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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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If left untreated, inflammatory pain becomes chronic

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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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Diagnosing pain – the pain face

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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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Ways to obtain analgesia

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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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Nerve blocks

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Nerve blocks

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Regional perfusion (Bier block)

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Infiltration analgesia

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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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