Pharmacology of the Equine Foot: Medical Pain Management for Laminitis.
Authors: K. Hopster, B. Driessen
Journal: The Veterinary clinics of North America. Equine practice
Summary
# Editorial Summary: Pharmacology of the Equine Foot—Medical Pain Management for Laminitis Pain management remains one of the most challenging aspects of laminitis treatment, and Hopster and Driessen's 2021 review examines the pharmacological options available to clinicians tackling this complex condition. The authors synthesise evidence supporting a multimodal approach as the gold standard, combining nonsteroidal anti-inflammatory drugs with opioids and/or constant rate infusions of alpha-2 agonists, ketamine, and lidocaine to target pain through multiple pathways simultaneously. Beyond these established agents, emerging evidence suggests potential roles for amitriptyline and soluble epoxide hydrolase inhibitors, though the authors acknowledge that clinical outcome studies are needed before these can be confidently recommended in practice. Local analgesic techniques—including long-acting local anaesthetic blocks and epidural catheterisation—offer particularly valuable adjuncts to systemic therapy, enabling potent pain relief whilst minimising systemic side effects. For equine professionals involved in laminitis cases, this work underscores the importance of individualised, layered analgesia protocols rather than relying on single agents, and suggests that regional techniques may deserve greater uptake where facilities and expertise permit.
Read the full abstract on PubMed
Practical Takeaways
- •Use multimodal pain management protocols (combining NSAIDs, opioids, and infusions) rather than single agents for better laminitis pain control in acute cases
- •Consider local anesthetic techniques and epidural catheters alongside systemic therapy to achieve pain relief with fewer adverse effects
- •Stay informed on emerging agents like amitriptyline as evidence develops, but rely on proven multimodal approaches for current clinical practice
Key Findings
- •Multimodal analgesia combining NSAIDs, opioids, and constant rate infusions of α-2 agonists, ketamine, and lidocaine is the best approach for laminitis pain control
- •Amitriptyline and soluble epoxide hydrolase inhibitors show promise for laminitis pain management but require further clinical studies
- •Local techniques including long-acting local anesthetics and epidural catheterization can reduce systemic side effects when combined with systemic pain control