully extrapolate dosing information from what has been published on lower

vertebrates (fishes, amphibians, reptiles).

Centipedes only reports of 5% isoflurane and 100% oxygen

Cephalopods Magnesium chloride (MgCl2) for anesthesia is reported, but no analgesics.Chaetognaths - Arrowworms no reports of surgery or anesthesia and analgesia

Coelenterates Flatworms Jellyfish Corals Tricaine methane sulfonate (MS-222) and ethanol has been usedfor both anesthesia and analgesia.

Crustaceans can and do respond to noxious stimuli by dropping appendages.

Agent Dose Comment

Ketamine 0.025-0.1 mg/kg

90g/g IM

Anesthesia within 15-45 seconds

Duration 1 hour

Lidocaine 30 g/g IM injected intrathoracically; duration 25 minutes

Procaine 25 mg/kg anesthesia within 20-30 sec, duration 2-3 h

Xylazine HCl 70 mg/kg

16-22 mg/kg

anesthesia within 5-6 min, duration 45 min

anesthesia within 2-3 min

Gastropods analgesia has not been addressed in the literature. Anesthetic agents have been used.


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Insects As of this time, the ways to alleviate pain in insects are: a. to kill the animal humanely b. to apply

supportive care.

Nematodes roundworms - respond to neuroactive drugs

Agent Dose Comment

Gramine 0.01 mg/ml serotonin antagonist inhibits pumping

Imipramine 20g/ml stimulates pumping; high concentration act as anesthetic

Ivermectin 0.05 ng/ml inhibits pumpingMuscimol 2g/ml This GABA agonist inhibits pumping

Serotonin 1 mg/ml stimulates pumping

Oligochaetes Leech only 5% ethanol is mentioned for anesthesia

Polychaetes only MgCl2 for anesthesia is mentionedSponges although surgery has been performed for decades, no anesthetics or analgesics are reportedTubellarians flatworms-flukes-tapeworms respond with characteristic behaviors to dopaminergic agonists and

antagonists. Low levels of cocaine cause them to become motionless.

References

Flecknell, PA Analgesia and Post-Operative Care inLaboratory Animal Anaesthesia 3rd Edition, Elsevier/Academic

Press, London, UK 160-174, 2009

Carpenter, JW.Exotic Animal Formulary, Elsevier/Saunders, St. Louis, MO, 2005

Fish RE, Brown MJ, Danneman PJ and Karas AZ.Anesthesia and Analgesia in Laboratory Animals, Academic

Press, London, UK, 2008

Longley L.,Anaesthesia of Exotic Pets, Saunders/Elsevier, London, UK, 2008

Johnson-Delany, C.Exotic Companion Medicine HandbookWingers Publishing, INC, Lake Worth, FL 1996

Lewbart, GA.Invertebrate Medicine Blackwell Publishing, Ames, Iowa 2006

In conclusion, no matter if the veterinary practice is companion animal, large animal, exotic-zoo-wildlife or

laboratory animal, no animal deserves to hurt, suffer or be in pain. In 1965, the UK government commissioned aninvestigation - led by Professor Roger Brambell - into the welfare of intensively farmed animals. On the basis ofProfessor Brambell's report, the UK government set up the Farm Animal Welfare Advisory Committee in 1967,

which became the Farm Animal Welfare Councilin 1979. The committee's first guidelines recommended that

animals require the freedoms to "stand up, lie down, turn around, groom themselves and stretch their limbs". The

guidelines have since been elaborated to become known as the Five Freedoms14:

Freedom from thirst and hunger - by ready access to fresh water and a diet to maintain full health and vigor.

Freedom from discomfort - by providing an appropriate environment including shelter and a comfortable

resting area.

Freedom from pain, injury, and disease - by prevention or rapid diagnosis and treatment.

Freedom to express normal behavior - by providing sufficient space, proper facilities and company of the

animal's own kind.

Freedom from fear and distress - by ensuring conditions and treatment which avoid mental suffering.

It is our ethical duty to see that each patient receives adequate veterinary care in accordance with recommendations

of the National Research Council published in the "Guide for the Care and Use of Laboratory Animals" 8th Edition

2010. Remember that physical medicine therapies such as rehabilitation, acupuncture, herbal, chiropractic and

massage may be incorporated into an analgesic plan often with no detriment to a research protocol. Each and everyperson in the veterinary practice has a vital role to play in pain management. This includes the research setting

where the veterinary staff is dependent on the observations of the animal care staff and the principle investigators

and their laboratory staff as well as the veterinary practice. In the veterinary practice the veterinarian, practice
http://en.wikipedia.org/wiki/Farm_Animal_Welfare_Councilhttp://en.wikipedia.org/wiki/Farm_Animal_Welfare_Councilhttp://en.wikipedia.org/wiki/Farm_Animal_Welfare_Council


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manager, veterinary technicians/nurses, receptionist, kennel staff and groomers all play a unique role that aids in

keeping animals pain free. Remember to look at each of your patients, whether tiny or big, for the Fourth Vital

Sign and do not allow them to suffer once you have identified it.

I would like to personally thank Dr. Tamara Grubb and Dr. Robin Downing for their assistance with this manuscript.

Their wisdom and experience are invaluable.

Footnotes

1. International Association for the Study of Pain Retrieved 6 October 2009. This often quoted definition was first

formulated by an IASP Subcommittee on Taxonomy Bonica, JJ (1979). "The need of a taxonomy".Pain6 (3): 247

252.

2. Lynn, B (1984) "Cutaneous nociceptors" in Holden, AV & Winlow, W The neurobiology of pain. Manchester,

UK: Manchester University Press. p. 106.

3. Woolf, CJ & Mannion, RJ (1999) "Neuropathic pain: aetiology, symptoms, mechanisms and management". The

Lancet353 (9168): 19591064.

4. Raj, PP (2007) "Taxonomy and classification of pain" in Kreitler, S; Beltrutti, D; Lamberto, A et al. Thehandbook of chronic pain. New York: Nova Science Publishers Inc.

5. McGraw-Hill Concise Dictionary of Modern Medicine. 2002 by The McGraw-Hill Companies, Inc.

6. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by

the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 1986; 3:S1-S226.

7. Bogduk, Nikolai; Merskey, Harold (1994). Classification of chronic pain: descriptions of chronic pain syndromesand definitions of pain terms (2nd ed.). Seattle: IASP Press. pp. 212.

8. Morton, D. B. and Griffiths, P. H. M. (1985) Guidelines on the recognition of pain, distress and discomfort in

experimental animals and an hypothesis for assessment. Veterinary Record116: 431-436.

9. Karas, AZ; Danneman, PJ; Cadillac JM (2008) Strategies for Assessing and Minimizing Pain inAnesthesia and

Analgesia in Laboratory Animals (2nd Ed). London: Elsevier Inc. p211.

10. Flecknell, P (1999) Pain-assessment, alleviation and avoidance in laboratory animalsANZCCART News 12 (4)

December pp 1-10 pg 4.

11. Woolf CJ. Pain: Moving from symptom control toward mechanism-specific pharmacologicmanagement. Annals of Internal Medicine 140:441-451, 2004.

12. Woolf CJ. Pain: Moving from symptom control toward mechanism-specific pharmacologicmanagement. Annals of Internal Medicine 140:441-451, 2004.

13. Karas, AZ; Danneman, PJ; Cadillac JM (2008) Strategies for Assessing and Minimizing Pain inAnesthesiaand Analgesia in Laboratory Animals (2nd Ed). London: Elsevier Inc. p205.

14. Five Freedoms: Farm Animal Welfare Council: http://www.fawc.org.uk/freedoms.htm

References

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