Page 141 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir CASE EXAMPLE CONTINUED exercise and cautious physiotherapy for 4 6

weeks or longer. ecompressive spinal
surgery might be considered depending on
INTERVERTEBRAL DISC PROTRUSION the severity.
(HANSEN TYPE II)
Anulus brosus hypertrophy causing spinal ACUTE NON-COMPRESSIVE NUCLEUS
cord or nerve root compression e.g. PULPOSUS EXTRUSION (ANNPE)
degenerative lumbosacral stenosis cauda
e uina syndrome ; associated with disc Acute nucleus pulposus extrusion into the
degeneration. spinal canal causing spinal cord contusion
without spinal cord compression. ften
History and presentation a ects normal discs.

ostly non chondrodystrophic breeds, with a History and presentation
usually chronic progressive presentation and
reluctance to exercise; can present with acute Acute non compressive presentation.
deterioration. Commonly there is no reported Commonly occurs during exercise. Similar in
or mild spinal pain. its presentation to brocartilaginous
embolism CE . owever, patients with CE
Clinical signs and signs of pain commonly show no pain a few hours after the
incident, whereas patients with ANNPE are
Commonly no or mild spinal pain, or pain on commonly mildly painful for a few days.
tail elevation, in cases of degenerative
lumbosacral stenosis. he dog is usually Clinical signs and signs of pain
ambulatory with a mild gait abnormality
ataxia or paresis . Some dogs have a chronic Commonly mild focal spinal pain.
history of neuropathic pain, particularly dogs Asymmetrical or symmetrical clinical signs
with lumbosacral stenosis. a ecting either both hindlimbs
thoracolumbar lesion or all limbs cervical
Treatment lesion , ambulatory or recumbent with
possible urinary incontinence. ANNPE is not
ogs commonly present with chronic considered likely if clinical signs continue to
neuropathic pain. NSAI s and gabapentin deteriorate for more than 4 hours, in which
should be combined and the response case other di erential diagnoses must be
monitored. If pain is severe, other medications considered.
such as amantadine, amitriptyline or tramadol
can be added to e ect one at a time . Treatment
Sedation is the limiting factor. A muscle
relaxant such as dia epam . mg kg orally Pain is usually mild and is usually present
8h or methocarbamol 4 mg kg orally only for a few days. NSAI treatment has
8h may be useful if muscle spasms are been reported to be bene cial. abapentin
apparent. In the author s experience, some can be added if still painful. It is a non
conservatively managed dogs with ansen surgical condition. anagement includes a
type II disc disease respond better in the long controlled exercise regime and physiotherapy
term to prednisolone . mg kg orally 4h for 4 6 weeks. he physiotherapy protocol
compared with NSAI therapy. Conservative can be expanded once a lack of spinal cord
management includes restricted controlled compression is con rmed.

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