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Summary

Background

Effective pain management is increasingly important to veterinarians across Europe as a growing body of knowledge on the efficacy of coxibs and other therapies becomes available and clients increasingly expect the same level of service in animal health as they encounter in human medicine. This was the message underlying the 6th European Pain Management Symposium in Albufiera, Portugal, on April 13-15, 2010, with new research and insights in the areas of chronic pain, acute pain and oncology forming centrepiece presentations at the event. Over 100 veterinarians from 11 countries across Europe and beyond were addressed by 18 experts in fields such as osteoarthritis, surgery, oncology and ophthalmology. The symposium was also the occasion of the fifth anniversary of the launch of Previcox (firocoxib), the highly-selective Cox-2 inhibitor introduced to the market by Merial in 2005.

Chronic Pain

Osteoarthritis in Dogs

Osteoarthritis (OA) in dogs was a particular focus on day one of the event and, in his presentation, Dr Denis Marcellin-Little, North Carolina State University, USA, addressed some key misconceptions pervasive around the disease. He explained that owners frequently construe OA to be the result of wear and tear of joint surfaces rather than as a result of its true causes, which are orthopaedic diseases that occur at the developmental stage of a dog's life. He further explained that the role of veterinary management must include a high level of owner education on how to manage the condition. The administration of a non-steroidal anti-inflammatory (NSAID) treatment was also cornerstone of OA pain management, he explained, particularly during flare-ups of the condition.

Pain Measurement

Samantha Lindley, University of Glasgow, UK, addressed the difficulty of measuring pain given that, unlike humans, animals cannot directly tell us what they are feeling and may mask pain from their owners. With a strong behaviourist background, Samantha explained that veterinarians needed to take a number of factors into account and, in particular, to distinguish between 'pain' and 'suffering'. Employing a nautical analogy, she explained how 'triangulation' of information can help veterinarians in this process. There are three bearings to be taken into account in this process: firstly, the presenting complaint or sign which has brought the animal to the examination room; secondly, behavioural changes in the individual animal, which may also be due to external circumstances, unrelated to the pain; and, thirdly, the information taken by the veterinarian through examination and study of the animal's gait and/or general movement. She concurred with Dr Marcellin-Little on the value of a treatment programme that combined owner education and common sense, with the appropriate use of NSAIDS.

Acute Pain

Dental Pain Management

Data on the effectiveness of firocoxib and its role in acute pain and dental pain management were central to a series of presentations by Dr Joseph Rosentel, Director, Pharmaceutical Projects, Merial, who presented results from the Previcox experience trial (PET), the largest post-approval field study of a canine NSAID ever conducted. The study, which involved over 100 veterinarians and1,000 dogs, concluded that 93% of dogs completing the study showed improvement as assessed by veterinarians when treated with firocoxib, with 86% of owners described their dogs as 'happier' or 'more active'.

Surgical Pain

Managing surgical pain through a multi-modal approach was the subject addressed by Derek Flaherty, University of Glasgow, UK, who explained that, by utilising a variety of drugs, such as opioids, NSAIDs and local anaesthetics, veterinarians can achieve analgesia with lower doses of each, and also limit side-effects.

Veterinary Ophthalmology

In his presentation on 'the use of NSAIDS and coxibs in veterinary opthalmology' Thomas Dulaurent, Veterinary Hospital, Saint Martin, France, explained that NSAIDs should be considered by veterinary opthalmologists for the management of daily clinical situations. He pointed to recent research studies that have demonstrated the specific benefits of coxibs in challenging ophthalmology situations.

Veterinary Oncology

A presentation by Enrique Grau Bassas, Faculty of Veterinary Medicine, Gran Canaria, Spain, focused on the 'use of firocoxib in peri- and postoperative pain management with focus on surgical oncology'. Enrique considered changing attitudes to the use of NSAIDS in peri-operative analgesia, explaining how the availability of highly specific Cox-2 inhibitors opened the possibility of using NSAIDs for surgical patients.

The growing body of knowledge on the use of coxibs in veterinary oncology was the focus of a number of speakers, including François Serres, Veterinary School of Alfort, France, whose presentation 'Cox inhibitors as a part of cancer treatment in clinical oncology' considered a number of possible multimodal treatments including a combination of Cox-2 inhibitors and anti-neoplastic chemotherapy. Central to their success was the growing evidence that the activity of these anti-neoplastic agents could be complementary, he explained.

Felisbina Queiroga, university of Trás-os-Montes and Alto Douro, Portugal, meanwhile, drew from research in the area of human health to highlight a small but growing number of studies on dogs indicated that Cox-2 expression might be a useful tool for estimating the progress of canine malignant melanomas.

Merial Pain Management Award: 2009 Winner

The symposium also saw the announcement of Sara Capelli, Vicenza, Italy as the winner of the 2009 Merial European Pain Management Award. Sara was called on to make a presentation of her winning paper 'Intrathecal anaesthesia in two dogs undergoing thoracolumbar vertebral fixation' and was presented with a prize of €3,000 at the event. Applications are invited for the 2010 pain management award, to be received by December 13th, 2010. Further details from Ms Agnes Vidal, Merial's European marketing director for pet animal and equine pharmaceutical products:

Conclusion

Concluding the event, Jean-Christophe Thibault, Technical Services Director with Merial, commented that it confirmed the speed at which the field of pain management has evolved in the five years since Previcox was launched and the value of Merial's Pain Management Symposiums as the most important source of new information on this area for European veterinarians in the years ahead.