Quantitative sensory testing in canine musculoskeletal pain: Findings from a systematic review, meta-analysis feasibility assessment, and limitations.

Quantitative sensory testing (QST) allows the study of pain mechanisms, patient phenotyping, and response to therapy. The goals of this study were to conduct a systematic review of the use of QST in dogs with musculoskeletal disease including osteoarthritis (OA), and to assess, by means of a meta-analysis, the ability of QST to differentiate affected dogs from healthy controls. The study protocol was registered; three bibliographic databases were screened. Studies involving QST in healthy dogs and those with musculoskeletal disease were included. Data were extracted using a standardized form. Assessment of quality and risk of bias were performed using the CAMARADES critical assessment tool. Twenty-nine articles met the inclusion criteria [systematic review (n = 11); meta-analysis (n = 28)]. In the systematic review, ten studies performed static QST: mechanical [punctate tactile (n = 6); mechanical pressure (n = 5)]; thermal [cold (n = 3); hot (n = 4)]; electrical (n = 1); and one study performed dynamic QST [conditioned pain modulation (n = 1)]. Most studies were of good scientific quality and showed low to moderate risk of bias. A meta-analysis was not possible due to numerous and severe issues of heterogeneity of data among studies. Methods to reduce risk of bias and use of reporting guidelines are some of the most needed improvements in QST research in dogs. Standardization of QST methodology is urgently needed in future studies to allow for data synthesis and a clear understanding of the sensory phenotype of dogs with and without chronic pain including OA.

Do owner-reported changes in mobility reflect measures of activity, pain and degenerative joint disease in cats?

OBJECTIVES: The aim of this blinded, nested case-control study was to compare cats with and without early owner-reported mobility changes using subjective and objective outcome measures (owner-completed questionnaires, orthopaedic examination). METHODS: A total of 57 cats with and without early owner-reported signs of impaired mobility were allocated to the case (n = 30) and control (n = 27) groups, respectively. Participating owners completed one inclusion and two pre-visit questionnaires (Feline Musculoskeletal Pain Index, VetMetrica). Cats were then visited in their own homes, where they underwent an orthopaedic examination, an assessment of their body condition score and temperament, and the placement of an accelerometer on their collar for 2 weeks. RESULTS: There was no significant difference between groups for age category, breed, sex, temperament and body condition score. Case cats scored significantly lower for the Feline Musculoskeletal Pain Index (P = 0.003) and the VetMetrica domain of Comfort (P = 0.002), but not Vitality (P = 0.009) or Emotional Wellbeing (P = 0.018). Total pain (P <0.0001), crepitus (P = 0.002) and thickening (P = 0.003) scores were higher in case cats, as was the presence of bilateral disease (P = 0.005, odds ratio 14) and the number of bilaterally affected joints (P = 0.001). CONCLUSIONS AND RELEVANCE: Both the Feline Musculoskeletal Pain Index and orthopaedic examination were able to differentiate cats with early owner-reported signs of impaired mobility from healthy cats. VetMetrica Comfort domain scores indicated a compromised quality of life for cats with early owner-reported signs of impaired mobility compared with healthy cats. Being able to recognise signs of mobility impairment earlier would allow interventions aimed at slowing disease progression, thereby improving feline health and welfare.

Prevalence of Work-Related Musculoskeletal Symptoms in Veterinary Surgeons-A Cross-Sectional Survey.

OBJECTIVES: The aim of this study was to determine the prevalence of work-related musculoskeletal symptoms (MSS) in veterinary surgeons using an online survey. STUDY DESIGN: An online survey was distributed to 1,031 diplomates of American College of Veterinary Surgeons. Responses were collected with data regarding surgical activities, experience with various types of MSS in 10 different body sites and attempts to reduce MSS. RESULTS: Two hundred and twelve respondents (21% response rate) completed the distributed survey in 2021. Ninety-three per cent of respondents had experienced MSS associated with surgery in at least one body part, with the neck, lower back and upper back frequently affected. Musculoskeletal discomfort and pain worsened with prolonged surgical hours. Forty-two per cent of them suffered from chronic pain persisting longer than 24 hours after surgeries. Musculoskeletal discomfort was common regardless of practice emphasis and procedure types. Forty-nine per cent of respondents with musculoskeletal pain had taken medication, 34% sought physical therapy for MSS and 38% ignored the symptoms. Over 85% of respondents showed more than some concern regarding career longevity due to musculoskeletal pain. CLINICAL SIGNIFICANCE: Work-related MSS are common in veterinary surgeons, and the results of this study warrant longitudinal clinical studies to determine risk factors and attention to workplace ergonomics in veterinary surgery.

Locking Compression Plate Fixation of Feline Acetabular Fractures: Application, Complications and Perioperative Outcome.

OBJECTIVES: The aim of this study was to report the use, complications and perioperative outcome of locking compression plates (LCP) for acetabular fracture fixation in feline patients. STUDY DESIGN: Medical records were reviewed for cats presented with acetabular fractures between 2011 and 2019. Only cases that involved open reduction and internal fixation with at least one LCP and had a minimum of 5-week postoperative follow-up were included. Long-term follow-up was based on the Feline Musculoskeletal Pain Index. RESULTS: Fifteen cats with 15 acetabular fractures met the inclusion criteria. Locking compression plates were used as a sole method of fixation in 11/15 cases, while with other ancillary implants in 4/15 cases. There were two minor complications related to the LCP consisting of a single screw backing out. Two major perioperative complications not related to the locking implants were described and required further surgical treatment. At the last clinical follow-up (median 46 days: 38-88 days), function was described as full for 7/15 cats, and acceptable for 8/15 cats. The Feline Musculoskeletal Pain Index questionnaire was completed by 9/15 owners at a median of 2,332 days; all owners reported their cats had minimal impairment. CLINICAL SIGNIFICANCE: Based on our results, LCP is a suitable implant for acetabular fracture fixation in cats, associated with a satisfactory outcome. Complications were similar to previously reported with other methods.

Conservative nonsurgical treatment for cranial cruciate ligament disease can be an effective management strategy in cats based on validated owner-based subjective assessment in some cases.

OBJECTIVE: To describe long-term outcomes of cats managed medically for cranial cruciate ligament disease (CCLD) via a validated owner-based questionnaire. ANIMALS: 18 client-owned cats. PROCEDURES: Retrospective review of medical records at 2 tertiary referral hospitals was conducted for records of cats diagnosed with CCLD for which medical management was pursued. History, physical examination findings, and medical management strategies were recorded. Owner follow-up was obtained via phone call or an email correspondence interview using a 2-part questionnaire. Part 1 consisted of 5 multiple-choice questions evaluating short-term outcomes following initiation of medical management. Part 2 assessed long-term outcomes via the validated Feline Musculoskeletal Pain Index-short form metrology instrument. RESULTS: Mean follow-up time was 66.5 ± 46.7 months (range, 7 to 154 months). Medical management included oral analgesics, activity restriction, and joint supplements. Of the 18 cats, 13 (72%) were always able to bear weight or became weight bearing within a week following initiation of medical management, and 15 (83%) were reportedly clinically normal within 3 months of initiating medical management, with complete resolution of lameness occurring in less than 2 months in 12 of those cats. Long term, 17 of the 18 (94%) owners reported they felt that their cat had a good to excellent outcome with medical management. The mean Feline Musculoskeletal Pain Index-short form score of all cats was 0.29 ± 0.53 (range, 0 to 2.13). CLINICAL RELEVANCE: Based on owner follow-up, conservative, nonsurgical management of CCLD can be an effective and appropriate management strategy for some cats; however, some may be best treated with surgical stabilization.

Multiple session mesotherapy for management of coxofemoral osteoarthritis pain in 10 working dogs: A case series.

The aim of this study was to document the effects of mesotherapy in working dogs diagnosed with hip osteoarthritis (OA) and related pain. Ten police working dogs with hip OA and related pain were treated with a combination of lidocaine, piroxicam, and thiocolchicoside, injected in multiple intradermal points. Seven treatment sessions were conducted. The Canine Brief Pain Inventory (CBPI) and the Hudson Visual Analogue Scale (HVAS) were used in the assessment of response to treatment compared to evaluation before treatment (T0), after 15 d, 30 d, 60 d, 90 d, 120 d, 150 d, and 180 d after initial treatment. Results were compared using the Wilcoxon signed-rank test. Significant differences were experienced in CBPI scores comparing moments with T0: at 15 d (P = 0.03 for Pain Interference Score - PIS) and P = 0.02 for Pain Severity Score - PSS), 30 d (P < 0.05 for PIS and P < 0.05 for PSS), 60 d (P = 0.04 for PIS and P = 0.01 for PSS) and 180 d (P = 0.04 for PSS). Individual treatment results were considered successful in 40% of animals at 15 d and 30 d, 66.7% at 60 d, 44% at 90 d, 37.5% at 120 d, and 25% at 150 d. The HVAS scores showed no significant differences. Mesotherapy may be an option for the treatment of canine musculoskeletal-related pain. Further studies are required.

Mésothérapie en plusieurs séances pour la prise en charge de la douleur arthrosique coxofémorale chez 10 chiens de travail : une série de cas. Le but de cette étude était de documenter les effets de la mésothérapie chez les chiens de travail diagnostiqués avec une arthrose de la hanche (OA) et des douleurs associées. Dix chiens de travail policiers souffrant d'OA et de douleurs associées ont été traités avec une combinaison de lidocaïne, de piroxicam et de thiocolchicoside, injectée en plusieurs points intradermiques. Sept séances de traitement ont été réalisées. Le Canine Brief Pain Inventory (CBPI) et l'échelle visuelle analogique de Hudson (HVAS) ont été utilisés dans l'évaluation de la réponse au traitement par rapport à l'évaluation avant traitement (T0), après 15 j, 30 j, 60 j, 90 j, 120 j, 150 j et 180 j après le traitement initial. Les résultats ont été comparés à l'aide du test des rangs signés de Wilcoxon. Des différences significatives ont été observées dans les scores CBPI comparant les moments avec T0 : à 15 jours (P = 0,03 pour Pain Interference Score ­ PIS) et P = 0,02 pour Pain Severity Score ­ PSS), 30 jours (P < 0,05 pour PIS et P < 0,05 pour PSS), 60 jours (P = 0,04 pour PIS et P = 0,01 pour PSS) et 180 jours (P = 0,04 pour PSS). Les résultats du traitement individuel ont été considérés comme réussis chez 40 % des animaux à 15 jours et 30 jours, 66,7 % à 60 jours, 44 % à 90 jours, 37,5 % à 120 jours et 25 % à 150 jours. Les scores HVAS n'ont montré aucune différence significative. La mésothérapie peut être une option pour le traitement des douleurs musculosquelettiques canines. Des études complémentaires sont nécessaires.(Traduit par Dr Serge Messier).

Evaluation of a nutritional supplement for the alleviation of pain associated with feline degenerative joint disease: a prospective, randomized, stratified, double-blind, placebo-controlled clinical trial.

OBJECTIVES: The purpose of this study was to evaluate the pain-alleviating and activity-enhancing effects of glucosamine/chondroitin sulfate (Dasuquin) in cats that had degenerative joint disease (DJD) and owner-noted mobility/activity impairment. We hypothesized that the nutritional supplement would produce pain-relieving and activity-enhancing effects in cats with painful DJD. METHODS: In this prospective, randomized, stratified, double-blind, placebo-controlled clinical trial, 59 cats with DJD pain were assigned to receive a placebo (n = 30) or supplement (n = 29) for 6 weeks after 2 weeks of placebo. Outcome measures (at-home accelerometry and client-specific outcome measures [feline (CSOMf); Feline Musculoskeletal Pain Index (FMPI); quality of life (QoL)]; and veterinarian examination) were collected at days 14, 28, 42 and 56. RESULTS: Twenty-seven cats in the treatment group and 30 in the placebo group completed the trial. Within the first 2 weeks (placebo administration to all cats), 78% of all cats had an improvement in CSOMf scores. Both groups showed significant improvement at most time points in CSOMf, FMPI, QoL and pain scores, with the placebo group showing greater improvement than the supplement group (significant for CSOMf [P = 0.01]). Overall, no differences in activity were seen between the groups. Cumulative distribution function analysis indicated that for most levels of activity, the placebo-treated cats were more active; however, the least active cats were more active on the supplement (P = 0.013). CONCLUSIONS AND RELEVANCE: This study showed a strong placebo effect. The glucosamine/chondroitin sulfate supplement did not show pain-relieving effects when compared with placebo.

Refinement of the Feline Musculoskeletal Pain Index (FMPI) and development of the short-form FMPI.

OBJECTIVES: The aim of this study was to investigate the reliability and responsiveness of the Feline Musculoskeletal Pain Index (FMPI) using the collective results of multiple clinical studies and iteratively refine the FMPI for future use. METHODS: Data were compiled from previously conducted studies involving client-owned cats with degenerative joint disease (DJD) and which used the FMPI. The reliability of the FMPI was assessed using the data from the initial visits of those studies. For the assessment of responsiveness of the FMPI, only placebo-controlled studies that used analgesic treatments were included. Treatment groups from each study were combined and categorized as 'placebo' group and 'analgesic' group. Then, the mean change from baseline in score of each FMPI item and across all items within and between these groups were assessed. Based on the results of the reliability and responsiveness of the FMPI, stepwise elimination was used to remove the items that were least able to distinguish between the placebo and analgesic groups. Finally, after the stepwise elimination, a proposed new FMPI-short form (FMPI-sf) was constructed and its reliability was reassessed using the data sets described above. Individual and combined data sets of the studies were also used to compare the responsiveness of the original FMPI and the FMPI-sf. RESULTS: The data from 180 cats from four studies were included. The original FMPI had a reasonable reliability, but low/no responsiveness. The elimination process of FMPI items refined the responsiveness of the instrument while maintaining its reliability. When the responsiveness was compared between the original FMPI (17 items) and the FMPI-sf (nine items), the treatment effect between groups was always greater when the FMPI-sf was used. CONCLUSIONS AND RELEVANCE: The proposed FMPI-sf may be able to better distinguish between placebo and analgesic effects in cats with DJD.

Prescribing practices of veterinarians in the treatment of chronic musculoskeletal pain in cats.

OBJECTIVES: Despite the high prevalence and increasing awareness of chronic musculoskeletal pain in cats, approved treatment options are completely lacking in the USA, and few other options have sufficient safety and efficacy data. Knowledge of current prescribing practices should inform future research of putative therapies. We aimed to determine which drug and non-drug therapies were being used by general practitioners for the treatment of musculoskeletal pain in cats and to understand demographic influences on prescribing practices. METHODS: We distributed a survey to 36,676 veterinarians who were members of the Veterinary Information Network in January 2017. Within 3 weeks, 1056 practitioners completed the survey. The survey included demographic and background information, questions on prescribing frequency and dosing regimen of 13 drug and non-drug therapies and questions on preferred medication formulations and dosing frequencies. Descriptive statistics were used, as well as χ2 testing to evaluate relationships between demographic variables and prescription practices. RESULTS: Gabapentin was prescribed most frequently (71% of respondents), followed by joint supplements (67.8%), meloxicam (64.0%), opioids (62.6%), fish oil (62.1%) and polysulfated glycosaminoglycans (61.9%). Years in practice appeared to influence prescribing habits, with practitioners graduated for >20 years prescribing glucocorticoids more frequently than other age groups ( P = 0.0002), whereas recent graduates (<1 year) reported prescribing therapies less frequently across all categories. CONCLUSIONS AND RELEVANCE: These results show a contrast between therapies prescribed by practitioners and what is supported by evidenced-based literature. Future research evaluating the safety and efficacy of gabapentin should be prioritised.

Effectiveness of combined acupuncture and manual therapy relative to no treatment for canine musculoskeletal pain.

Despite the rise in popularity of both acupuncture and manual therapy in veterinary medicine, and the increasing number of Canadian veterinarians practising these techniques, there is little research demonstrating their effectiveness. In this repeated measures, therapeutic trial, 47 client-owned dogs with naturally occurring lameness were assessed for clinical response to treatment. Owners were blinded to the treatment schedule and completed questionnaires to assess their dogs' comfort and mobility. Comparison between pre- and post-treatment results demonstrated that combined acupuncture and manual therapy provides immediate short-term improvement in comfort and mobility, as demonstrated by owner observed changes in play behavior (P = 0.015), walking (P < 0.001), trotting (P = 0.002), jumping (P < 0.001), descending stairs (P = 0.003), rising from a lying position (P < 0.001), and reduced stiffness after rest (P < 0.001) or following exercise (P < 0.001). Mood and attitude also improved, but did not attain statistical significance.

Efficacité de l'acupuncture et de la thérapie manuelle combinées par rapport à l'absence de traitement pour la douleur musculo-squelettique canine. Malgré la croissance de la popularité de l'acupuncture et de la thérapie manuelle en médecine vétérinaire et le nombre grandissant de vétérinaires canadiens qui pratiquent ces techniques, il existe peu de recherche démontrant leur efficacité. Dans cet essai thérapeutique à mesures répétées, 47 chiens appartenant à des clients atteints de boiterie naturelle ont été évalués pour leur réponse clinique au traitement. Les propriétaires n'ont pas été informés du calendrier de traitement et ils ont rempli des questionnaires afin d'évaluer le confort et la mobilité de leurs chiens. La comparaison entre les résultats avant et après le traitement ont démontré que l'acupuncture et la thérapie manuelle combinées offraient une amélioration immédiate à court terme pour le confort et la mobilité, comme le démontrent les observations faites par les propriétaires pour le comportement de jeu (P = 0,015), la marche (P < 0,001), le galop (P = 0,002), le saut (P < 0,001), la descente d'escaliers (P= 0,003), le lever d'une position couchée (P < 0,001) et une raideur réduite après le repos (P < 0,001) ou après de l'exercice (P < 0,001). L'humeur et l'attitude se sont aussi améliorées, mais sans atteindre une importance statistique.(Traduit par Isabelle Vallières).

Joint Mobilization and Manipulation for the Equine Athlete.

Joint mobilization and manipulation provide important diagnostic and therapeutic approaches for addressing musculoskeletal issues in veterinary medicine. Soft tissue and joint mobilization are used to assess the quality and quantity of joint range of motion and as a primary means of treating musculoskeletal disorders. Spinal manipulation was shown to be effective for reducing pain, improving flexibility, reducing muscle tone, and improving symmetry of spinal kinematics in horses. Because of potential misuse and safety issues, joint mobilization and manipulative therapies should be provided only by specially trained veterinarians or licensed human manual therapists.

Kinesio Taping Fundamentals for the Equine Athlete.

The Kinesio taping method was developed in Japan for use in humans in 1979. The use of complementary therapies is becoming common in equine athletes and the discovery of Kinesio taping potential brought it into the animal world. Kinesio taping can be used to treat a wide range of clinical conditions, from tendon injuries to neurologic disorders and from muscle contractures to postural insufficiencies. Its use in veterinary medicine is promising, but relies heavily on evidence-based clinical reports. Further scientific research is needed to fully understand the real effectiveness of application.

Feline musculoskeletal pain index: responsiveness and testing of criterion validity.

BACKGROUND: Progress in establishing if therapies provide relief to cats with degenerative joint disease (DJD)-associated pain is hampered by a lack of validated owner-administered assessment methods. HYPOTHESIS: That an appropriately developed subjective owner-completed instrument (Feline Musculoskeletal Pain Index-FMPI) to assess DJD-associated impairment would have responsiveness and criterion validity. ANIMALS: Twenty-five client-owned cats with DJD-associated pain. METHODS: FMPI responsiveness (ability to detect the effect of an analgesic treatment) and validity (correlation with an objective measure) were explored through a stratified, randomized, double blinded, placebo-controlled, crossover 10-week clinical study. Meloxicam was administered to effect pain relief. A linear mixed model, backward stepwise regression, and Pearson correlations were used to assess responsiveness and criterion validity with the assumption that the NSAID would increase activity. RESULTS: Positive responses of cats to placebo (P = .0001) and meloxicam treatment (P = .0004) were detected; however, the instrument did not detect any difference between placebo and meloxicam (linear mixed model), even for the high impairment cases. Percent meloxicam target dose administered, temperament, and total baseline FMPI score were covariates that most affected FMPI scores. Controlling for significant covariates, most positive effects were seen for placebo treatment. Positive treatment effects on activity were detected, but only for the cases designated as most highly impaired. CONCLUSIONS AND CLINICAL IMPORTANCE: Neither responsiveness nor criterion validity were detected by the inclusion criteria for cases in this study. The data suggest that further work is indicated to understand factors affecting activity in cats to optimize inclusion criteria.

Evaluation of oral administration of firocoxib for the management of musculoskeletal pain and lameness associated with osteoarthritis in horses.

OBJECTIVE: To generate data on the effects of firocoxib administration to horses with osteoarthritis. ANIMALS: Client-owned horses with signs of lameness and joint pain associated with osteoarthritis. PROCEDURES: Firocoxib was administered as an oral paste (0.1 mg/kg, q 24 h) for 14 days. Assessments were performed on day 0 (baseline) and days 7 and 14. RESULTS: 390 of 429 horses from 80 sites in 25 states met the criteria for analysis. Quarter Horse and Thoroughbred were the 2 most commonly represented breeds, comprising half of the study population. Signs of musculoskeletal pain or lameness attributed to osteoarthritis were diagnosed in a single joint in 197 (197/390 [50.5%]) horses and in multiple joints in 193 (193/390 [49.5%]) horses. In those with involvement of a single joint, the tarsus was the most frequently affected joint (79/197 [40.1 %]). Among the 390 horses with complete lameness data, improvement was reported in approximately 80% by day 14. Investigators rated 307 (78.7%) horses as improved, whereas owners or handlers rated 316 (81.0%) horses as improved at the termination of the study. Horses treated with firocoxib paste had significant improvement in lameness scores from baseline values. Improvement was most rapid within the first 7 days after starting treatment and continued, albeit at a slower rate, through treatment day 14. CONCLUSIONS AND CLINICAL RELEVANCE: Firocoxib significantly improved lameness scores throughout the 14-day period with few adverse effects. Firocoxib can be a safe cyclooxygenase-2-specific NSAID for the treatment of musculoskeletal pain and lameness associated with osteoarthritis.