“Management of severe skeletal pain in the horse can be a challenging task in practice, and is complicated by the fact that many drugs used for this purpose are controlled substances,” said Jessica Kidd, BA, DVM, CertES(Orth), DipECVS, MRCVS, of the University of Cambridge, in her presentation at the 43rd annual British Equine Veterinary Association Congress, held Sept. 15-18 in Birmingham, U.K. She described several options for controlling severe skeletal pain, including systemic opioids, epidurals, transdermal narcotics, and slings.

The indications for using these powerful pain management methods, she said, include the following:

• Fractures;
• Septic arthritis or osteomyelitis;
• Following orthopedic surgery;
• Some tendon injuries, including tendon lacerations;
• Myopathy (a painful condition of muscles either following exercise or anesthesia); and
• Neuropathy (a painful condition of peripheral nerves usually seen as a complication of anesthesia).

Of the pain management options listed, Kidd said systemic opioids are not generally used “as there is a very narrow margin between achieving analgesia and the development of side effects such as excitement and the potential to slow intestinal transit time (increasing the risk of colic).” However, intramuscular detomidine is effective (detomidine is an alpha-2 agonist marketed under the trade name “Domosedan”) and easy to use, she said. It does have mild side effects, including sedation and sweating, which are not usually problematic, but she noted that owners should be warned so they know what to expect.

“Epidurals are the next step,” Kidd went on. “These effects are limited largely to the perineal region and the hindlimb and are less useful for forelimb pain.” She explained epidural technique and dosages, and noted that a commercially available epidural catheter can be used if repeat epidurals need to be given, she added