It’s a mixed bag when it comes to equine pain, so it’s important for reps to know a wide range of issues and solutions.

How do you spell relief? When it comes to equine pain, there’s no one answer. Depending on how a horse is worked, it may present very different pain symptoms, says John Hubbell, DVM, MS, ACVA, professor of veterinary medicine, The Ohio State University (Columbus, Ohio). Race horses that are made to work as young as 2 years old tend to develop foot and joint pain at an early age. Farm horses also may develop foot pain, and show/race horses can develop back pain from carrying a rider and jumping over hurdles. In fact, “most pain starts in the foot. Once the horse is relieved of its exercise, the pain issue often is resolved.”

Age is another factor that can contribute to equine pain, according to Joseph Manning, senior technical services, Intervet Schering-Plough Animal Health (Roseland, N.J.) “Sometimes young horses that aren’t fully developed face unique challenges,“ he says. “Then there are the challenges facing older horses that only get exercised on weekends.”
Indeed, pain management in horses is a broad topic, and veterinarians have different perspectives, depending on the area of medicine they practice. So, while colic, or abdominal pain, is common, veterinarians who practice sports medicine tend to see a lot of foot pain, joint pain and back and soft tissue pain, says Manning. Similarly, “veterinarians who deal with geriatric horses see a lot of back, joint and foot pain, and ophthalmologists see more eye pain,” he says. “A veterinarian may have to deal with colic on one hand and joint pain on the other. Because pain is so common in horses, veterinarians must be especially good at detecting it.”
General practitioners in particular are exposed to a broad gamut of issues, he continues. “They have a similar challenge to that of pediatricians, since the patients can’t tell them where they are hurting,” he says. It comes down to providing a good, thorough examination and knowing the patient’s history.”
Sometimes, detecting and addressing the pain source can be solved relatively easily through trial and error. For instance, veterinarians can treat hoof pain by adjusting the size of the shoe and the angle of the horse’s foot. Diagnostic tests, such as regional anesthesia, also can be helpful in pinning down the source of pain. The veterinarian observes the horse’s gait before and after administering a nerve block. “If the horse walks normally after receiving the nerve block, the veterinarian can get a better idea of where the source of pain is,” says Manning. “Veterinarians begin at the lowest point on a nerve and work their way up.” In other cases, joint blocks can help the veterinarian pin down a source of pain caused by fluid buildup in the joints. “The veterinarian might deaden the horse’s joint and then test its gait,” he explains. “Similarly, in the case of abdominal pain, the veterinarian might detect the source by palpating an ovary during a rectal exam. However, in other cases, such as colic, detecting the source of pain may be more invasive, calling for exploratory surgery.”

Solutions
Acupuncture for horses? It’s not unheard of. In fact, alternative medicine, such as this, is becoming increasingly accepted as a complement to traditional medicine among equine veterinarians, according to Manning. Acupuncture involves inserting and manipulating sterilized, disposable, ultra-thin needles (between 0.18-0.25 mm wide) into various points on the body to relieve pain or for therapeutic purposes. Supporters claim it can benefit musculoskeletal, respiratory, neurological and cardiovascular conditions.
More often than not, however, veterinarians approach equine pain through a combination of supplements, such as glucosamine chondroitin, and non-steroidal anti-inflammatory drugs (NSAIDs). “Supplements appear to work well and get good testimonial,“ says Manning. However, there is no clinical proof to support them, he adds.
“There are believers and non-believers when it comes to supplements,” says Hubbell. Often, veterinarians recommend certain diets that contain supplements, he notes.
Generally, veterinarians like to use NSAIDs in combination with supplements. The two most common are Bute (phenylbutazone) and Banamine (flunixin meglumine). They are in the same category as aspirin and ibuprofen, and are designed to reduce fever, swelling and inflammation. However, if not used responsibly, NSAIDs can cause the horse much damage. For instance, over time, horses on NSAIDs can develop gastric issues, he says. Similarly, if they are administered over a long period of time and the horse becomes dehydrated, NSAIDs can lead to kidney problems, he adds. “But, for the most part, NSAIDs are safe and can have a positive effect by breaking the cycle of inflammation, preserving the horse’s joint and helping it feel better.”
Although NSAIDs tend to be the preferred treatment among equine veterinarians, short-term steroid therapy (seven to 10 days) is not out of the question. “Steroids do have some positive effects,” says Manning. “They do help quell inflammation. But, they also depress the immune system and [limit] the body’s ability to repair itself. So, veterinarians [tend to] consider a 7-to-10-day therapy treatment to be safe.”

Mending the breaks
It may be next to impossible to convince a horse to stay off a broken leg. But, that hasn’t deterred veterinarians from setting and casting broken bones, generally from the knee down, in combination with a plate and screws to help support a bone fracture. “When a horse breaks a bone, we do cast it for support, although the cast materials must be strong enough to support the horse’s weight,” says Hubbell.
Newer fiberglass casts are available today with different levels of resin for different levels of strength, says Manning. Changing the cast every two or three weeks can help the patient avoid pressure sores, he notes.

Physical therapy
Equine physical therapy is a growing area of pain management. In fact, veterinarian-trained physical therapists who work with horses suffering from strains, injuries or other skeletalmuscular problems are very similar to those who work with humans. Equine physical therapy encompasses a number of techniques, including the following:
Massage.
Exercise, such as walking on the treadmill or swimming in a pool.
Ultrasound therapy. Ultrasound treatment provides deep tissue heating in underlying muscles and tendons. It can soften scar tissue and provide pain relief, and is often used to treat hoof wall abscesses among other conditions.
Heat therapy. Heat therapy increases metabolic activity in the muscle cells, increases blood flow, reduces joint stiffness, relaxes muscle fibers and provides pain relief.
Cold therapy. Cold therapy is often used to reduce swelling and pain in acute injuries. One form of cold therapy, cryotherapy, is applied in the form of ice chips or packs or bandages soaked in crushed ice. Ice massage is used for muscle pain, bruising, swelling and acute tendinitis.

Magnetic therapy. This is an alternative therapy that employs static magnetic fields. It often is used to treat hood problems, tendonitis and bone fractures.
Electrical stimulation therapy. This is used to help reduce pain, increase circulation and promote healing. Electrodes are applied to the skin to deliver intermittent, low-voltage stimulation to the surface nerves, blocking pain signals and releasing endomorphins.

The rep’s role
Veterinarians today must deal with animal pain on some level, says Hubbell. “They all receive training in school to work with [animals’] pain. The education has increased in recent years.” That said, they are looking to stay abreast of new developments in the field, and distributor reps can help them do so, Hubbell points out.
Manning agrees. “Sales reps should be aware of what medications are available and what they target,” he says. “They should know how sedatives work with regard to pain management. They should understand how morphine-like substances can help. And, they should be aware of the different corticosteroids – both the ones that are injected directly to the joint and those that are taken orally. And, finally, they should understand the different types of NSAIDs.” By showing their veterinarian customers that they know their products, distributor reps are that much closer to winning their trust and confidence.