SPORTS MEDICINE AND REHABILITATION
chosen that target the hind feet. Treatment is performed once weekly for 3 to 4 weeks, then once every 2 to 4 weeks, depending on the horse’s response to treatment. Local points are also chosen over lumbar and gluteal region to help with secondary muscle pain, as toler- ated by the patient. This treatment may not be tolerated by the horse until the wind-up pain is addressed.
● TENS: TENS is applied for 30 minutes 2 to 3 times per day in the same manner as for acute laminitis.
● Manual therapy: A massager is applied over the thoracolumbar and gluteal musculature daily, as tolerated by the patient. This treat- ment may not be tolerated by the horse until the wind-up pain is addressed.
● Epidural: An epidural consisting of morphine at 0.2 mg/kg and detomidine at 30 g/kg is administered via epidural catheter every 12 hours.
● Gabapentin: Gabapentin is prescribed at 20 mg/kg q12h PO. This dose is slowly tapered over 3 to 4 weeks once the wind-up pain has resolved. Tapering of the dose (reducing total dose by 1
⁄2 every week) has been advised to prevent rebound pain.
● Biologics: IVRP with mesenchymal stem cells is performed at 1-month intervals for 3 to 6 treatments. After placing a tourniquet above the fetlock, 20 to 30 million stem cells suspended in lactated ringer’s solution are in- fused in the palmar digital vein. Intra-arte- rial administration via the palmar digital or medial artery could also be considered. No tourniquet is used if intra-arterial injection is to be performed.
5. Summary
Pain management of the laminitic horse can be ex- tremely challenging. Given the various types of pain these horses experience, a multimodal ap- proach to pain management of the laminitic horse is necessary. While evidence for pharmaceutical and non-pharmaceutical approaches in the laminitic horse is somewhat limited, multiple treatment op- tions are available.
Acknowledgments
Declaration of Ethics The Authors have adhered to the Principles of Vet- erinary Medical Ethics of the AVMA.
Conflict of Interest The Authors have no conflicts of interest.
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