44 research outputs found

    diagnosis of pain in small companion animals

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    It is now widely accepted that animals are able to experience pain in a similar way to humans. Acute and/or chronic pain is associated not only with many surgical procedures, but also with various medical diseases, where pain may increase morbidity and mortality. Moreover, some types of pain (e.g., neuropathic pain) can be considered as an illness in themselves. Recognizing pain and assessing its intensity are both essential for its effective management: If pain is not recognised, then it is unlikely to be treated. Two major problems account for the difficulties in pain diagnosis in veterinary patients: (1) animals are not able to verbalise and cannot refer to the state of pain they are experiencing and (2) almost all animal species tend instinctively to mask signs of pain and weakness. Therefore, pain recognition in a diseased animal may be challenging. However, practitioners can rely on different strategies, which can be put in place to reveal the presence of pain in their patients. A presumptive diagnosis, a clinical exam, the evaluation of psychomotor changes and pain expressions, the attribution of pain scores and the response to therapy are all tools which, especially when used in combination, can help the veterinary practitioner recognise a subject suffering from pain and allow a correct approach to therapy. This review summarizes the current available information regarding the methodology that could be applied in small companion animals for a correct diagnosis of pain, offering veterinarians with some "easy to use" tools to apply in their daily practice

    Pain and Suffering in Invertebrates: An Insight on Cephalopods

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    Invertebrates are a broad group of animals that includes more than 90% of the estimated 10 million species in the world. Some species are abundantly used by man in scientific research and for human consumption. However, the current legislation is still very lacking about the protection toward conditions of pain, suffering, distress or lasting harm that these animals may suffer as a result of experimental practices, fishing and cooking. The purpose of this paper is to summarize what has already been stated by other Authors regarding the possibility that invertebrates (with a specific emphasis on cephalopods) can experience pain and suffering. The results of studies that show the existence, in these animals, of a number of elements that can be associated with the ability to feel pain and not only nociception are highlighted. Objective indicators (such as changes in physiological parameters) and behavioral attitudes of cephalopods that might be related to pain will be addressed as well

    medical abdominal visceral pain in dogs

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    Abdominal visceral pain of medical origin is one of the most frequent reasons for request of medical treatment in humans. Its control is of paramount importance not only for ethical reasons, but also because, if untreated, pain can cause a stress response leading to alterations concerning many organs and apparatuses. Causes of acute or chronic medical visceral pain in men are numerous, with pain originating from various regions of the body. Considering the similarities with regard to the nervous system between humans and other mammals, it is very likely that pathological conditions that cause visceral pain in men are painful in animals as well. Despite this, in veterinary practice medical visceral pain is rarely considered and poorly treated, often for the difficulty in its identification and for a lack of specific guidelines addressing this specific topic. Moreover, no detailed and specific information on this subject are available in the current literature. The present review lists the main pathologies likely responsible of medical abdominal visceral pain in the canine species, trying to summarize, for each considered condition, the available information regarding the pathogenesis and the management of pain

    Pharmacokinetics of cannabidiol following single oral and oral transmucosal administration in dogs

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    IntroductionIn the last few years, different formulations containing cannabidiol (CBD) were tested with regard to its efficacy on chronic pain, refractory epilepsy, anxiety, aggressive behavior and atopic dermatitis in dogs. CBD is generally administered orally, but its low bioavailability, probably due to a first-pass metabolism, represents a great limitation. The aim of this study was to evaluate if CBD bioavailability increases after oral transmucosal administration (OTM) compared to oral treatment.MethodsTwelve dogs diagnosed with mild chronic pain were enrolled in the study and treated once orally or OTM (6 dogs/group) with a pure CBD in oil formulation at a dosing rate of 1 mg/kg b.w. At prefixed time points, blood samples were collected to define CBD plasma concentrations vs. time profiles, and the main pharmacokinetics parameters were obtained by non-compartmental model.ResultsCBD Cmax, Tmax, terminal half-life and AUC0 − t were 206.77 ± 167 and 200.33 ± 158.33 ng/mL, 2.17 ± 0.98 and 1.92 ± 1.11 h, 2.67 ± 0.53 and 2.62 ± 0.64 h, 647.51 ± 453.17, and 536.05 ± 370.21 h*ng/mL, following oral and OTM administration, respectively. No significant difference in pharmacokinetic parameters were observed between treatments.DiscussionThe OTM administration did not increase cannabidiol bioavailability compared to oral treatment. The almost perfectly superimposable mean plasma concentrations of cannabidiol following the two treatments suggests that CBD is not able to be adsorbed by the oral mucosa or that its absorption is very scarce, and that CBD is swallowed and absorbed in the gastrointestinal tract

    Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia

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    <p>Abstract</p> <p>Background</p> <p>One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.</p> <p>Methods/Design</p> <p>The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome.</p> <p>Discussion</p> <p>The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00395915</p

    Cystic Fibrosis

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    Cystic fibrosis (CF) is an inherited disorder that causes severe damage to the lungs, digestive system, and other organs in the body. It causes the cells that produce mucus, sweat, and digestive enzymes to produce thick secretions. Short-acting anesthetics are recommended to allow a rapid recovery in CF patients; propofol and sevoflurane used at low dosages are the most rational agents to use for the induction of anesthesia. Anesthesia management needs to strictly respect the possibility to apply a regional anesthesia technique whenever feasible. When general anesthesia is required, it is necessary to use a grading, proportional to the severity of the CF disease and to the risk of surgery, from noninvasive to invasive hemodynamic monitoring. Postoperative intensive care unit admission depends on the respiratory reserve and on the presence of pulmonary hypertension. Postoperative pain relief with a multimodal analgesia is mandatory, as is chest physiotherapy, which has to be performed as soon as possible to keep out all the sticky secretions to avoid pulmonary infections. When medical treatment fails, patients with CF can nowadays be submitted to lung transplantation. These procedures improve the quality of life of CF patients and make their average life longer

    Psychometric Testing and Validation of the Italian Version of the Helsinki Chronic Pain Index (I-HCPI) in Dogs with Pain Related to Osteoarthritis

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    Pain assessment is of paramount importance for properly managing dogs with osteoarthritis (OA) pain. The aim of the present study was to develop and psychometrically validate the Italian version of the Helsinki Chronic Pain Index (I-HCPI). Owners of OA painful (n = 87) and healthy dogs (n = 40) were administered the I-HCPI once or twice after an eight-week meloxicam treatment. Sixty-nine owners of healthy and OA dogs also completed the Italian version of the Canine Brief Pain Inventory (I-CBPI). Pain on palpation on a 0–4 scale was assessed on all recruited dogs. Construct validity was tested both with hypothesis testing and principal component analysis, confirming the I-HCPI accurately measured chronic pain. Good convergent and criterion validity were shown through correlations with I-CBPI subscores and distribution among pain on palpation scores (p < 0.0001). The significant difference between the pre- and post-treatment I-HCPI scores (p < 0.0001) and Cohen’s effect size (2.27) indicated excellent responsiveness. The I-HCPI was shown to be reliable through communalities (range 0.47–0.90) and Cronbach α (≥0.95). Discriminative ability and cut-off point, as tested through Receiver Operating Characteristic analysis, showed excellent diagnostic accuracy with a threshold value of 11 (specificity 0.98 and sensitivity 0.94). The I-HCPI was confirmed to be a valid, sensitive, reliable, and accurate tool to discriminate between dogs with and without pain

    Pharmacokinetics of tramadol and its metabolite M1 following intravenous administration in sheep

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    Sheep are widely used for invasive biomedical research, but there are limited data surrounding administration of analgesic drugs to sheep. The aim of this study was to investigate the pharmacokinetics of tramadol and its metabolite M1 in sheep. Six healthy adult sheep were administered 4 (T4) and 6 mg kg-1 (T6) tramadol intravenously in a cross over design with a 2 week wash-out period between doses. Blood samples were collected at specific time points up to 24 hours after administration. Analytical determination of tramadol in plasma was performed as described by Giorgi et al. (2009). Pharmacokinetic analysis fitted a two-compartmental (tramadol) and a non-compartmental (M1) model. At the first time point, five minutes after T4 and T6 administration, tramadol concentrations were 1.29\ub10.17 and 1.56\ub10.10 \ub5g ml-1 respectively; plasma levels decreased very quickly in T4 and T6, and were below the limit of quantification 6 hours after administration. Mean elimination half-life was 0.67\ub10.42 and 0.57\ub10.12 hours for T4 and T6 respectively. M1 time to maximum plasma concentration was 0.37\ub10.33 and 0.40\ub10.27 hours and maximum plasma concentration was 0.14\ub10.02 and 0.16\ub10.04 \ub5g ml-1 for T4 and T6 respectively; M1 was detectable up to 4 hours post-administration in all animals. IV administration of T4 and T6 in sheep was associated with a rapid metabolism and short lasting presence of M1 in plasma. Further studies are warranted to assess the analgesic efficacy of tramadol in this species
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