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TABLE 3: Median mechanical nociceptive thresholds of the horse’s back (Haussler et al. 2006)
Area tested Cervical
Thoracic Lumbar Pelvic
Median algometric pressure readings (kg/cm2)
9
12 13 16
Median algometric pressure readings (Newtons/mm2)
0.88 1.18 1.27 1.57
pressure algometer records an objective measurement of a horse’s reaction to pain. It helps localise the pain and may be useful in evaluating response to therapy. This allows clinicians to objectively evaluate the horse and compare results to those taken initially. The potential value of the algometer has not yet been
fully realised and further research is needed to confirm its efficacy as a clinical tool for the evaluation of back pain in horses.
Discussion
A horse with osteoarthritis of the hock or suspensory ligament desmitis will almost always have accompanying radiographic or ultrasonographic changes. We can easily relate the pain, which manifests as lameness, to the diagnostic image and understand the pathological process. This is not straightforward when considering the horse’s back. While imaging of the TL spine has improved considerably over the past thirty years and the diagnosis of changes to vertebral articular facets, DSPs and vertebral bodies are now being recognised, their relationship to pain and loss of performance is still relatively unknown. It is also recognised that multiple diagnoses are possible in the same horse, especially in chronic cases, making diagnosis and prognosis even more difficult (Jeffcott 1980b). Alternately, in some cases, significant osseous changes to the TL spine have been found on clinically normal horses that continue to compete successfully in their sport (Jeffcott 1979c; Stubbs et al. 2010). What does the general practitioner do when faced with a
horse that has back pain? Compassionate owners find it difficult to continue riding a horse with sensitivity in the back and well meaning friends will question their compassion and the lack of a diagnosis. Our own perception of back pain and its chronic and crippling effects induce a large amount of empathy in owners, trainers and bystanders and veterinarians need to be concerned too. Interpreting the implications of back pain in horses must
be a paramount objective and would benefit from further study, including clinically based research. Case studies would also help with furthering the understanding of equine TL pain. There are a variety of treatment protocols and rehabilitation programmes being developed for horses with back pathology and their effects also need further evaluation. It is necessary to determine which horses require treatment and which treatments to use. Currently, our knowledge of TL pain in horses is not evidence-based, is open to bias and further research is required. In practice, the veterinarian presented with a horse
displaying pain in the back should always conduct a careful clinical examination in combination with a thorough history.
Authorship
As the paper was a review of current advances, no study was undertaken. The majority of the manuscript was prepared by L. Jeffcott and G. Burns, in consultation with A. Dart.
References
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This examination will provide evidence as to whether a primary, secondary or apparent back problem exists. Flexibility, conformation and symmetry of the muscles, ligaments and DSPs of the back can be evaluated. Following this logical sequence of examination at rest and at work, saddle evaluation and manual palpation, the veterinarian will be able to determine if further diagnostic evaluation should be pursued. It is also important for the veterinarian to be able to give the owner a guide to prognosis, even if a definitive diagnosis has not been established.
Authors’ declaration of interests No conflicts of interest have been declared.
Ethical animal research Ethical review not applicable for this review article.
Source of funding None.
© 2016 EVJ Ltd
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