Last night I attended another AAEP Round Table discussion – “Equine Pain Management: Hospital Patient vs Performance Horse.” The 2 speakers were very informed as both were trained anesthesiologists. One works at Colorado State vet school and the other lives in KY and works the show circuit in CA and MI.

What I found most interesting was the abundance of pain relieving drugs available to be used on horses and the extremely little data gleaned from research for their use in horses. It was ALL anecdotal! They would say things like, “This may not work in all horses the same way,” or “Yes I have tried using that in this manner with fairly good results.” As with all horse research, there is no money to incentivize research in pain medication, nutrition or just about anything else in horses. We, as a group, are being cast aside.

An interesting side note here is that I talked with a client of mine yesterday who has financed the development of a better way to test for insulin in horses. He did this because his horse had been lost to laminitis and their vet knew a vet who wanted to do this research. He promised to send me the link to their work but I have not received it yet.

Back to pain medications. The “gold standard” for these two for field use are bute and Banamine. For hospital use they like hydrocodone. They both like Torbugesic but insist we all don’t administer enough to be fully effective. For dentistry, my dose which is up to 1/5 the recommended dose works well for the oral cavity. They also like giving it subcutaneously (SQ) which is off label use.

I was made aware of an alternative to reserpine for a relaxing type drug. Reserpine given by injection has serious side effects (colic and diarrhea) and orally is often ineffective. Trazadone, they say, appears to work well in severe anxiety situations and is given orally. This is a human drug that veterinarians have started to use with apparently no side effects.

Another recent favorite pain medication used at the hospital is good old Tylenol. They are using this alone or in combination with bute. They say the liver damage studies in humans are over rated and apply only with chronic overdosing. Again, no studies with horses.

The field vet uses acupuncture, cold laser (especially red), homeopathic medicines, shock wave and massage for pain relief. She was very aware of the rules regarding withdrawal times in USEF and FEI and some were different for the same medication or treatment modalities.

Last note – the field vet uses Ulcer Guard at a partial dose when giving bute, Banamine and other NSAID’s while the hospital vet says that decision is not in her department. The hospital vet also said, as an anesthesiologist, she “loves using drugs, drugs, drugs!” While her population are horses in severe pain and/or anxiety, this comment comes from a question about using sedation in horses for procedures. And she is teaching the students who will soon be working on YOUR horses.

Did I learn anything here that would alter what I do in this practice? No not really. I was disappointed that they did not discuss the different effects of medications on different parts of the body. For instance these two vets love detomidine (Dormosedan) as a sedative and described its use in different ways but they never discussed Dorm’s lower effectiveness in pain prevention in the oral mucosa (and the whole digestive tract) while the similar drug xylazine (Rompun) has potent pain killing properties there in addition to sedation. This subtlety is very important in drug selection for use in horses.