Multimodal analgesia for inpatients

Pain is a common clinical problem in hospitalised horses that can be extremely difficult to manage when it is severe or chronic. While most clinicians are cognisant of pain in their patients, research suggests that the degree of pain may be under-recognised in many patients. This lack of recognition of the severity of the pain response coupled with concern over administration of ‘too much’ analgesic medication, can result in under-treated pain with a variety of negative physiological consequences. The type, source and duration of pain can markedly influence the horse’s response to analgesic treatment. For example, the nonsteroidal anti-inflammatory drugs (NSAIDs) that are most effective for inflammatory pain may have markedly diminished effectiveness for treatment of neuropathic pain. Using a multimodal approach to analgesia – the simultaneous use of multiple analgesic agents with differing mechanisms of action – a clinician can often administer lower dosages of individual drugs and minimise adverse effects while achieving more effective pain relief. In the hospitalised patient, the clinician has many choices of drugs and routes of administration to achieve therapeutic goals. In most horses, the analgesic plan begins with selection of a systemic NSAID unless the horse is intolerant to those drugs or has medical problems that preclude their safe use. The clinician should next consider a variety of local and systemic analgesic options. The final multimodal plan can be very specific to the needs and responses of individual patients. […]