Analgesic Efficacy of Non-Steroidal Anti-Inflammatory Drug Therapy in Horses with Abdominal Pain: A Systematic Review.
Authors: Citarella Gerardo, Heitzmann Vanessa, Ranninger Elisabeth, Bettschart-Wolfensberger Regula
Journal: Animals : an open access journal from MDPI
Summary
# Editorial Summary: NSAID Efficacy for Equine Abdominal Pain Researchers conducting a systematic review of literature published between 1985 and May 2023 sought to establish which NSAIDs—including meloxicam, flunixin meglumine, phenylbutazone, firocoxib, and ketoprofen—provide superior analgesia for horses with abdominal pain, a question that remains surprisingly unresolved despite decades of clinical use. Only 10 studies met rigorous inclusion criteria across three databases (PubMed, Embase, Scopus), and critically, just one employed a validated pain-scoring system to assess outcomes, with most investigations hampered by selection, performance, and other significant methodological biases as identified using the SYRCLE risk-of-bias tool. The review concludes that robust comparative evidence distinguishing one NSAID's analgesic potency from another in the colic setting is essentially absent from the peer-reviewed literature. This evidence gap has important implications for practice: whilst NSAIDs remain standard therapy for equine abdominal pain, clinicians cannot currently rely on high-quality comparative data to justify preferring one agent over another, meaning drug selection continues to be driven by tradition, availability, cost, and individual clinical experience rather than proven superiority. Future rigorously designed trials incorporating validated pain assessment tools would help establish whether meaningful pharmacological differences exist between these commonly used agents.
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Practical Takeaways
- •Current scientific evidence does not support superiority of any single NSAID (meloxicam, flunixin meglumine, phenylbutazone, firocoxib, or ketoprofen) over others for equine abdominal pain
- •Clinical decision-making regarding NSAID choice for colic should rely on experience, individual horse response, and contraindications rather than comparative efficacy data
- •Higher-quality controlled trials with standardized, validated pain assessment tools are urgently needed to guide evidence-based NSAID selection in equine colic management
Key Findings
- •Only 10 studies met inclusion criteria for systematic review of NSAIDs in equine abdominal pain between 1985 and May 2023
- •Only one of the 10 included studies used a validated pain scoring tool to assess analgesic efficacy
- •High risk of bias identified across studies due to selection, performance, and other types of bias
- •Insufficient evidence exists to determine whether one NSAID is more potent than another for treating abdominal pain in horses