Articles by Mark E. Epstein, DVM, DABVP, DAAPM, CVPP - Veterinary Medicine
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Articles by Mark E. Epstein, DVM, DABVP, DAAPM, CVPP

Recognition, assessment and scoring of pain in dogs and cats (Proceedings)

May 1, 2011

It is now a settled matter that the adaptive capacities of animals, coupled with the innate biases of human observers, seriously impairs our ability to "know" which of our patients are in pain, how much they are in pain, and sometimes, even where they are in pain. Historically the absence of behaviors easily associated with pain (crying, whimpering, etc.) has been equated with the absence of pain.

Adjunctive analgesic drugs: beyond NSAIDS and opioids (Proceedings)

May 1, 2011

The framework of effective pain management systems rests solidly on the foundation of recognition/assessment, pre-emption, and using multiple modalities. Multiple modalities allow for intervention at several different places of the nociceptive pathway, increasing effectiveness and minimizing the need for high or protracted doses of any one particular drug.

Making the case for pain management: Why and how (Proceedings)

Aug 1, 2010

In the last 10 years, the veterinary profession has undergone what can only be described as a sea change in perspectives about animal pain and pain control. A 1993 evaluation of a veterinary teaching hospital surgical caseload revealed only 40% of patients that had undergone highly invasive, painful procedures (including orthopedic repair, thoracotomy, and intervertebral disc decompression) received any sort of pain control, and then only based on clinical signs.

Multimodal analgesia: Not "too many" drugs, rather a sage and effective synergy (Proceedings)

Aug 1, 2010

Pain can be protective, but through the stress response it may also contribute significantly to patient morbidity and even mortality. Anxiety may contribute directly to the hyperalgesic state through cholecystikinin-mediated "nocebo" effect.

Using local anesthetics for surgical analgesia: why, where, what and when (Proceedings)

Aug 1, 2010

Local anesthetics were once a mainstay of pain management in veterinary medicine, and may now be one of the most under-utilized modalities. Administered locally or regionally, they are the only modality that renders complete anesthesia to a site, i.e. no transmission of nociceptive impulses as long as the drug exerts its effect.

Gila, genomica, and more: emerging trends in pain management (Proceedings)

Aug 1, 2010

Rapid advances are being made in understanding the neurobiology of pain, which in turn reveal potential new targets for prevention and treatment.

Assessment of postsurgical pain in cats (Proceedings)

Aug 1, 2010

Cats add an extra dimension of difficulty when it comes to assessing pain in animals. Listed below, are just some of the "new onset pain behaviors" shown by cats in acute severe pain. (adapted from Karol Matthews's excellent chapter in the Veterinary Clinics of North America Small Animal Management of Pain, July 2000 Vol 30 issue entitled: Pain Assessment and General Approach to Management). However, the observer must be very astute if they are to pick up signs of moderate or mild pain, and are exhibited not by the onset of new behaviors, but rather absence of usual behaviors.

Assessment of postsurgical pain in dogs (Proceedings)

Aug 1, 2010

It is now a settled matter that the adaptive capacities of animals, coupled with the innate biases of human observers, seriously impairs our ability to "know" which of our patients are in pain, how much they are in pain, and sometimes, even where they are in pain. Historically the absence of behaviors easily associated with pain (crying, whimpering, etc.) has been equated with the absence of pain.

Rational use of NSAIDs for chronic pain in dogs and cats (Proceedings)

Aug 1, 2010

Pain can be protective, but through the stress response it may also contribute significantly to patient morbidity and even mortality. Undermanaged acute (peri-operative or post-trauma) pain can slow or even prevent recovery, and chronic pain is not merely acute pain of extended duration.

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