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Pain Management and Livestock Patients
Mary Ellen Goldberg BS, LVT, CVT, SRA, CCRVN, CVPP, VTS-physical rehabilitation, VTS- lab animal medicine (research anesthesia)
mewhitester@gmail.com Vetscope 2019

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Organizations to help with Livestock Pain

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Livestock

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Multimodal Pain Management
https://www.awionline.org/
-Multimodal analgesia is the preferred method of pain relief for even minor surgical procedures.
-"Livestock are not just things to be owned, but instead they can feel pain and suffer" – Dr. Temple Grandin

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Recognition of Pain in Cattle
-Dull and depressed
-Head held low
-Abdominal pain stance with one hindfoot placed directly in front of the other -Rigid posture, weight loss, lack of milk production
-Grunting
-Bellowing

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Recognition of Pain in Sheep
-Tachypnea
-Inappetence
-Grinding of teeth
-Immobility
-Abnormal gait

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Flehman in Lamb after castration
-Dorsal lip curling
-Restlessness
-Bleating
-Neck extension
-Hyperventilation

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Recognition of Pain in Goats
-Painful kid from disbudding
-Very vocal
-Intolerant of pain
-Kids commonly hide and wait for their mother to return and feed them

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Recognition of Pain in Pigs
-Changes in gait and posture
-Unwilling to move and may hide
-Squealing
-Anorexia
-Lameness

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Pain Scales for Livestock
-Veterinary Nurses have an ethical duty to be able to recognize and assess pain in all species
-Pain Charts and Scales help assess pain
-Grimace Scales are a type of pain scale
-Can teach farmers, owners and personnel how to use these scales

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Why analgesics are not used more frequently in livestock
-Lack of knowledge in recognizing pain,
-The belief that farm animals feel less pain than smaller animals,
-Economic reasons
-The lack of valid and reliable instruments to assess pain

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Grimace Scale for Horses
Just for those that think of Horses as Livestock Horse Grimace Pain Scale (HGS). The Horse Grimace Pain Scale with images and explanations for each of the 6 facial action units (FAUs). Each FAU is scored according to whether it is not present (score of 0), moderately present (score of 1) and obliviously present (score of 2).
Dalla Costa E, Minero M, Lebelt D, Stucke D, Canali E, et al. (2014) Development of the Horse Grimace Scale (HGS) as a Pain Assessment Tool in Horses Undergoing Routine Castration. PLoS ONE 9(3): e92281. doi:10.1371/journal.pone.0092281

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Description of each Facial Action Unit (FAU) of the Horse Grimace Scale (HGS) as reported in the handout distributed to the veterinarians
Emanuela Dalla Costa, Diana Stucke, Francesca Dai, Michela Minero, Matthew C. Leach and Dirk Lebelt. Using the Horse Grimace Scale (HGS) to Assess Pain Associated with Acute Laminitis in Horses (Equus caballus) Animals 2016, 6, 47; doi:10.3390/ani6080047

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Pain Management Beef Cattle

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Flower F, Weary D: Effect of hoof pathologies on subjective assessments of dairy cow gait. J Dairy Sci 2006, 89:139–146
-Validated
-Scoring System for Gait
-Severe hoof lesions
-Notice the rounded, kyphotic spine

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Oliveira FA, Loureiro Luna SP, Barros do Amaral J et al. Validation of the UNESP-Botucatu Unidimensional composite pain scale for assessing postoperative pain in cattle. BMC Veterinary Research 2014, 10, http://www.biomedcentral.com/1746-6148/10/200
Characteristic signs of pain in cattle after orchiectomy.
A - Head below the line of spinal column
B - Hind limbs extended caudally when in standing posture
C - Moves and arches the back when in standing
D - Kicking/foot stamping
E - Licking the surgical wound
F – Lying down in ventral recumbency with full or partial extension of one or both hind limbs.

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Gleerupa KB, Andersenb PH, Munksgaardc L, Forkmanaa B. Pain evaluation in dairy cattle. Applied Animal Behaviour Science, 2015, 171: 25-32
The Cow Pain Scale
-Attention towards the surroundings
-Head position
-Ears position
-Facial expressions
-Response to approach
-Back position

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Abu-Serriah M, Nolan AM, Dolan S. Pain assessment following experimental maxillofacial surgical procedure in sheep. Laboratory Animals (2007) 41, 345–352
-Postoperative hypersensitivity lasting at least three days after surgery
-Analgesics used: NSAIDS, opioids, local anesthetics
Note study done in 2007. With today’s analgesics like Nocita by Aratana, 72 hour bupivacaine, would analgesia be better?

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Kaler J, Wassink GJ, Green LE. The inter- and intra-observer reliability of a locomotion scoring scale for sheep. The Veterinary Journal 180 (2009) 189–194

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McLennan KM, Rebelo CJB, Corke MJ et al. Development of a facial expression scale using footrot and mastitis as models of pain in sheep. Applied Animal Behaviour Science, 2016, 176, 19-26
-Orbital tightening
-Cheek tightening
-Abnormal ear position front and side
-Abnormal lip and jaw tightening
-Abnormal nostril and philtrum shape
Example image outlining how the facial features of each lamb were measured quantitatively including placement of sticker markers on the test lambs. The larger rectangle denotes a calibration sticker of a known size for later analysis.

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Muri K and Valle PS. Human-animal relationships in the Norwegian dairy goat industry: assessment of pain and provision of veterinary treatment (Part II). Animal Welfare, 2012, 21: 547-558
This goat has osteoarthritis that can be treated with various multimodal analgesics like NSAIDS, Gabapentin, Amantadine

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Staffieri F, Driessen B, Lacitignola L and Crovace A. A comparison of subarachnoid buprenorphine or xylazine as an adjunct to lidocaine for analgesia in goats; Veterinary Anaesthesia and Analgesia, 2009, 36, 502–511.
Comparison Scale of:
-Comfort
-Movement
-Flock Behavior

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Giminiani PD, Brierley VLMH, Scollo A, Gottardo F, Malcolm EM, Edwards SA, Leach MC. The Assessment of Facial Expressions in Piglets Undergoing Tail Docking and Castration: Toward the Development of the Piglet Grimace Scale. Front. Vet. Sci., 14 November 2016 | https://doi.org/10.3389/fvets.2016.00100
-Temporal Tension
-Forehead Profile
-Orbital Tightening
-Cheek Tension
-Tension Above Eyes
-Lower Jaw Profile
-Upper Lip Contraction
-Snout Plate Changes
-Snout Angle
-Nostril Dilation

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Lonardi, C., Leach, M., Gottardo, F., Edwards, S. 2013. The ‘Grimace Scale’: do piglets in pain change their facial expression? Proceedings of the Joint Meeting of the 5th European Symposium of Porcine Health Management and the 50th Anniversary Meeting of the Pig Veterinary Society of Great Britain, Edinburgh, UK, 22nd – 24th May 2013
In piglets subjected to tail docking cheek tension score significantly increased from before to after the procedure (P<0.05)

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Göransson L. Porcine pain face – identifying visible characteristics of pain in pigs. Doctoral Dissertation, Number of part of series: 2016:37, ISSN: Online publication: http://stud.epsilon.slu.se

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(b) Pig during Capsaicin trial with lowered and asymmetrical ears. (c) Pig during Capsaicin trial with ears held backwards.

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Obese Pot Bellied Pig Pets

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Pig Lameness Exam

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Procedures that cause Pain in Cows
-GI or colic surgery - Severe
-Abomasopexy - Moderate
-Claw removal - Moderate to severe
-Dehorning - Moderate to severe
-Teat surgery - Moderate to severe
-Castration - Moderate
-C-section - Moderate to severe

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Cattle Claw Removal

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Cattle Castration

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Teat Surgery

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C-Section

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Procedures that Cause Pain in Sheep and Goats

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Adult Dehorning Sheep or Goats

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Disbudding

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C-Section in Sheep

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Procedures that Require Analgesia in Pigs
Piglet Castration

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Adult Pig Castration

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Aural Hematoma in Pig

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Atresia Ani – No rectum

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Entropion: frequent in pot-bellied pigs

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Ovariohysterectomy in Swine

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Prolapse: rectal, vaginal, uterine

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Tusk Trimming or Removal

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Vasectomy
Epidural for anesthesia
Dorsal Recumbency

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Medications Used in Livestock
When considering pain management strategy, one should contemplate prevention (preemptive) and control of those pain pathways already activated in nociception

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Cattle Analgesics
-NSAIDS
-Opioids
-Local techniques
-Alpha-2-Adrenergic agonists
-Ketamine
-Analgesic Adjuvants
-Constant Rate Infusions (CRIs) have been described

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Sheep and Goat Analgesics
-NSAIDS
-Opioids
-Alpha-2-Adrenergic Agonists
-NMDA Receptor antagonists
-Local Anesthetic blocks
-Analgesic Adjuvants
-CRIs have been utilized in small ruminants.

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Pig or Swine Analgesics
-Opioids
-NSAIDS
-Alpha-2-Adrenergic Agonists
-NMDA Receptor antagonists
-Local Anesthetic blocks
-Analgesic Adjuvants
-CRIs have been commonly utilized in pigs

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Withdrawal Period
Interval required after dosing for tissue concentrations of a drug or its metabolite to deplete to less than a specific concentration that has been established to be safe for human consumption

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Conclusion
-Veterinary nurse must learn about recognition and assessment of pain in livestock
-Score pain in cattle, sheep, goats and pigs
-Teach veterinary staff and owners about pain
-Teach owners how to score pain in their livestock

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Thank you