Pain Management for Veterinary Technicians and Nurses

Cover
Title Page
Copyright Page
Contents
List of Contributors
Foreword
Acknowledgments
About the Companion Website
Chapter 1 Advancing Veterinary Pain Management into a New Era
	1.1 Introduction
	1.2 Brief History of Human Pain Management
	1.3 Veterinary Pain Management Through the Centuries
	1.4 Animal Research Contributions
	1.5 History of Animal Nursing Staff
		1.5.1 National Association of Veterinary Technicians in America Recognized Veterinary Technician Specialty Academies
	1.6 Eyewitness to 50 Years of Changes for Veterinary Technicians
	1.7 Veterinary Technician Pioneers in Pain Management
	1.8 Future Directions for Veterinary Technician Pain Management
	1.9 Conclusion
	References
Chapter 2 Careers in Animal Pain Management
	2.1 Introduction
	2.2 Pain Management Certifications Available for Veterinary Technicians/Nurses
		2.2.1 Certified Veterinary Pain Practitioner (CVPP)
		2.2.2 Veterinary Technician Specialist (Anesthesia and Analgesia), and Veterinary Technician Specialist (Laboratory Animal Medicine – Research Anesthetist)
		2.2.3 Veterinary Technician Specialist (Physical Rehabilitation)
		2.2.4 Surgical Research Anesthetist (SRA)
		2.2.5 The University of Tennessee Companion Animal Pain Management Certificate Program
		2.2.6 AAHA Pain Management Guidelines Certificate Course (AAHA Pain Management Champion)
		2.2.7 WSAVA Certificate in Pain Management
		2.2.8 Canine Rehabilitation Veterinary Technician Certifications
		2.2.9 Equine Rehabilitation Veterinary Technician Certifications
		2.2.10 Certified Equine Massage Therapist
		2.2.11 Animal Acupressure and Massage
		2.2.12 TCVM Veterinary Technician Programs Offered by the Chi Institute
		2.2.13 Animal Acupuncture
		2.2.14 Low-Stress Certifications
		2.2.15 Veterinary Anaesthesia and Analgesia (MSc), (PgDip), (PgCert), or (PgProfDev)
		2.2.16 Canine Arthritis Management Practitioner (CAMP)
		2.2.17 Certified Companion Animal Rehabilitation Therapist (CCAT)
	2.3 Leveraging Veterinary Technicians in Pain Management
	2.4 Conclusion
Chapter 3 Pain Physiology and Psychology
	3.1 Introduction
	3.2 What Is “Pain”
		3.2.1 The Negative Effects of Pain
	3.3 Breaking Down the Nociceptive Pathway
		3.3.1 Transduction
		3.3.2 Transmission
		3.3.3 Modulation
		3.3.4 Perception
		3.3.5 The Dorsal Horn
		3.3.6 Ventral Horn and Intermediate Zone
		3.3.7 White Matter
		3.3.8 Descending Pathways
		3.3.9 Spinothalamic Tract
		3.3.10 Spinoreticular Tract
		3.3.11 Peripheral Sensitization
		3.3.12 Central Sensitization
	3.4 The Endocannabinoid System and Pain
	3.5 The Gate Control Theory
	3.6 Psychological Aspects of Pain
		3.6.1 Personality and the Pain Experience
		3.6.2 Stress and Anxiety on Pain
		3.6.3 Pain Catastrophizing
		3.6.4 Boredom and Pain
		3.6.5 Neuroplasticity and the Memory of Pain
		3.6.6 Caregiver Placebo
	3.7 Types of Pain
		3.7.1 Somatic, Visceral, and Referred Pain
		3.7.2 Physiological/Adaptive/Acute Pain
		3.7.3 Pathological/Maladaptive/Chronic Pain
		3.7.4 Neuropathic Pain
		3.7.5 Radicular Pain
		3.7.6 Chronic/Persistent Postsurgical Pain
		3.7.7 Complex Regional Pain Syndrome
		3.7.8 Social Resilience and Pain
	3.8 The Microbiome and Pain Pathophysiology
		3.8.1 What Is a Microbiome?
		3.8.2 Determining “Healthy” in a Microbiome
		3.8.3 Gut Microbiome Imbalance or Dysbiosis
		3.8.4 The Gut-Brain Axis
		3.8.5 Microbial Derived Mediators
		3.8.6 Pathogen-Associated Molecular Patterns (PAMPs)
		3.8.7 Microbial-Derived Metabolites
		3.8.8 Neurotransmitters or Neuromodulators
		3.8.9 Endocannabinoid Axis
		3.8.10 Pain Medication and the Microbiome
	References
Chapter 4 Integrating Pain Recognition and Scoring in Companion, Equine, Food and Fiber Species, and Exotic/Lab Animal Species
	4.1 Introduction
	4.2 Pain Domains
		4.2.1 Pain Intensity and Affect
		4.2.2 Temporal Dimensions
		4.2.3 Location and Bodily Distribution of Pain
	4.3 Disposition and Personality
	4.4 Breed or Species Bias
	4.5 Dysphoria, Emergence Agitation, and Emergence Delirium
	4.6 Placebo, Caregiver Placebo, and Placebo-by-Proxy
	4.7 Non–species-specific Assessments
		4.7.1 Quantitative Sensory Testing (QST)
		4.7.2 Temporal Summation (TS)
		4.7.3 Nociceptive Withdrawal Reflex (NWR)
		4.7.4 Gait Analysis
		4.7.5 Pain Biomarkers
		4.7.6 Machine Learning and Artificial Intelligence (AI)
		4.7.7 Activity Monitors (AMs)
		4.7.8 Facial Expression or Grimace Scales
	4.8 Clinical Pain Scoring Tools (Canine and Feline)
		4.8.1 Canine Acute Pain Scoring
			4.8.1.1 Glasgow Composite Measure Pain Scale – Short and Long Forms (CMPS) (Validated)
			4.8.1.2 French Association for Animal Anesthesia and Analgesia Pain Scoring System (4A-Vet)(Validated)
			4.8.1.3 University of Melbourne Pain Scale (UMPS) (Validated)
		4.8.2 Canine Chronic Pain Scoring
			4.8.2.1 Canine Brief Pain Inventory (CBPI) (Validated)
			4.8.2.2 Helsinki Chronic Pain Index (HCPI) (Validated)
			4.8.2.3 Liverpool Osteoarthritis in Dogs (LOAD) (Validated)
		4.8.3 Feline Acute Pain Scoring
			4.8.3.1 Glasgow Composite Measure Pain Scale-Short-Form (CMPS-SF) (Validated)
			4.8.3.2 Feline Grimace Scale (FGS) (Validated)
		4.8.4 Feline Chronic Pain Scoring
			4.8.4.1 Client-specific Outcome Measures – Feline (CSOMf) (Validated)
			4.8.4.2 Montreal Instrument for Cat Arthritis Testing-caretaker (MI-CAT-(c)) (Validated)
			4.8.4.3 Feline Musculoskeletal Pain Index (FMPI) (Not Validated)
			4.8.4.4 Oral Pain Scale – Canine/Feline (COPS–C/F) (Validated)
			4.8.4.5 Cincinnati Orthopedic
			4.8.4.6 HHHHHMM Scale (Not Validated)
			4.8.4.7 VetMetrica™ Health-related Quality of Life (HRQoL) (Validated)
			4.8.4.8 Food and Fiber Species Pain Recognition and Scoring
	4.9 Bovids
		4.9.1 Indications of Pain in Cattle
	4.10 Small Ruminants and Camelids
	4.11 Swine
		4.11.1 Normal Behavioral Observations in Swine
	4.12 Equid Pain Recognition and Scoring
		4.12.1 Horses
			4.12.1.1 Appearance of the Normal Horse
			4.12.1.2 Somatic Pain Indicators
			4.12.1.3 Signs of Laminitis Pain Vary with the Progression of the Disease
			4.12.1.4 Visceral Pain Indicators
			4.12.1.5 Horse Grimace Scale
		4.12.2 Donkeys
	4.13 Exotic Species Pain Recognition and Scoring
		4.13.1 Birds
		4.13.2 Appearance of a Non-painful Bird
		4.13.3 Appearance of a Painful Bird
		4.13.4 Developing a Pain Score in Birds
	4.14 Reptiles
		4.14.1 Appearance of a Nonpainful Reptile
		4.14.2 Appearance of a Reptile in Pain
		4.14.3 Developing a Pain Score in Reptiles
	4.15 Amphibians and Fish
		4.15.1 Appearance of a Nonpainful Fish and Amphibian
		4.15.2 Appearance of a Painful Fish and Amphibian
		4.15.3 Developing a Pain Scoring Assessments in Fish and Amphibians
	4.16 Small Exotic Mammals
		4.16.1 Appearance of Nonpainful Small Exotic Mammals
		4.16.2 Appearance of Painful Small Exotic Mammals
		4.16.3 Developing a Pain Score in Small Exotic Mammals
	References
Chapter 5 Analgesia Pharmacology
	5.1 Introduction
	5.2 Definitions
	5.3 Analgesic Drugs
	5.4 Opioids
		5.4.1 Full Opioid Agonists
		5.4.2 Individual Drug Facts
			5.4.2.1 Morphine
			5.4.2.2 Meperidine (Pethidine)
			5.4.2.3 Methadone
			5.4.2.4 Hydromorphone
			5.4.2.5 Oxymorphone
			5.4.2.6 Fentanyl, Remifentanil, Sufentanil, Alfentanil, Carfentanil
			5.4.2.7 Fentanyl Patches
			5.4.2.8 Codeine
			5.4.2.9 Hydrocodone and Oxycodone
			5.4.2.10 Tramadol
			5.4.2.11 Tapentadol
		5.4.3 Partial Agonist Opioids
			5.4.3.1 Buprenorphine
			5.4.3.2 Simbadol
			5.4.3.3 Zorbium
			5.4.3.4 Sustained or Extended Release (SR or ER) Buprenorphine
			5.4.3.5 Buprenorphine Patches
		5.4.4 Agonist/Antagonist Opioids: Butorphanol and Nalbuphine
		5.4.5 Opioid Antagonists: Naloxone, Nalmefene, Naltrexone
		5.4.6 Mixing Opioids
	5.5 Non-steroidal Anti-inflammatory Drugs (NSAIDs)
		5.5.1 Washout
		5.5.2 Piprant Class
	5.6 Corticosteroids
	5.7 Cannabinoids
	5.8 Local Anesthetics
		5.8.1 Nocita
		5.8.2 Systemic Toxicity
		5.8.3 Lidocaine as a CRI
	5.9 Gabapeninoids
		5.9.1 Gabapentin
		5.9.2 Pregabalin
	5.10 Alpha-2 Agonists
		5.10.1 Xylazine, Medetomidine, Dexmedetomidine, Romifidine, Detomidine
		5.10.2 Zenalpha® (Medetomidine and Vatinoxan)
	5.11 N-Methyl-D-Aspartate (NMDA) Antagonists
		5.11.1 Ketamine and Tiletamine
		5.11.2 Precautions/Contraindications
		5.11.3 Amantadine and Memantine
	5.12 Neurokinin-1 Inhibitors
	5.13 Bisphosphonates
	5.14 Acetaminophen (Paracetamol)
	5.15 Frunevetmab (Solensia®) and Bedinvetmab (Librela®)
	5.16 Polysulfated Glycosaminoglycans (PSGAGs)
	5.17 Dipyrone (Metamizole)
	5.18 Tricyclic Antidepressants (TCAs), Selective Serotonin Reuptake Inhibitors (SSRIs), and Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)
	5.19 Acepromazine
	5.20 Trazodone
	References
Chapter 6 Regional Anesthesia and Local Blocks
	6.1 Introduction
	6.2 Current Drug Options for Regional Anesthesia and Nerve Blocks
		6.2.1 Mixing Local Anesthetics
		6.2.2 Adjunctive Agents
		6.2.3 Volume Expansion, Onset Time, and Buffering
		6.2.4 Maximum Recommended Dose (MRD)
		6.2.5 Equipment Selection
	6.3 Dental and Facial Regional/Local Anesthesia
	6.4 Dentistry and Facial Blocking Techniques
		6.4.1 Inferior (Caudal) Alveolar Nerve Block (Extraoral/Intraoral)
		6.4.2 Middle Mental Foramen Nerve Block
		6.4.3 Infraorbital Nerve Block
		6.4.4 Major Palatine Block: Small Animal
		6.4.5 Caudal Maxillary Block
		6.4.6 Auriculopalpebral Nerve Block: Motor Blockade of the Eyelid
		6.4.7 Retrobulbar Block
		6.4.8 Frontal Nerve (Supraorbital Foramen) Block
		6.4.9 Auriculotemporal Block + Greater Auricular Block
	6.5 Common Regional and Local Anesthetic Techniques: Less Specified
		6.5.1 Intraperitoneal Lavage Technique for Dogs and Cats
		6.5.2 Incisional Line Block
		6.5.3 Circumferential Block
	6.6 Regional and Local Blocks of the Thorax and Abdomen
		6.6.1 Intercostal Blocks
		6.6.2 Interpleural Block
		6.6.3 Intratesticular and Spermatic Cord Block
		6.6.4 Sacrococcygeal Block
		6.6.5 Epidural
		6.6.6 Spinal Anesthesia
		6.6.7 Epidural Catheter
		6.6.8 Erector Spinae Plane Block (ESP)
		6.6.9 Thoracic Paravertebral Block
		6.6.10 Transverus Abdominis Plane (TAP) Block
	6.7 Blocks of the Limbs
		6.7.1 Femoral-Saphenous Nerve Complex Block
		6.7.2 Sciatic Nerve Block
		6.7.3 Brachial Plexus Block
		6.7.4 Radial, Ulnar, Median, and Musculocutaneous (RUMM) Nerve Blocks
	6.8 Common Equine Techniques
		6.8.1 Local Analgesia for Horse Castration
		6.8.2 Caudal Epidural in the Horse
	6.9 Common Production Animal Techniques
		6.9.1 Analgesia for Castration
		6.9.2 Cornual Nerve Block
		6.9.3 Analgesia for Livestock Epidural
		6.9.4 Local Anesthetic Blocks for Exotics and Laboratory Animals
	References
Chapter 7 Analgesia for Acute Pain
	7.1 Introduction
	7.2 Fear, Anxiety, and Stress in the Acute Pain Response
	7.3 Multimodal Therapies
	7.4 Types of Acute Pain
		7.4.1 Surgical Pain
			7.4.1.1 Premedication
			7.4.1.2 Induction
			7.4.1.3 Maintenance
			7.4.1.4 Postoperative Analgesic Medications
			7.4.1.5 Pain Vacation
			7.4.1.6 Take-homeAnalgesics
	7.5 Creating an Effective Acute Pain Analgesic Plan
		7.5.1 Continuous Rate Infusions
	7.6 Analgesia Plans for Painful Procedures
		7.6.1 Reproductive Tract Surgery
			7.6.1.1 Premedication
			7.6.1.2 Regional Anesthesia
			7.6.1.3 Maintenance
			7.6.1.4 Postoperative Analgesic Plan
			7.6.1.5 Home Medications
		7.6.2 Analgesia for Surgery Involving the Eye
			7.6.2.1 Premedication
			7.6.2.2 Regional Anesthesia
			7.6.2.3 Maintenance
			7.6.2.4 Postoperative Analgesic Plan
			7.6.2.5 Home Medications
		7.6.3 Analgesia Techniques for Surgery Involving the Ear
			7.6.3.1 Premedication
			7.6.3.2 Regional Anesthesia
			7.6.3.3 Maintenance
			7.6.3.4 Postoperative Analgesic Plan
			7.6.3.5 Home Medications
		7.6.4 Gastrointestinal Procedures or Acute Abdominal Pain
			7.6.4.1 Premedication
			7.6.4.2 Maintenance
			7.6.4.3 Regional Anesthesia
			7.6.4.4 Postoperative Analgesic Plan
			7.6.4.5 Home Medications
		7.6.5 Thoracic Procedures
			7.6.5.1 Premedication
			7.6.5.2 Maintenance
			7.6.5.3 Regional Anesthesia
			7.6.5.4 Postoperative Analgesic Plan
			7.6.5.5 Home Medications
		7.6.6 Protocols for Patients with Cranial Disease, Injury, or Neurosurgery
			7.6.6.1 Premedication
			7.6.6.2 Maintenance
			7.6.6.3 Regional Anesthesia
			7.6.6.4 Postoperative Analgesic Plan
			7.6.6.5 Home Medications
		7.6.7 Analgesia Protocols for the Patient with Urinary Disease
			7.6.7.1 Premedication
			7.6.7.2 Regional Anesthesia
			7.6.7.3 Maintenance
			7.6.7.4 Postoperative Analgesic Plan
			7.6.7.5 Home Medications
		7.6.8 Minimally Invasive Procedures
			7.6.8.1 Premedication
			7.6.8.2 Regional Analgesia
			7.6.8.3 Maintenance
			7.6.8.4 Postoperative Analgesic Plan
			7.6.8.5 Home Medications
	7.7 Orthopedic Procedures
		7.7.1 Orthopedic Procedures of the Forelimb
			7.7.1.1 Premedication
			7.7.1.2 Maintenance
			7.7.1.3 Regional Anesthesia
			7.7.1.4 Postoperative Analgesic Plan
			7.7.1.5 Home Medications
		7.7.2 Hindlimb Amputation, Spinal Disease, Spinal Surgery, and Pelvic Fracture Repair
			7.7.2.1 Premedication
			7.7.2.2 Maintenance
			7.7.2.3 Regional Anesthesia
			7.7.2.4 Postoperative Analgesic Plan
			7.7.2.5 Home Medications
		7.7.3 Surgery of the Tail
		7.7.4 Mandibulectomy/Maxillectomy
			7.7.4.1 Inferior Alveolar (Mandibular) Blocks
			7.7.4.2 Maxillary Blocks
	7.8 Postoperative Patient Evaluation
	7.9 Management of Painful Dermatologic Conditions
		7.9.1 Sensory Perception in the Skin
		7.9.2 Recognizing Cutaneous Discomfort
		7.9.3 Painful and Pruritic Cutaneous Conditions
			7.9.3.1 Allergic Skin Disease
			7.9.3.2 Skin Infections
			7.9.3.3 Autoimmune and Immune-mediated Dermatopathies
			7.9.3.4 Cutaneous Burns
		7.9.4 Treatment of Cutaneous Pain and Pruritus
	7.10 Conclusion
	References
Chapter 8 Analgesia for the Pregnant, Neonatal, and Pediatric Patient
	8.1 Introduction
		8.1.1 Pain Management During Pregnancy
		8.1.2 Analgesic Drugs Used During Pregnancy and C-Sections
			8.1.2.1 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
			8.1.2.2 Opioids
			8.1.2.3 Alpha-2Agonists
			8.1.2.4 Dissociative Agents
			8.1.2.5 Local and Regional Blocks
	8.2 Postoperative Analgesia
	8.3 Anesthesia and Analgesia Case Management for a Cesarean Section
	8.4 Pain Management for Neonates and Pediatrics
		8.4.1 Insulting the Neonatal Pain Pathways
			8.4.1.1 NMDA Receptors
			8.4.1.2 Cutaneous Receptors
		8.4.2 Treatment of Pain in Neonatal and Pediatric Patients
			8.4.2.1 Opioids
			8.4.2.2 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
			8.4.2.3 Alpha-2Agonists
			8.4.2.4 Local and Regional Blocks
	References
Chapter 9 Analgesia in the Emergency and Critical Care Setting
	9.1 Introduction
	9.2 Treating Pain in the Emergency and Critical Care Veterinary Patient
	9.3 Evaluating Pain in ER and ICU Patients
	9.4 Nursing Care and the Role of Pain Management in Kirby’s Rule of 20
	9.5 Pain and the Physiological Stress Response: A Summary
	9.6 Sleep Deprivation
	9.7 Windup Pain in the ER
	9.8 Techniques and Nuances for Analgesic Delivery in the Emergency Room
		9.8.1 Pain Vacations (Acute Pain)
		9.8.2 Lidocaine Use in ECC
		9.8.3 Opioid Analgesia for Emergency and Critical Care Patients
		9.8.4 Local/Regional Analgesia in ECC
		9.8.5 NSAIDS
		9.8.6 Maropitant
		9.8.7 Physical Rehabilitation Methods in ECC
	9.9 Common Painful Conditions in the ER/ICU Setting
		9.9.1 Fractures
		9.9.2 Acute Soft Tissue Injuries
		9.9.3 Feline Lower Urinary Tract Obstruction
		9.9.4 Trauma Patients
		9.9.5 Abdominal Pain in ECC Patients
		9.9.6 Acute Swelling and Edema
	9.10 Conclusion
	References
Chapter 10 Chronic Pain Management for the Companion Animal
	10.1 Introduction
	10.2 The Complexity of Chronic Pain
	10.3 Neuropathic Pain
	10.4 Common Chronic Pain Conditions
		10.4.1 Chronic Joint Pain-Osteoarthritis (OA)
		10.4.2  Oncologic/Malignant Pain
		10.4.3 Chiari Malformation Pain
		10.4.4 Headaches and Migraines in Animals
		10.4.5 Meningitis
		10.4.6 Chronic Wounds
	10.5 Assessing Chronic Pain
	10.6 Goals and Modalities for Treating Chronic Pain
	10.7 Pharmacological Interventions
		10.7.1 Pain Vacation (Chronic Pain)
		10.7.2 Mesotherapy
		10.7.3 Transdermal Medications
		10.7.4 Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
		10.7.5 Acetaminophen
		10.7.6 Corticosteroids
		10.7.7 Opioids
		10.7.8 Atypical Opioids: Tramadol and Tapentadol
		10.7.9 Tricyclic Antidepressants (TCAs), Selective Serotonin Reuptake Inhibitors (SSRIs), and Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)
		10.7.10 Gabapentinoids: Gabapentin and Pregabalin
		10.7.11 N-Methyl-D-Aspartate Antagonists
		10.7.12 Neurokinin-1 Inhibitors
		10.7.13 Bisphosphonates
		10.7.14 Anti-NGF, Monoclonal Antibodies
		10.7.15 Nutraceuticals and Animal Health Supplements
	10.8 Lifestyle Modifications
		10.8.1 Weight Loss and Appropriate Nutrition
		10.8.2 Routine Exercise and Physical Therapy
		10.8.3 Thinking “Out of the Box” through Environment Modifications
	10.9 Conclusion
	References
Chapter 11 Analgesia for Shelter Medicine and Trap–Neuter–Return Programs
	11.1 Introduction
	11.2 Multimodal Analgesia
		11.2.1 Opioids
		11.2.2 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
		11.2.3 NMDA Antagonists
		11.2.4 Alpha-2 Adrenoceptor Agonists
		11.2.5 Local Anesthetics
		11.2.6 Adjunct Therapies
	11.3 HQHVSN and TNR Programs
	11.4 Rabbits
	11.5 Conclusion
	References
Chapter 12 Pain Management in Equids
	12.1 Introduction
	12.2 Pain Assessment in Horses
	12.3 Common Analgesics and Strategies in Horses
		12.3.1 Butorphanol
		12.3.2 Buprenorphine
		12.3.3 Meperidine
		12.3.4 Tramadol
		12.3.5 Pure Opioid Agonists
		12.3.6 Non-steroidal Anti-inflammatories
		12.3.7 NMDA Receptor Antagonists
		12.3.8 Alpha-2 Agonists
		12.3.9 N-butylscopolammonium Bromide (NBB)
		12.3.10 Dimethylsulfoxide (DMSO)
		12.3.11 Prokinetics and Antispasmodics
		12.3.12 Locoregional Anesthetics and Techniques
	12.4 Lidocaine Use in Horses
		12.4.1 Postoperative Period Lidocaine Use
	12.5 Common Painful Conditions and Procedures in Horses
		12.5.1 Surgical Pain
		12.5.2 Gastrointestinal (Colic and Ulcers) Pain
		12.5.3 Lameness
		12.5.4 Osteoarthritis
		12.5.5 Laminitis
		12.5.6 Pleuropneumonia
		12.5.7 Dystocia
	12.6 Analgesia in Foals
	12.7 Pain Management in the Donkey
		12.7.1 Common Painful Conditions
		12.7.2 Pain Scoring and Behaviors
		12.7.3 Anatomic and Physiologic Distinctions from the Horse
		12.7.4 Analgesics in Donkeys
	12.8 Nonpharmacologic Approaches to Pain
	12.9 Conclusion
	References
Chapter 13 Food and Fiber Species
	13.1 Introduction
	13.2 Cattle
		13.2.1 Bovine or Cattle Medications
			13.2.1.1 Opioids
			13.2.1.2 NSAIDS
			13.2.1.3 Alpha-2-AdrenergicAgonists
			13.2.1.4 NMDA Antagonists
		13.2.2 Regional Anesthesia and Analgesia
			13.2.2.1 Local Anesthetic Agents
			13.2.2.2 Intravenous Regional Anesthesia
			13.2.2.3 Teat Block
			13.2.2.4 Infusion of the Teat Cistern
			13.2.2.5 Epidural Analgesia
			13.2.2.6 Analgesia for Dehorning
			13.2.2.7 Spermatic Cord Block
		13.2.3 Analgesic Adjuvants
			13.2.3.1 Gabapentin
			13.2.3.2 Continuous Infusion Analgesia
		13.2.4 Withdrawal Period
	13.3 Sheep (Ovine) and Goat (Caprine) Medications
		13.3.1.1 Opioids
		13.3.1.2 NSAIDs
		13.3.1.3 Alpha-2-AdrenergicAgonists
		13.3.1.4 NMDA Antagonists
		13.3.2 Regional and Local Anesthesia
			13.3.2.1 Cornual Block
			13.3.2.2 The Inverted L-Blockor 7-Block
			13.3.2.3 Paravertebral Nerve Block
			13.3.2.4 Caudal Epidural
		13.3.3 Intravenous Regional Anesthesia
			13.3.3.1 Bier Block
			13.3.3.2 Intratesticular Block
			13.3.3.3 Continuous Rate Infusions
		13.3.4 Pain Management for Pigs (Swine)
			13.3.4.1 Opioids
			13.3.4.2 NSAIDs
			13.3.4.3 Alpha-2Adrenergic Agonists
			13.3.4.5 Lumbosacral Epidural Block
			13.3.4.6 Continuous Rate Infusions
	13.4 Pain Management for Camelids
		13.4.1 Camelid Medications
			13.4.1.1 Opioids
			13.4.1.2 NSAIDS
			13.4.1.3 Alpha-2Agonists
			13.4.1.4 Local Anesthetics
			13.4.1.5 NMDA Antagonists
			13.4.1.6 CRI Techniques
			13.4.1.7 Tramadol
			13.4.1.8 Gabapentin
	13.5 Conclusion
Chapter 14 Exotic Companion Animals
	14.1 Introduction
	14.2 Why Treat Pain?
	14.3 Rabbits
		14.3.1 Painful Behaviors: Rabbits
		14.3.2 Pain Scoring: Rabbits
		14.3.3 Nursing Care and Environmental Management: Rabbits
		14.3.4 Common Analgesics in Rabbits
	14.4 Rodents and Ferrets
		14.4.1 Mice
			14.4.1.1 Pain Scoring: Mice
		14.4.2 Rats and Ferrets
			14.4.2.1 Pain Scoring: Rats and Ferrets
		14.4.3 Gerbils
		14.4.4 Hamsters
		14.4.5 Guinea Pigs
			14.4.5.1 Pain Scoring: Gerbils, Hamsters, Guinea Pigs, and Ferrets
			14.4.5.2 Common Analgesics in Rodents
			14.4.5.3 Opioids
			14.4.5.4 NSAIDs
			14.4.5.5 Regional and Local Anesthesia
	14.5 Multimodal Analgesia: All Species
	14.6 Avian Analgesia
		14.6.1 Recognizing Relevant Behaviors for Each Species
		14.6.2 Avian Pain Scoring and Management
		14.6.3 Avian Drug Delivery
		14.6.4 Common Analgesics in Birds
			14.6.4.1 NSAIDS
			14.6.4.2 Opioids
			14.6.4.3 Regional and Local Analgesia
			14.6.4.4 Adjunctive Analgesics
	14.7 Reptile Analgesia
		14.7.1 Causes of Pain in Reptiles
		14.7.2 Analgesic Medications
			14.7.2.1 Opioids
			14.7.2.2 NSAIDs
			14.7.2.3 Local Anesthetics
			14.7.2.4 Adjunctive Analgesics in Reptiles
	14.8 Analgesia in Fish and Amphibians
		14.8.1 Fish and Amphibian Treatment Strategies
	14.9 Analgesia in Invertebrates
		14.9.1 Invertebrate Analgesia Strategies
	14.10 Conclusion
	References
Chapter 15 Analgesia in Zoo Animals
	15.1 Veterinary Technicians in a Zoological Setting
		15.1.1 Types of Questions to Ask Keepers Include
	15.2 Recognizing Pain in Non-domestic Animals
		15.2.1 Scoring Pain and Discomfort
	15.3 Treatment
	15.4 Medication Administration
	15.5 Adjunctive Therapies
	15.6 Choosing a Pain Regimen
	15.7 Taxon-specific Considerations
		15.7.1 Elephants
		15.7.2 Great Apes
		15.7.3 Old World and New World Non-human Primates (NHP)
		15.7.4 Exotic Ungulates
		15.7.5 Swine
		15.7.6 Wildlife
	15.8 Conclusion
	References
Chapter 16 Physical Rehabilitation
	16.1 Scope of Training for the Team
		16.1.1 Team Approach to Care
		16.1.2 Applications in Veterinary Medicine
	16.2 The Veterinary Technician and Physical Rehabilitation
		16.2.1 Common Conditions and Therapeutic Modalities
		16.2.2 General Wound Healing
		16.2.3 Bone
		16.2.4 Muscle
		16.2.5 Tendons and Ligaments
		16.2.6 Articular Cartilage
	16.3 Client Communication and Activity Modification
	16.4 Patient Assessment
		16.4.1 Veterinary Diagnosis – The Rehabilitation Team
		16.4.2 Objective Outcomes: Goniometry and Muscle Girth
		16.4.3 Pain and Disability Scoring – Methodology in Pain Scoring and Assessment
		16.4.4 The Musculoskeletal System
		16.4.5 Structural and Postural Evaluation
		16.4.6 Gait Analysis and Movement
		16.4.7 Lameness
		16.4.8 The Aging Patient
	16.5 Patient Management
		16.5.1 Assistive Devices: Mobility Wheelchairs, Harnesses, and Footwear
		16.5.2 Bracing, Splinting, and Prosthesis
		16.5.3 Kinesio Taping
		16.5.4 Environmental Modifications
	16.6 Therapeutic Modalities and Emerging Treatments
		16.6.1 Superficial Thermal Therapies
		16.6.2 Photobiomodulation (Therapeutic Laser)
		16.6.3 Electrical Stimulation
		16.6.4 Extracorporeal Shock Wave Therapy (ESWT)
		16.6.5 Therapeutic Ultrasound (ThUS)
		16.6.6 Electro-Magnetic Therapy
	16.7 Manual Therapy and Myofascial Trigger Points
		16.7.1 Myofascial Trigger Points
		16.7.2 Joint Mobilizations and Chiropractic
		16.7.3 Joint Range of Motion – Passive
		16.7.4 Therapeutic Massage
	16.8 Emerging Therapeutic Medical Interventions
		16.8.1 Regenerative Medicine and Biological Treatments
		16.8.2 Corticosteroids and Hyaluronic Acid
		16.8.3 Stem Cells
		16.8.4 Platelet Rich Plasma (PRP)
		16.8.5 Interleukin-1 Receptor Antagonist Protein (IRAP)
		16.8.6 Prolotherapy
		16.8.7 Emerging Technologies: Radiosynoviorthesis (Conversion Electron Therapy)
		16.8.8 Emerging Technologies: Viscoelastic Therapies – Injectable Hydrogel Microparticles and Polyacrylamide Gels
	16.9 Therapeutic Exercise and Aquatic Therapy
		16.9.1 Therapeutic Exercise Principles and Application
		16.9.2 Land Treadmills
		16.9.3 Hydrotherapy or Aquatic Therapy
			Appendix 16.A Obtaining Goniometric Measurements in the Canine Patient
			Appendix 16.B Limb Circumference
			Appendix 16.C Postural Compensations and Associated Medical Conditions
			Appendix 16.D Photobiomodulation Example Protocols Adapted from (Monici et al. 2019)
			Appendix 16.E Electrical Stimulation Example Protocols (Armitage 2019)
			Appendix 16.F Myofascial Trigger Point (MTrP) and Myofascial Pain Syndrome (MPS) Terminology
			Appendix 16.G Myofascial Trigger Point Examination Techniques
			Appendix 16.H Techniques Addressing Myofascial Trigger Points
			Appendix 16.I Joint Mobilizations
			Appendix 16.J Passive Range of Motion
			Appendix 16.K Therapeutic Massage Techniques
			Appendix 16.L Therapeutic Exercises for Early Rehabilitation
			Appendix 16.M Sample Guidelines
	References
Chapter 17 Nutrition and Integrative Medicine
	17.1 Nutrition – The 5th Vital Assessment
		17.1.1 Components of a Nutrition Assessment
		17.1.2 Nutrition Plan
		17.1.3 Complete and Balanced Nutrition
		17.1.4 Obesity’s Role in Inflammation and Pain
		17.1.5 Key Nutritional Factors
		17.1.6 Macronutrients and Micronutrients
		17.1.7 Antioxidants
		17.1.8 Nutrient-Focused Diets
	17.2 Microbiota Health
		17.2.1 Prebiotics
		17.2.2 Probiotics
		17.2.3 Fecal Microbial Transplant (FMT)
		17.2.4 Postbiotics
	17.3 Cannabinoid Medicine
		17.3.1 History of Cannabis
		17.3.2 Cannabis Potential in Veterinary Medicine
	17.4 The Endocannabinoid System (ECS) and Endocannabinoidome (eCBome)
		17.4.1 Primary Cannabinoid Receptors
		17.4.2 Endocannabinoids
		17.4.3 Retrograde Signaling
		17.4.4 Exogenous Cannabinoids
		17.4.5 Major Cannabinoids
		17.4.6 Minor Cannabinoids
		17.4.7 Terpenoids and Flavonoids
		17.4.8 Entourage Effect and Synergy
	17.5 Cannabinoid Role in Pain Management
		17.5.1 Acute Pain
		17.5.2 Chronic Pain
		17.5.3 G-Coupled Protein Receptors (GPR)
		17.5.4 Glycine Receptors (GlyR)
		17.5.5 N-Methyl-d-Aspartate (NMDA) Receptor
		17.5.6 Peroxisome Proliferator-activated Receptors (PPAR)
		17.5.7 Serotonin Receptors (5-HT)
		17.5.8 Transient Receptor Potential (TRP) Cation Channel Superfamily
		17.5.9 Opioids and Opioid Receptors (OPD1, OPK1, OPM1)
		17.5.10 Acetaminophen and the ECS
		17.5.11 Gabapentinoids
	17.6 Cannabis Safety and the Veterinary Technicians Role in Client Education
	17.7 Harm Reduction Education (HRE)
		17.7.1 THC Intoxication
		17.7.2 Cognitive Perception Modulation
		17.7.3 Product Guidance
		17.7.4 Dosing
		17.7.5 Monitoring
	17.8 Acupuncture
	17.9 Supplements for Pain Management
		17.9.1 Omega-3 Fatty Acids
		17.9.2 Palmitoylethanolamide (PEA)
		17.9.3 Turmeric (Curcumin)
		17.9.4 Glucosamine/Chondroitin and Undenatured Collagen-based Supplements
		17.9.5 Kratum
		17.9.6 Magnesium
		17.9.7 Green Lipped Mussel Extract
		17.9.8 Passion Fruit Peel Extract
		17.9.9 Avocado/Soybean Unsaponifiables (ASU)
		17.9.10 Yucca Schidigera
		17.9.11 Melatonin
	17.10 Conclusion
	References
Chapter 18 Pain Management for End-of-Life Care
	18.1 Hospice and Palliative Care
		18.1.1 Veterinary Staff in the Hospice and Palliative Care Environment
		18.1.2 Work Areas
	18.2 Technicians’ Roles in a Hospice and Palliative Care Practice
		18.2.1 Patient Presentation and Evaluation
		18.2.2 Planning of Care
		18.2.3 Delivery of Care
		18.2.4 Caregiver Education and Training
		18.2.5 Setting Up the Physical Environment
		18.2.6 Social Environment
		18.2.7 Support for the Family
		18.2.8 Pain Recognition and Management
			18.2.8.1 Neoplasia
			18.2.8.2 Osteoarthritis
			18.2.8.3 Analgesia for Specific Procedures and Special Problems
		18.2.9 Advocacy
	18.3 Euthanasia and Analgesia for the Dying Patient
		18.3.1 Euthanasia
		18.3.2 Natural Death
		18.3.3 Pain Management for the Dying Animal
	18.4 Support for the Family of the Dying Patient
	18.5 Conclusion
	References
Chapter 19 Selected Case Studies in Analgesia
Index
EULA