List of Contributors xxiii Foreword xxvii Acknowledgments xxix About the Companion Website xxxi 1 Advancing Veterinary Pain Management into a New Era 1 Mary Ellen Goldberg 1.1 Introduction 1 1.2 Brief History of Human Pain Management 1 1.3 Veterinary Pain Management Through the Centuries 3 1.4 Animal Research Contributions 3 1.5 History of Animal Nursing Staff 4 1.5.1 National Association of Veterinary Technicians in America Recognized Veterinary Technician Specialty Academies 4 1.
6 Eyewitness to 50 Years of Changes for Veterinary Technicians 5 1.7 Veterinary Technician Pioneers in Pain Management 6 1.8 Future Directions for Veterinary Technician Pain Management 7 1.9 Conclusion 7 References 7 2 Careers in Animal Pain Management 9 Tasha McNerney and Stephen Niño Cital 2.1 Introduction 9 2.2 Pain Management Certifications Available for Veterinary Technicians/Nurses 9 2.2.1 Certified Veterinary Pain Practitioner (CVPP) 9 2.
2.2 Veterinary Technician Specialist (Anesthesia and Analgesia), and Veterinary Technician Specialist (Laboratory Animal Medicine - Research Anesthetist) 10 2.2.3 Veterinary Technician Specialist (Physical Rehabilitation) 11 2.2.4 Surgical Research Anesthetist (SRA) 11 2.2.5 The University of Tennessee Companion Animal Pain Management Certificate Program 11 2.
2.6 AAHA Pain Management Guidelines Certificate Course (AAHA Pain Management Champion) 11 2.2.7 WSAVA Certificate in Pain Management 12 2.2.8 Canine Rehabilitation Veterinary Technician Certifications 12 2.2.9 Equine Rehabilitation Veterinary Technician Certifications 12 2.
2.10 Certified Equine Massage Therapist 12 2.2.11 Animal Acupressure and Massage 12 2.2.12 TCVM Veterinary Technician Programs Offered by the Chi Institute 12 2.2.13 Animal Acupuncture 13 2.
2.14 Low- Stress Certifications 13 2.2.15 Veterinary Anaesthesia and Analgesia (MSc), (PgDip), (PgCert), or (PgProfDev) 13 2.2.16 Canine Arthritis Management Practitioner (CAMP) 14 2.2.17 Certified Companion Animal Rehabilitation Therapist (CCAT) 14 2.
3 Leveraging Veterinary Technicians in Pain Management 14 2.4 Conclusion 15 3 Pain Physiology and Psychology 17 Stephen Niño Cital, Tasha McNerney, and Robin Saar 3.1 Introduction 17 3.2 What Is "Pain" 17 3.2.1 The Negative Effects of Pain 18 3.3 Breaking Down the Nociceptive Pathway 18 3.3.
1 Transduction 18 3.3.2 Transmission 20 3.3.3 Modulation 20 3.3.4 Perception 20 3.3.
5 The Dorsal Horn 21 3.3.6 Ventral Horn and Intermediate Zone 23 3.3.7 White Matter 23 3.3.8 Descending Pathways 23 3.3.
9 Spinothalamic Tract 23 3.3.10 Spinoreticular Tract 24 3.3.11 Peripheral Sensitization 24 3.3.12 Central Sensitization 24 3.4 The Endocannabinoid System and Pain 27 3.
5 The Gate Control Theory 28 3.6 Psychological Aspects of Pain 29 3.6.1 Personality and the Pain Experience 29 3.6.2 Stress and Anxiety on Pain 29 3.6.3 Pain Catastrophizing 29 3.
6.4 Boredom and Pain 30 3.6.5 Neuroplasticity and the Memory of Pain 31 3.6.6 Caregiver Placebo 31 3.7 Types of Pain 32 3.7.
1 Somatic, Visceral, and Referred Pain 32 3.7.2 Physiological/Adaptive/Acute Pain 32 3.7.3 Pathological/Maladaptive/Chronic Pain 33 3.7.4 Neuropathic Pain 33 3.7.
5 Radicular Pain 34 3.7.6 Chronic/Persistent Postsurgical Pain 34 3.7.7 Complex Regional Pain Syndrome 35 3.7.8 Social Resilience and Pain 35 3.8 The Microbiome and Pain Pathophysiology 35 3.
8.1 What Is a Microbiome? 36 3.8.2 Determining "Healthy" in a Microbiome 37 3.8.3 Gut Microbiome Imbalance or Dysbiosis 37 3.8.4 The Gut- Brain Axis 38 3.
8.5 Microbial Derived Mediators 38 3.8.6 Pathogen- Associated Molecular Patterns (PAMPs) 38 3.8.7 Microbial- Derived Metabolites 39 3.8.8 Neurotransmitters or Neuromodulators 39 3.
8.9 Endocannabinoid Axis 41 3.8.10 Pain Medication and the Microbiome 42 References 42 4 Integrating Pain Recognition and Scoring in Companion, Equine, Food and Fiber Species, and Exotic/Lab Animal Species 47 Stephen Niño Cital, Ian Kanda, Taly Reyes, Jessica Birdwell, and Mary Ellen Goldberg 4.1 Introduction 47 4.2 Pain Domains 48 4.2.1 Pain Intensity and Affect 48 4.
2.2 Temporal Dimensions 48 4.2.3 Location and Bodily Distribution of Pain 48 4.3 Disposition and Personality 48 4.4 Breed or Species Bias 50 4.5 Dysphoria, Emergence Agitation, and Emergence Delirium 51 4.6 Placebo, Caregiver Placebo, and Placebo- by- Proxy 52 4.
7 Non-species- specific Assessments 52 4.7.1 Quantitative Sensory Testing (QST) 52 4.7.2 Temporal Summation (TS) 53 4.7.3 Nociceptive Withdrawal Reflex (NWR) 53 4.7.
4 Gait Analysis 53 4.7.5 Pain Biomarkers 53 4.7.6 Machine Learning and Artificial Intelligence (AI) 54 4.7.7 Activity Monitors (AMs) 54 4.7.
8 Facial Expression or Grimace Scales 55 4.8 Clinical Pain Scoring Tools (Canine and Feline) 55 4.8.1 Canine Acute Pain Scoring 56 4.8.1.1 Glasgow Composite Measure Pain Scale - Short and Long Forms (CMPS) (Validated) 56 4.8.
1.2 French Association for Animal Anesthesia and Analgesia Pain Scoring System (4A- Vet) (Validated) 58 4.8.1.3 University of Melbourne Pain Scale (UMPS) (Validated) 58 4.8.2 Canine Chronic Pain Scoring 58 4.8.
2.1 Canine Brief Pain Inventory (CBPI) (Validated) 58 4.8.2.2 Helsinki Chronic Pain Index (HCPI) (Validated) 59 4.8.2.3 Liverpool Osteoarthritis in Dogs (LOAD) (Validated) 59 4.
8.3 Feline Acute Pain Scoring 59 4.8.3.1 Glasgow Composite Measure Pain Scale- Short- Form (CMPS- SF) (Validated) 59 4.8.3.2 Feline Grimace Scale (FGS) (Validated) 60 4.
8.4 Feline Chronic Pain Scoring 60 4.8.4.1 Client- specific Outcome Measures - Feline (CSOMf) (Validated) 60 4.8.4.2 Montreal Instrument for Cat Arthritis Testing- caretaker (MI- CAT-(c)) (Validated) 60 4.
8.4.3 Feline Musculoskeletal Pain Index (FMPI) (Not Validated) 60 4.8.4.4 Oral Pain Scale - Canine/Feline (COPS-C/F) (Validated) 62 4.8.4.
5 Cincinnati Orthopedic Disability Index (CODI) (Not Validated) 62 4.8.4.6 HHHHHMM Scale (Not Validated) 62 4.8.4.7 VetMetrica(tm) Health- related Quality of Life (HRQoL) (Validated) 62 4.8.
4.8 Food and Fiber Species Pain Recognition and Scoring 63 4.9 Bovids 63 4.9.1 Indications of Pain in Cattle 71 4.10 Small Ruminants and Camelids 71 4.11 Swine 73 4.11.
1 Normal Behavioral Observations in Swine 73 4.12 Equid Pain Recognition and Scoring 73 4.12.1 Horses 74 4.12.1.1 Appearance of the Normal Horse 74 4.12.
1.2 Somatic Pain Indicators 75 4.12.1.3 Signs of Laminitis Pain Vary with the Progression of the Disease 75 4.12.1.4 Visceral Pain Indicators 75 4.
12.1.5 Horse Grimace Scale 75 4.12.2 Donkeys 77 4.13 Exotic Species Pain Recognition and Scoring 77 4.13.1 Birds 77 4.
13.2 Appearance of a Non- painful Bird 78 4.13.3 Appearance of a Painful Bird 78 4.13.4 Developing a Pain Score in Birds 81 4.14 Reptiles 82 4.14.
1 Appearance of a Nonpainful Reptile 82 4.14.2 Appearance of a Reptile in Pain 82 4.14.3 Developing a Pain Score in Reptiles 83 4.15 Amphibians and Fish 84 4.15.1 Appearance of a Nonpainful Fish and Amphibian 84 4.
15.2 Appearance of a Painful Fish and Amphibian 84 4.15.3 Developing a Pain Scoring Assessments in Fish and Amphibians 84 4.16 Small Exotic Mammals 85 4.16.1 Appearance of Nonpainful Small Exotic Mammals 85 4.16.
2 Appearance of Painful Small Exotic Mammals 85 4.16.3 Developing a Pain Score in Small Exotic Mammals 85 References 89 5 Analgesia Pharmacology 95 Darci Palmer and Stephen Niño Cital 5.1 Introduction 95 5.2 Definitions 95 5.3 Analgesic Drugs 96 5.4 Opioids 97 5.4.
1 Full Opioid Agonists 97 5.4.2 Individual Drug Facts 99 5.4.2.1 Morphine 99 5.4.2.
2 Meperidine (Pethidine) 99 5.4.2.3 Methadone 99 5.4.2.4 Hydromorphone 100 5.4.
2.5 Oxymorphone 100 5.4.2.6 Fentanyl, Remifentanil, Sufentanil, Alfentanil, Carfentanil 100 5.4.2.7 Fentanyl Patches 100 5.
4.2.8 Codeine 101 5.4.2.9 Hydrocodone and Oxycodone 101 5.4.2.
10 Tramadol 101 5.4.2.11 Tapentadol 102 5.4.3 Partial Agonist Opioids 102 5.4.3.
1 Buprenorphine 102 5.4.3.2 Simbadol 104 5.4.3.3 Zorbium 104 5.4.
3.4 Sustained or Extended Release (SR or ER) Buprenorphine 104 5.4.3.5 Buprenorphine Patches 105 5.4.4 Agonist/Antagonist Opiods: Butorphanol and Nalbuphine 105 5.4.
5 Opioid Antagonists: Naloxone, Nalmefene, Naltrexone 105 5.4.6 Mixing Opioids 106 5.5 Non- steroidal Anti- inflammatory Drugs (NSAIDs) 106 5.5.1 Washout 108 5.5.2 Piprant Class 108 5.
6 Corticosteroids 109 5.7 Cannabinoids 109 5.8 Local Anesthetics 110 5.8.1 Nocita 110 5.8.2 Systemic Toxicity 110 5.8.
3 Lidocaine as a CRI 111 5.9 Gabapeninoids 111 5.9.1 Gabapentin 111 5.9.2 Pregabalin 112 5.10 Alpha- 2 Agonists 112 5.10.
1 Xylazine, Medetomidine, Dexmedetomidine, Romifidine, Detomidine 112 5.10.2 Zenalpha® (Medeto.