Analgesia for Animals: My Lottery Theory of Multimodal Pain Treatment

My Lottery Theory of Multimodal Animal Pain Management:

Good lab animal welfare requires effective treatment of any pain scientists cause. It is way too easy to pick a drug from the list, pick a dose, and never really know if the drugs is actually helping the animal feel better. One variation on this is to use three drugs, or multimodal analgesia treatment — going Beyond Buprenorphine (the most common single-agent treatment) to maximize pain relief

It’s been years now that I’ve been advocating combining different classes of pain medicines to treat research animal pain. I haven’t always prevailed; most notably, I consistently failed to get the vets or the animal committee on my recent job to enforce this standard on one particularly resistant monkey-user scientist.

I think a lot about evidence-based ethical treatment of animals when the evidence just isn’t there. When it comes to fine-tuning pain treatments for animals, our evidence is so very sparse. Whether it’s monkeys, mice, fish or others, how do we evaluate the level of pain they’re experiencing? How do we evaluate if pain medicines truly make them feel better? How then can we know if combining analgesics is even better (or worse) than using single drugs? What about side-effects of pain drugs? What about how either drugs or untreated pain might affect the experiments the animals are on?

We totally lack the most important info for even our most common drugs, and that is, what if our animal patients could self-medicate or somehow tell us they need another dose, or a stronger dose, of their pain meds?

Frankly, we don’t have the info we need to pronounce on the best pain management — other than the obvious, which is to first, cause no pain. And so IACUCs end up making an ethical decision, in what I call the ethics-of-uncertainty. Do they err on the side of caution, and require more aggressive pain treatment than some scientists want to provide? Or do they privilege concerns about how drugs will affect research data?

With my recommended 3-drug multimodal regimen, we combine an opioid (usually buprenorphine; an MD would rely more on morphine or codeine) with a Non-steroidal anti-inflammatory NSAID (for animals, we use carprofen or meloxicam; an MD might rely on ibuprofen) and also, a local “block” at the surgical incision (bupivacaine or lidocaine; your dentist uses a lot of lidocaine). Our doses for these drugs are not wild guesses, but neither are they very solid science either. We don’t know exactly how much to use, we don’t know when to re-dose, we don’t give mice or monkeys their own medicine chests, and we don’t have the best skills at round-the-clock pain evaluations.

Hence, the Lottery Theory: use all three and hope you’re getting at least one of them mostly right. While I’m watching the science develop and hoping we’ll get good answers on just what pain management, my short term approach is that we should buy three tickets in the analgesics lottery, and hope at least one of them is a winner. And yes, let’s scale back on doing painful things to animals in the first place

Published by larrycarbone

Larry Carbone is a veterinarian with 40 years of experience caring for animals in laboratories. In addition to his veterinary degree, he holds a PhD in History and Philosophy of Science and Technology, and specialty certifications in Animal Welfare (ACAW) and in Laboratory Animal Medicine (ACLAM). Carbone left the University of California San Francisco in 2019, and is now a freelance animal welfare scholar, consultant, speaker, and trainer in laboratory animal welfare. Carbone writes about public policy, ethics, and laboratory animal welfare. His 2004 book, What Animals Want: Expertise and Advocacy in Laboratory Animal Welfare [Oxford University Press] tells the story the United States Animal Welfare Act. Once Congress decided to update that law and regulate how scientists use animals in their experiments, everyone wanted to tell them what changes would really matter to the animals themselves. How could medical researchers, animal protectionists, veterinarians and citizens disagree so much on how big a cage a guinea pig harem should have, how to evaluate and treat pain in a lab mouse, what makes for a psychologically enriched monkey, or how much exercise dogs need, settle for, or yearn for in their caged lives? What Animals Want is available in print or kindle. With one foot in the humanities and one in veterinary science, Carbone is uniquely poised to examine the policy and ethical ramifications of emerging information animal welfare science. Humans use and impact captive, domestic and wild animals in so many ways, and we must understand how our actions matter to the animals as perceived by the animals. Much of his recent work has focused on pain management: Animals cannot run to the medicine chest for an aspirin, so people must have the best tools for recognizing pain, preventing pain, treating pain, assessing whether the treatments are effective, and deciding when animals will be left with untreated pain in the pursuit of medical research. When not working on animal issues, Larry Carbone is a potter in San Francisco, a member of Ruby’s Clay Studio. His work is mostly functional wheel-thrown stoneware and porcelain, with occasional flights to the dysfunctional. Carbone is a traveler, especially to places where he can see and photograph animals. He travels with his husband, David Takacs, professor of environmental law at UC Hastings College of the Law.

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