Therapeutic options for the treatment of chronic pain in dogs

Transcutaneous electrical nerve stimulation as an adjuvant treatment for thoracolumbar acute hyperesthesia in chondrodystrophic dogs: a prospective blinded controlled clinical study

Introduction

Acute paraspinal hyperesthesia in dogs can result in a combination of nociceptive and neuropathic pain, often requiring pharmacological intervention. However, non-pharmacologic approaches, such as two-channel transcutaneous electrical nerve stimulation (TENS), may also be beneficial. Evidence from human medicine suggests that conventional TENS reduces pain scores and potentially decreases the need for analgesic medication. This study aimed to evaluate the efficacy of TENS as an adjunctive treatment for thoracolumbar paraspinal hyperesthesia in dogs.

Methods

This prospective, blinded, controlled cohort study was conducted in a clinical setting. Dogs diagnosed with paraspinal hyperesthesia, classified as grade 4 or 5 on the modified Frankel scale (MFS) and with a dynamic interactive visual analog scale (DIVAS) score ≥14, were included. The subjects were randomized into two groups: the study group (SG), which received standard pharmacological protocol (PSP) plus TENS, and the control group (CG), which received PSP only. Observers blinded to treatment allocation scored video recordings of the dogs. Assessments were performed every 24 hours from T0 (admission) to T8, with evaluations in SG occurring 5 minutes before each TENS session.

Results

A total of 818 dogs were enrolled, with 605 (74%) in the SG and 213 (26%) in the CG. In the first 48 hours, SG demonstrated a faster reduction in muscle tone compared to CG. While all dogs transitioned from a hyperesthetic to a non-painful state, SG showed a significantly faster recovery from T2 (48 h) to T4. A significant difference was observed between groups in DIVAS scores (p < 0.001). Additionally, SG had a shorter mean hospital stay (2.14 days) compared to CG, which required twice as long (p < 0.001).

Discussion

These findings suggest that TENS may be an effective adjunctive therapy for managing acute thoracolumbar hyperesthesia in dogs, promoting early recovery by reducing pain, medication dependency, and hospitalization duration. However, the study's reliance on subjective assessments presents a limitation, potentially introducing bias. Further research with objective outcome measures is necessary to validate these findings and optimize the integration of TENS in veterinary pain management protocols.

Chronic Pain in Dogs and Cats: Is There Place for Dietary Intervention with Micro-Palmitoylethanolamide?

The management of chronic pain is an integral challenge of small animal veterinary practitioners. Multiple pharmacological agents are usually employed to treat maladaptive pain including opiates, non-steroidal anti-inflammatory drugs, anticonvulsants, antidepressants, and others. In order to limit adverse effects and tolerance development, they are often combined with non-pharmacologic measures such as acupuncture and dietary interventions. Accumulating evidence suggests that non-neuronal cells such as mast cells and microglia play active roles in the pathogenesis of maladaptive pain. Accordingly, these cells are currently viewed as potential new targets for managing chronic pain. Palmitoylethanolamide is an endocannabinoid-like compound found in several food sources and considered a body's own analgesic. The receptor-dependent control of non-neuronal cells mediates the pain-relieving effect of palmitoylethanolamide. Accumulating evidence shows the anti-hyperalgesic effect of supplemented palmitoylethanolamide, especially in the micronized and co-micronized formulations (i.e., micro-palmitoylethanolamide), which allow for higher bioavailability. In the present paper, the role of non-neuronal cells in pain signaling is discussed and a large number of studies on the effect of palmitoylethanolamide in inflammatory and neuropathic chronic pain are reviewed. Overall, available evidence suggests that there is place for micro-palmitoylethanolamide in the dietary management of chronic pain in dogs and cats.

Clinical Practice Guidelines: An Opinion of the Legal Implication to Veterinary Medicine

The strengthening of the bond between humans and animals has changed the landscape of the veterinary profession. This has, in turn, led the legal system to assess damages in veterinary malpractice and liability cases more carefully, paying attention to the possibility of using clinical practice guidelines (CPGs) to prove whether the defendant veterinarian contravened or not the standard of care. In this era of evidence-based veterinary medicine, CPGs are becoming an integral part of many aspects of veterinary practice, even if CPGs do not have the force of law and are situated halfway between ethical rules and legal requirements. Although guidelines have been used for several years, there seems to be a general lack of recognition of the medical and legal ramifications of CPGs for veterinarians. This creates ambiguity and inconsistency in the care that veterinary practitioners provide, compromises the care animals receive, and prevents the courts from assessing veterinarian competence in a systematic and rational way. On the basis of these considerations, this article discusses the legal implications of CPGs in veterinary medicine for dogs and cats and explores how the law may treat CPGs in the future. Redefining the CPGs should be a priority for veterinary profession. NOTE: The authors chose to use the terms "companion animal," "pet," and "small animal" interchangeably throughout this article, as all three are commonly in use and refer to the same animals (dogs and cats).

Companion Animal Owner Perceptions, Knowledge, and Beliefs Regarding Pain Management in End-of-Life Care

The senior companion animal is the fastest growing segment of the pet population. End-of-life care, quality of life, and pain management (PM) are extremely important to pet owners. Research into PM and end-of-life care is essential due to lack of information on owner knowledge, attitudes, and beliefs. A survey was developed to gather information from owners. Surveys were developed using expert focus groups, and participants were recruited through social media. Survey validation employed emergent themes and grounded theory. Data from respondents (n = 986) were analyzed using descriptive statistics, Kruskal-Wallis, Jonckheere-Terpstra, or Wilcoxon rank-sum tests, with post hoc adjustment. Approximately 87% of respondents felt that euthanizing for unmitigated pain was appropriate. Households where there were multiple pets, both cats and dogs, and owners who were not first-time pet owners showed even greater preferences (P < .05) for euthanasia with unmitigated pain. Pain control was important to respondents, but owners lacked knowledge and had unrealistic attitudes and beliefs about treatment options, costs, and long-term feasibility. Limitations of this research included homogeneity of online survey respondents and convenience sampling. Translational research should be fostered to increase the availability and affordability of PM techniques in veterinary practice.

In situ fabrication of 3D Ag@ZnO nanostructures for microfluidic surface-enhanced Raman scattering systems

In this work, we develop an in situ method to grow highly controllable, sensitive, three-dimensional (3D) surface-enhanced Raman scattering (SERS) substrates via an optothermal effect within microfluidic devices. Implementing this approach, we fabricate SERS substrates composed of Ag@ZnO structures at prescribed locations inside microfluidic channels, sites within which current fabrication of SERS structures has been arduous. Conveniently, properties of the 3D Ag@ZnO nanostructures such as length, packing density, and coverage can also be adjusted by tuning laser irradiation parameters. After exploring the fabrication of the 3D nanostructures, we demonstrate a SERS enhancement factor of up to ∼2×10(6) and investigate the optical properties of the 3D Ag@ZnO structures through finite-difference time-domain simulations. To illustrate the potential value of our technique, low concentrations of biomolecules in the liquid state are detected. Moreover, an integrated cell-trapping function of the 3D Ag@ZnO structures records the surface chemical fingerprint of a living cell. Overall, our optothermal-effect-based fabrication technique offers an effective combination of microfluidics with SERS, resolving problems associated with the fabrication of SERS substrates in microfluidic channels. With its advantages in functionality, simplicity, and sensitivity, the microfluidic-SERS platform presented should be valuable in many biological, biochemical, and biomedical applications.