Because poorly controlled pain can be a deciding factor for euthanizing laminitic horses, Guedes said an appropriate and timely approach to pain therapy is critical for proper case management. | Photo: iStock

The severe pain associated with the breakdown of the hoof’s fragile laminae is one of the leading reasons laminitis treatment fails, said Alonso Guedes, DVM, MS, PhD, of the University of California, Davis, School of Veterinary Medicine. To address the issue, Guedes presented a lecture on the topic at the 2013 American Association of Equine Practitioners’ Convention, held Dec. 7-11 in Nashville, Tenn.

While veterinarians still have a lot to learn about laminitis, research results now show that the disease involves both neuropathic (having to do with the sensory system) and inflammatory (heat and swelling) pain. This, Guedes said, means laminitis requires a multimodal pain management approach that addresses both types of pain.

Veterinarians frequently use non-steroidal anti-inflammatory drugs (NSAIDs), such as phenylbutazone (Bute) and flunixin meglumine (Banamine), to manage horses’ laminitis pain. However, Guedes suggested that the additional use of tramadol (a narcoticlike pain reliever), ketamine (a dissociative drug used to treat severe pain in horses), or gabapentin (a drug originally used to treat neuropathic pain and seizures in humans, but now also being used to treat laminitic horses) might help modulate neuropathic and pathologic pain states in horses. These pain states are characterized by hyperalgesia (exaggerated response to painful stimulus) and allodynia (pain response to a normally nonpainful stimulus)