Zero Pain Philosophy

In our latest podcast, Modifying the Microbiome to Minimise Pain, Matt talks to Dr Siobhain O’Mahony, a leading academic in microbiome research. Dr O’Mahony has published work within human medicine, examining the link between the microbiome and pain outcomes after surgery. And we ask, ‘How could this translate into our field of veterinary pain management?’  We also touch upon what we should eat ourselves and ask whether we are feeding our pets correctly. References for shownotes The gut microbiota as a key regulator of visceral pain (2017) The gut microbiota in persistent post-operative pain following breast cancer surgery https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11137075/ [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11137075/] Stevens, Christina et al. “Gut Microbiome and Osteoarthritis: Insights From the Naturally Occurring Canine Model of Osteoarthritis.” Arthritis & rheumatology (Hoboken, N.J.), 10.1002/art.42956. 19 Jul. 2024, doi:10.1002/art.42956 Stewart, H L et al. “Differences in the equine faecal microbiota between horses presenting to a tertiary referral hospital for colic compared with an elective surgical procedure.” Equine veterinary journal vol. 51,3 (2019): 336-342. doi:10.1111/evj.13010 Stewart, Holly L et al. “Changes in the faecal bacterial microbiota during hospitalisation of horses with colic and the effect of different causes of colic.” Equine veterinary journal vol. 53,6 (2021): 1119-1131. doi:10.1111/evj.13389 Jan S Suchodolski [https://pubmed.ncbi.nlm.nih.gov/?term=Suchodolski+JS&cauthor_id=34514619] https://pubmed.ncbi.nlm.nih.gov/34514619/ The Dysbiosis Index (DI) is a validated quantitative PCR assay for canine fecal samples that measures the abundance of seven important bacterial taxa and summarizes the results as one single number.  The DI can be used to assess the microbiome in clinical patients over time and in response to therapy (eg, fecal microbiota transplantation).

Spoiler alert - you need to listen to this podcast to understand if there is a place for subcutaneous methadone in veterinary clinical practice! In this edition, Matt reviews the first paper that investigated pharmacokinetics of subcutaneous methadone and first raised the question of using this route in dogs. Matt then chats to anaesthesia specialist Aoife Ryan about a study they performed together to attempt to enhance our understanding around this topic. With Carl, we then chat through a recent publication examining this route of administration in dogs. For more on methadone, please see our pain update 'Methadone, the most versatile opioid' here https://www.zeropainphilosophy.com/post/methadone-the-most-versatile-opioid Need more detail? You can watch this webinar on methadone https://www.zeropainphilosophy.com/members-webinars References discussed in this podcast Bini G, Vettorato E, De Gennaro C, Corletto F. A retrospective comparison of two analgesic strategies after uncomplicated tibial plateau levelling osteotomy in dogs. Vet Anaesth Analg. 2018 Jul;45(4):557-565. doi: 10.1016/j.vaa.2017.11.005. Ingvast-Larsson C, Holgersson A, Bondesson U, Lagerstedt AS, Olsson K. Clinical pharmacology of methadone in dogs. Vet Anaesth Analg. 2010 Jan;37(1):48-56. doi: 10.1111/j.1467-2995.2009.00476.x. Ryan AC, Murrell JC, Gurney MA. Post-operative nausea and vomiting (PONV) observed in a clinical study designed to assess the analgesic effects of intravenous and subcutaneous methadone in dogs. Vet J. 2022 Sep;287:105876. doi: 10.1016/j.tvjl.2022.105876. Upchurch D, Lin KTT, KuKanich B. Two doses of subcutaneous methadone for postoperative analgesia in dogs undergoing tibial plateau levelling osteotomies. J Small Anim Pract. 2024 Jun;65(6):368-375. doi: 10.1111/jsap.13728.

Professor Clare Rusbridge is a global thought leader in the management of syringomyelia, Chiari malformation and phantom scratching. To assist vets in treatment of these conditions, Clare has recently updated and released her 2024 treatment algorithms. In this episode, Matt discusses the new algorithms with Clare, as well as ensuring we have our diagnosis correct and also looking to the future with these diseases. You can read the treatment algorithms here: https://veterinary-neurologist.co.uk/cmsm-new-treatment-algorithm-2024/ [https://veterinary-neurologist.co.uk/cmsm-new-treatment-algorithm-2024/] This is the link to the symptom checker: https://veterinary-neurologist.co.uk/chiari-checker/ Find Clare's YouTube channel here: https://www.youtube.com/@clare-neurovet [https://www.youtube.com/@clare-neurovet] Link to Head Space project: https://www.surrey.ac.uk/research-projects/head-space-project-canine-chiari-group

Meet Prof Paulo Steagall. Hear about his career, where the feline grimace scale developed from, and what the future of the FGS is. In this episode, Matt & Carl chat through all things relating to feline pain scoring with Paulo and explore a number of questions. Where does AI fit with the future of the feline grimace scale? Can pet owners use the feline grimace scale? Are cats difficult to pain score? The podcast takes a look at how pain scoring is just one part of the picture of enabling us to give optimal care to our feline patients. Listen to Paulo’s reflections on burprenorphine and how the use of the FGS has enhanced our understanding   Show notes below are the papers that we refer to within the podcast and you can link to the mentioned pain scale resource here [https://www.zeropainphilosophy.com/post/pain-scoring-systems-new-resource]   Steagall PV, Robertson S, Simon B, Warne LN, Shilo-Benjamini Y, Taylor S. 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats. J Feline Med Surg. 2022 Jan;24(1):4-30. doi: 10.1177/1098612X211066268. PMID: 34937455.   Steagall PV, Monteiro BP. Acute pain in cats: Recent advances in clinical assessment. J Feline Med Surg. 2019 Jan;21(1):25-34. doi: 10.1177/1098612X18808103. Epub 2018 Oct 15. PMID: 30320529.   Marangoni S, Beatty J, Steagall PV. An ethogram of acute pain behaviors in cats based on expert consensus. PLoS One. 2023 Sep 28;18(9):e0292224. doi: 10.1371/journal.pone.0292224. PMID: 37768967; PMCID: PMC10538801.   Evangelista MC, Watanabe R, Leung VSY, Monteiro BP, O'Toole E, Pang DSJ, Steagall PV. Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale. Sci Rep. 2019 Dec 13;9(1):19128. doi: 10.1038/s41598-019-55693-8. PMID: 31836868; PMCID: PMC6911058.   Steagall PV, Monteiro-Steagall BP, Taylor PM. A review of the studies using buprenorphine in cats. J Vet Intern Med. 2014 May-Jun;28(3):762-70. doi: 10.1111/jvim.12346. Epub 2014 Mar 21. PMID: 24655078; PMCID: PMC4895465.   Watanabe R, Frank D, Steagall PV. Pain behaviors before and after treatment of oral disease in cats using video assessment: a prospective, blinded, randomized clinical trial. BMC Vet Res. 2020 Apr 10;16(1):100. doi: 10.1186/s12917-020-02302-w. PMID: 32272922; PMCID: PMC7146962.   Watanabe R, Doodnaught G, Proulx C, Auger JP, Monteiro B, Dumais Y, Beauchamp G, Segura M, Steagall P. A multidisciplinary study of pain in cats undergoing dental extractions: A prospective, blinded, clinical trial. PLoS One. 2019 Mar 1;14(3):e0213195. doi: 10.1371/journal.pone.0213195. PMID: 30822336; PMCID: PMC6396900.   Monteiro BP, Lee NH, Steagall PV. Can cat caregivers reliably assess acute pain in cats using the Feline Grimace Scale? A large bilingual global survey. J Feline Med Surg. 2023 Jan;25(1):1098612X221145499. doi: 10.1177/1098612X221145499. PMID: 36649089.   Belli M, de Oliveira AR, de Lima MT, Trindade PHE, Steagall PV, Luna SPL. Clinical validation of the short and long UNESP-Botucatu scales for feline pain assessment. PeerJ. 2021 Apr 12;9:e11225. doi: 10.7717/peerj.11225. PMID: 33954046; PMCID: PMC8048399. Zero Pain Philosophy is an educational resource for vet professionals. If you are a pet owner, please encourage for vet to connect with us. We are unable to offer advice direct to pet owners.

It's been two years since bedinvetmab was launched as a treatment for the pain associated with osteoarthritis - quickly followed by frunevetmab. During that time Matt has lectured around the world on the topic. This podcast brings together a number of questions that have been raised as part of those lectures - and we always say that if someone has a question, then 10 are people are thinking the same thing! After this podcast you will have a better understanding of the anti nerve growth factor agents. If you have questions, we would love to help. Please use the contact box to send us a message. Don't forget that we offer a telemedicine service [https://www.zeropainphilosophy.com/vet-professionals] - so for case advice, please ask for our help! Reflective learning What further questions does this podcast content raise for you? How will this understanding impact the management of your current and future patients? Learning actions Revise the mechanism of action of anti nerve growth factor agents (both references below) Review the data sheet (summary of product characteristics) for bedinvetmab (Librela [https://www.ema.europa.eu/en/documents/product-information/librela-epar-product-information_en.pdf]/Beransa [https://www2.zoetis.com.au/content/_assets/SDS/Beransa-Solution-for-Injection-for-Dogs-SDS.pdf]) and frunevetmab (Solensia [https://www.ema.europa.eu/en/documents/product-information/solensia-epar-product-information_en.pdf]). Practice discussion As a practice team do we feel that anti-NGF agents are a first line treatment for OA in dogs and cats? References Enomoto M, Mantyh PW, Murrell J, Innes JF, Lascelles BDX. Anti-nerve growth factor monoclonal antibodies for the control of pain in dogs and cats. Vet Rec. 2019 Jan 5;184(1):23. doi: 10.1136/vr.104590. Epub 2018 Oct 27. PMID: 30368458; PMCID: PMC6326241. Schmelz M, Mantyh P, Malfait AM, Farrar J, Yaksh T, Tive L, Viktrup L. Nerve growth factor antibody for the treatment of osteoarthritis pain and chronic low-back pain: mechanism of action in the context of efficacy and safety. Pain. 2019 Oct;160(10):2210-2220. doi: 10.1097/j.pain.0000000000001625. PMID: 31145219; PMCID: PMC6756297.