dr. monique pairis-garcia, dr. anna johnson butters - pain management
DESCRIPTION
Pain Management - 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. More presentations at http://www.swinecast.com/2014-world-pork-expoTRANSCRIPT
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Pain Management For Piglets During
Castration and Tail Docking
Monique Pairis-Garcia BS, DVM, PhD, [email protected] Anna Johnson BSc, MSc, PhD, [email protected]
Department of Animal Science,Iowa State University
Ames, IA
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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
Defining PainPain: “Unpleasant sensory and emotional experience associated with actual or potential tissue damage”1
u Pain and suffering are clinically important conditions adversely affecting an animal’s quality of life (short-term or long-term)
u Prevention and alleviation of animal pain and suffering (i.e., management) are important goals
1IASP, 2004 3
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Procedures Management
Procedures
Disease
Painful Events
• 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
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Procedures Management
Procedures
Disease
Painful Events
• 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
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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
2Petherick , 2010Mcglone, 2014
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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 withphysical removal3
Liat Romme Thomsen, 2013
3Sutherland et al, 2011
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How to measure pain• Physiological measures– Hormones, Catecholamines, Immune response
• Behavioral measures– Locomotion, postures, maintenance behaviors
• Performance measures
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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**
4Prunier et al, 2005; 5Hay et al 2003
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Physiological Measures
• Immune function6
– Acute phase proteins– Pro-inflammatory cytokines– Antibody response
**May result in greater welfare concerns if animal’s health is compromised**
Wikipedia, 20146Moya et al, 2008
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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
7Wemelsfeder and van Putten, 1985; 8McGlone and Hellman, 1988
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Vocalization
• Behavioral indicator of pain9
– Immediate vocal response– High frequency calling– Increased calling rate
9Xin et al, 1989
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Performance Measures
• Average daily gain• Feed intake• Market weight• Carcass quality• Mortality
Iowa State University, 2011
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Manage Pain On Farm
Husbandry Techniques
Pharmacological Techniques
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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)
10Smith and Modric, 2013 11Coetzee, 2011
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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.
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Pharmacological• Local Anesthetics– Lidocaine
• General Anesthetics–CO2 Gas– Isoflurane
• Analgesics–NSAIDs
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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**12Muir et al, 1995
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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
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General Anesthetics
• Loss of feeling or sensation• State of unconsciousness with absence of
pain sensation• Suppresses cerebral activity– Co2
– Isoflurane– Sevoflurane
**Short Acting**
AnalgesicsNon-steroidal anti-inflammatory drugs (NSAIDs)
Flunixin meglumine
Meloxicam
Ketoprofen
**Longer acting but take time to have an effect**
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Case Study: Pain relief for castration
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Materials and Methods
• 141 litters• Four male piglets/ litter• Four treatments– Castration alone (C) – Castration + Meloxicam (M)– Castration + Lidocaine (L)– Castration + Lidocaine + Meloxicam (LM)
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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
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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
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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
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THANK YOU VERY MUCH FOR YOUR ATTENTION
QUESTIONS?