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Approaching Pain in Cattle

Cattle Pain Scale The 3 S Approach Score 0 1 2 Suppress Every effort should be made to suppress the procedures or environments that are a source of pain. For Interactive Active, attention to Apathetic: still remains close Apathetic: isolated from other example, incorporate the use of polled genetics and sexed semen to reduce the need for dehorning and Behavior tactile, visual and audible to other animals animals, does not respond to castration. stimuli stimuli Substitute Substitute a technique causing pain by another less painful one. For example, dehorning should Response to Looks at observer, ears Looks at observer, ears not May not look at observer, ears preferably be done at a young age, cauterizing the horn bud. Approach forward forward, leaves when not forward, may leave slowly Soothe In situations where pain is known to be present, because of a procedure or pathology, systemic or local approached or not respond pharmacological treatments should be used to soothe pain. Guatteo, R., et al., 2012. Minimising pain in farm animals: the 3S approach–‘Suppress, Substitute, Soothe’. Animal Locomotion Normal Gait Restricted walking, hunched Reluctant to stand, stands with back and short steps difficulty or not walking

Appetite Normal eating and Not eating but ruminating Not eating or ruminating Recommended Dosage and Withdrawal Intervals Following Extra-Label Drug Use in Cattle rumination

Drug Dosage Route of Meat WDI Milk WDI Gleerup, K. B., et al., 2015. Pain evaluation in dairy cattle. Applied Animal Facial Expression Attentive Strained, furrows above eyes Strained, furrows above eyes Behaviour Science Administration (days) (days) and puckers above nostrils and puckers above nostrils Anesthesia, Drugs and Reversal Agents Pain-Related Facial Expressions Head Position High Level of withers Low Acepromazine 0.05 mg/kg IV or IM 7 2 Ear Position Both ears forward or back Ears back or asymmetric Both ears lower than usual (1) Relaxed cow Back Position Normal Slightly arched Arched 0.25 mg/kg IV or IM 5 3 (2) Cow in pain with low ears de Oliveira, F. A., et al., 2014. Validation of the UNESP-Botucatu unidimensional composite pain scale for assessing postoperative pain in cattle. BMC Vet. Res. Detomidine 0.08 mg/kg IV or IM 3 3 (3) Cow in pain with ears tense and backwards Gleerup, K. B., et al., 2015. Pain evaluation in dairy cattle. Applied Animal Behaviour Science Guaifenesin 100 mg/kg IV 3 2 5 mg/kg IV or IM 3 3 Common Questions . Do calves feel pain? Depiction of Epinephrine Release After Surgical 1.5 mg/kg IV or 4 3 It is well established that cattle of all ages are sentient and have the ability to feel pain (Walker Castration Causing Vasoconstriction Max of 15 mL epidural SC and Coetzee, 2017). Changes in EEG readings characterize calves’ perception of noxious stimuli Max of 20 mL nerve block during castration as similar to changes associated with the human experience of pain 5 - 6 mg/kg IV 3 NA (Bergamasco et al., 2011). The thermography photos to the right show color changes indicating altered peripheral perfusion associated with catecholamine release following castration. Tolazoline 2 - 4 mg/kg IV or IM 8 2 . What’s the evidence that works? 0.11 - 0.33 mg/kg IV or IM 4 1 Following castration, have reduced the physiologic, behavioral and neuroendocrine changes that occur subsequent to the noxious stimuli (Stock et al., 2013). Reductions in cortisol, Yohimbine 0.25 mg/kg IV 7 3 plasma substance P, and heart rate have been demonstrated after administration of pain relief and Anti-Inflammatory Drugs (Coetzee et al., 2012; Stock et al., 2013; Stock and Coetzee, 2015), see Benefits of Pain Management table below. The graph shows changes in peak plasma cortisol concentrations of 50 mg/kg Oral 1 1 Coetzee, J. F. 2013. Assessment and management of pain associated with castration in calves after castration and the benefit of multi-modal pain management. cattle. Veterinary Clinics: Food Animal Practiice. Carprofen 1.4 mg/kg IV or SC 21 NA . Are there benefits to administering pain relief drugs? Flunixin 2.2 mg/kg IV 4 2 Analgesics have demonstrated numerous benefits to cattle during pain states. In addition to Minimizing Procedural Pain For flunixin, IM injection prolongs the WDI from alleviating pain responses, increases in milk production, average daily gain and reduction of 3.3 mg/kg Topical 8 4 4 days (IV) to more than 30 days. Violative lameness and disease are proven benefits of pain relief (Coetzee, 2011; Coetzee et al., 2012a; (1) Dehorning and castrating at the earliest age residues have been detected with IM flunixin administration and is strongly discouraged. Coetzee et al., 2015; Carpenter et al., 2016; Kleinhenz et al., 2018), see Benefits of Pain possible; Gabapentin 20 mg/kg Oral 21 3 Management table below. (2) Providing proper restraint, while minimizing stress; . Is extra-label use of pain management drugs legal? (3) Preventing procedural and post-procedural pain 3.3 mg/kg IV or IM 7 1 The Animal Medicinal Drug Use Clarification Act (AMDUCA) of 1994 permits extra-label drug use using an appropriate analgesic. Meloxicam 1 mg/kg Oral 21 5 (ELDU) in order to relieve suffering in cattle. Analgesics are permitted under AMDUCA given the criteria for ELDU are followed (AVMA, 2019). To legally use drugs in an extra-label manner, the Phenylbutazone 10 mg/kg Oral 55 NA Prohibited in lactating dairy cows practitioner must be able to establish a proper meat and/or milk withdrawal interval before 2 mg/kg IV 7 1 administering the drug (AVMA, 2019). Pharmacokinetic tissue residue data are available for many of the common anesthesia and analgesia drugs used in cattle and recommendations on Food Animal Residue Avoidance Databank. 2019. Withdrawal Interval Recommendations. http://www.farad.org/wdilookup/wdi_cattle.html. Smith, G. 2013. Extralabel use of anesthetic and analgesic compounds in cattle. Veterinary Clinics: Food Animal Practice meat and milk withdrawal intervals are provided. Veterinarians are advised to contact the Food The withdrawal periods recommended in this table are based on the specified dose, route and frequency of administration and are presented as a means for comparisons between different drug choices. Since only flunixin meglumine has an established tolerance in cattle, any amount of all the other drugs which is detected would be violative. Animal Residue Avoidance Databank (FARAD) at (http://www.farad.org/) or 1-888-873-2723 for Therefore, the actual withdrawal is dependent on the technology used for residue detection. FARAD should be contacted for the most current withdrawal time withhold period recommendations. recommendation.

Elective Procedures Practical Strategies for Pain Benefits of Pain Management Management and Chemical Drug Administration Benefit Reference Surgery Restraint Teat Elective Extra Teat Meloxicam Prior to Reduced BRD pull rate from Coetzee, Tail Docking Dehorning Castration Branding Amputation . Combination of Xylazine, Ketamine, Procedures Removal Displaced castration 45.2% to 25.8% (P 0.05) 2012a or Dry Off Claw and Butorphanol Enucleation Abomasum or Amputation . Dosage: Xylazine 0.05 mg/kg, Flunixin During Lower cortisol levels≤ at 2, 3, Kleinhenz, Caesarian Flunixin administration castration 4, and 12 hours after 2018 Is there Ketamine 0.1 mg/kg, Butorphanol 0.02 pre and post-partum Research Research Research mg/kg has been shown to castration (P 0.05) evidence to NO YES YES YES YES YES cause retained placenta Limited Limited Limited . in lactating cows support? Onset: IV faster than IM faster than SC ≤ . Suppress: Not completely Duration: SC > IM > IV Lidocaine and Prior to There was no significant Stafford, YES YES, over time YES, but Can the but should Ketoprofen castration increase in cortisol over an 2002 Manage the with Polled difficult to YES NO YES YES YES Buffering Lidocaine procedure be manage to 8-hour period and there Environment Genetics manage . Bicarbonate reduces the pain of avoided? minimize was a significant cortisol lidocaine injection, may enhance Laparoscopic increase in calves only given YES YES YES Substitute: YES YES YES abomasopexy, analgesia, may decrease the time of a (P Surgical Perform at Joint lavage, excision, Are there Trim the Apply paste Freeze Proactive LDA toggle onset, but may decrease the duration 0.05) castration earliest arthrotomy cryotherapy, switch within 24 branding or mastitis suture or in of the block Meloxicam Post-partum Meloxicam administered≤ at Carpenter procedures that within 1 possible age and or hyper- hours RFID tags control some cases, . cause less pain? week resection thermia Ratio: 10:1 of 2% lidocaine to 8.4% 1 mg/kg increased daily , 2016 pelvic splitting sodium bicarbonate combined milk production by 4 kg/d, Soothe: immediately prior to administration and overall increased 305-d Is there a way to YES YES YES YES YES YES YES mature-equivalent milk Research alleviate Local Local Local Local Local Local Local Potentiating Local Anesthesia 0.05) NO Limited yield by 733 kg (P Anesthetic + Anesthetic + Anesthetic + Anesthetic + Anesthetic + Anesthetic + Anesthetic + . procedural and NSAID sulfate combined with Meloxicam Post-partum Cows were willing to place Kleinhenz, post-procedural NSAID NSAID NSAID NSAID NSAID NSAID NSAID lidocaine competitively antagonizes more total force (49%≤ vs 2018 pain? NMDA receptors similar to ketamine 46%) on their rear limbs (P Food Safety Marginal, in Marginal, in YES, YES, YES, YES, YES, 0.02) NO YES and prolongs the duration of the = Risk? VEAL, YES VEAL, YES manageable manageable manageable manageable manageable anesthetic Meloxicam Prior to ADG increase of Coetzee, Likely Consumer Possible Possible Possible Conditional Conditional Conditional Conditional Conditional Conditional . Combine 1 mL of magnesium sulfate dehorning 0.65 kg bodyweight/day (P 2012b Acceptance? Resistance Resistance Resistance with 5 mL of 2% lidocaine immediately 0.05) over a 10-day YES YES YES, under period post dehorning Should I do the Avoid YES, under YES, under prior to administration ASAP with a ASAP with a guidance of Consider Consider ≤ procedure, if yes, NO wherever guidance of a guidance of a Xylazine, Prior to Less head shaking, ear- Faulkner, local and local and a Alternatives Alternatives possible veterinarian veterinarian Oral Meloxicam Lidocaine, and dehorning flicking, and increased 2000 how? NSAID NSAID veterinarian . Meloxicam is a prescription-only Ketoprofen weight gain than calves only Adapted From: Walker, J., et al., 2017. Elective Procedures in Dairy Cattle. Large Dairy Herd Management 3rd edition NSAID used to treat arthritis in people given a sedative and local 0.05) . anesthetic (P Cortisol Concentrations after Castration Meloxicam tablets have mean 100% Cornual Block oral in ruminant calves ≤ . Human generic tablets are very

inexpensive (<$0.20/calf) Testicular Block . Oral meloxicam at 1 mg/kg has a half- life of 27 hours

Gabapentin . Gabapentin (15 mg/kg) alone or in combination with an NSAID such as

Anatomy of Palpation of the Injection of local Injection of local Injection of local meloxicam (1 mg/kg) has resulted in the cornual temporal ridge anesthetic below the anesthetic caudal anesthetic lateral an increase in ADG in 6-month-old innervation ridge half-way between to the horn bud to the horn bud calves following dehorning and when

the lateral canthus of administered for lameness has also the eye and the horn shown an analgesic effect alone, and Injection of local Injection of local Injection of local more effectively in combination with anesthetic into left anesthetic into right anesthetic into Authors: Miriam Martin, Dr. Mike Kleinhenz and Dr. Hans Coetzee, Kansas State University College of Veterinary , 2019 meloxicam. spermatic cord spermatic cord median rafae