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Advances in areas of chronic pain,acute pain and oncology

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01 July 2010, at 12:00am

Veterinary Practice reports on a recent European symposium on pain management.

The growing range of uses of coxibs in veterinary and human medicine was the main theme of the sixth European Pain Management Symposium hosted by Merial in Portugal in April. 

More than 100 veterinary surgeons from 11 countries gathered at Albufeira, for the three-day event which highlighted some of the major advances being made in animal pain management in the areas of chronic pain, acute pain and oncology. 

Presentations by leading academics, veterinary specialists and medical professionals in human health attested, in particular, to the growing body of knowledge around classic and novel uses of coxibs in pain management. 

The event also marked the fifth anniversary of the launch of Previcox (firocoxib), the Cox-2 inhibitor introduced by Merial in 2005. 

Jean-Christophe Thibault, Merial’s technical services director, said that with data from the fields of osteoarthritis, surgery and oncology brought directly to an audience of practising veterinarians, the company’s aim was “to actively advance dialogue on a European-wide basis, by bringing together so many different perspectives”.

Misconceptions about OA 

Keynote speakers included Dr Denis Marcellin-Little of North Carolina State University in the USA, whose presentation Osteoarthritis(OA)in young dogs – more common than you think… addressed some key misconceptions that relate to OA. 

“Many owners construe OA as the result of wear and tear of joint surfaces
rather than as a result of its true causes: orthopaedic diseases that occur in the first year of a dog’s life,” he said, adding that owner education had to be a key part of managing the condition. 

“Owners should be taught to recognise the signs of OA flares in their dogs and should know what activities to be promoted and what to be avoided. The administration of a non-steroidal anti-inflammatory (NSAID) treatment is a cornerstone of OA pain management.”

Behaviour 

In her presentation on Osteoarthritis in the dog – assessment and treatment of the individual, Samantha Lindley from the Glasgow veterinary school used a nautical analogy to explain how “triangulation” of information could help veterinarians in diagnosing pain. 

“The presenting  complaint or sign is the starting point for most consultations. The second ‘bearing’ to take on board is behavioural changes for the individual animal and the third bearing is taken from the examination and the animal’s gait and/or general movement,” she said. 

She offered a checklist for the long term treatment of OA in the mnemonic ABCDE: analgesia (with NSAIDS being the first line treatment); bodyweight; control/common sense; disease modification and exercise. 

In a series of presentations, Dr Joseph Rosentel, director of pharmaceutical projects at Merial, shared new data on the effectiveness of firocoxib and its role in acute pain and dental pain management. 

Highlighting results from the Previcox experience trial (PET) – the largest ever post-approval field study of a canine NSAID – he explained how over 100 veterinarians and1,000 dogs had been enrolled in the study, which concluded that 93% of dogs which had completed the study showed improvement as
assessed by veterinarians when treated with firocoxib, with 86% of owners describing their dogs as “happier” or “more active”.

Acute pain management 

Acute pain was the theme on day two of the symposium. Highlights included: A multimodal approach to surgical pain in veterinary medicine in which Derek Flaherty of Glasgow addressed the complex subject of the neurophysiology of pain and explained the value of a multimodal or balanced approach to analgesia. 

“By utilising a variety of drugs (e.g. opioids, NSAIDs and local anaesthetics) we can achieve analgesia with lower doses of each, and also limit sideeffects,” he said. 

In his presentation on The use of NSAIDs and coxibs in veterinary ophthalmology, Thomas Dulaurent of the Veterinary Hospital in Saint Martin, France, explained that “many pathologic processes generate inflammation, which may be very detrimental to ocular and periocular structures”, adding that NSAIDs and especially coxibs should be considered by veterinary ophthalmologists for the management of daily clinical situations. 

Among other scenarios, he outlined the benefits of NSAIDs in the medical management of diabetic patients where corticosteroids are inadvisable, stating that “recent research studies have demonstrated specific effects of coxibs in challenging ophthalmology situations”. 

A presentation by Enrique Grau Bassas, of the Faculty of Veterinary Medicine in Gran Canaria, on The use of firocoxibinperi-and post-operative pain management with focus on surgical oncology further addressed changing attitudes to the use of NSAIDs in peri-operative analgesia. 

He explained how the availability of highly specific Cox-2 inhibitors opened the possibility of using NSAIDs for surgical patients and gave details of findings from a study of 21 dogs which confirmed that firocoxib could be safely used in this context.

Oncology 

The third day focused on the use of coxibs in oncology. François Serres, from the Veterinary School of Alfort, France, spoke on Cox inhibitors as a part of cancer treatment in clinical oncology, looking at a number of possible multimodal treatments including a combination of Cox-2 inhibitors and anti-neoplastic chemotherapy. 

“There is growing evidence that the activity of these anti-neoplastic agents could be complementary,” he said. Felisbina Queiroga, of the University of Trás-os-Montes and Alto Douro, Portugal, asked: “Is there a place for using Cox-2 inhibitors in canine malignant melanomas?” 

Drawing from research in the area of human health, he highlighted a small but growing number of studies on dogs which indicated that Cox-2 expression might be a useful tool for estimating the progress of canine malignant melanomas. 

“Although the actual knowledge is scarce and needs additional investigation, a number of studies strongly indicate a way for therapeutics, especially for malignant oral melanomas, using Cox-2 specific inhibitors,” she said. 

Pain management award 

The winner of the 2009 Merial European Pain Award was announced during the symposium. 

The award, which is designed to increase the awareness of pain and its management among veterinarians, with a view to improving clinical day-to-day work, invites submissions from veterinary practitioners all over Europe of original case studies with detailed information on the illness, treatment and diagnostic procedures. 

The 2009 winner, Sara Capelli of Vicenza, Italy, was highly praised by the judges for her winning paper, Intrathecal anaesthesia in two dogs undergoing thoracolumbar vertebral fixation, which was also presented at the event.