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

Mark E. Epstein, DVM, DABVP, DAAPM, CVPP


Articles
Assessment of post-surgical pain (Proceedings)
August 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.

Opioids: the good, the bad? and the future (Proceedings)
August 1, 2011

Synthetic opioids are powerful, useful tools to manage pain for one simple reason: Receptors for naturally-occurring opioids (endorphins, enkephalins) are distributed ubiquitously throughout the body and can be found in both central and peripheral tissues.

Expanding your use of loco-regional anesthetics (Proceedings)
August 1, 2011

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.

Multimodal analgesia: not "too many" drugs, rather a safe and effective synergy (Proceedings)
August 1, 2011

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.

Adjunctive pain meds: beyond NSAIDS and opioids (Proceedings)
August 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 in your practice—why and how (Proceedings)
August 1, 2011

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 approach to pain management analgesia: not "too much", rather a safe and effective synergy (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.

Opioids: the good, the bad? and the future (Proceedings)
May 1, 2011

Synthetic opioids are powerful, useful tools to manage pain for one simple reason: Receptors for naturally-occurring opioids (endorphins, enkephalins) are distributed ubiquitously throughout the body and can be found in both central and peripheral tissues.

Expanding your use of local anesthetics (Proceedings)
May 1, 2011

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.

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