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N. Schoemaker1, Y. van Zeeland1
1Utrecht University, Division of Zoological Medicine, Utrecht, Netherlands Antilles
Pain Management in Exotic Companion Mammals
Nico Schoemaker, DVM, PhD, Dip ECZM (Small mammal & Avian), Dipl. ABVP-Avian
Division of Zoological Medicine, Faculty of Veterinary Medicine, Utrecht University
A broad range of conditions are associated with pain (e.g. acute or chronic in ammatory disease, neoplasm, trauma and iatrogenic causes such as surgery). Pain should not only be treated from a welfare and ethical point of view, but also from a medical perspective. It
is well documented that poor pain management in the post-operative period has detrimental effects on the recovery, including wound healing and maximal restoration of function of the patient.
Managing pain in exotic companion mammals requires recognition of pain in these species. Once pain is recognized or suspected, this should be addressed by looking at all treatment options and taking unwanted side-effects into consideration.
Recognizing pain:
Pain is a highly subjective and individual experience and similar surgeries or disease states will be experienced differently by every individual. In addition, assessment of pain is dif cult as many of the displayed signs are subtle. It is therefore best when behavioral changes
Pharmacological pain management
Different classes of analgesic drugs can be used to prevent, eliminate or reduce the nociceptive input at different stages, forming the basis of a multimodal approach to pain management. The advantage of a multimodal approach is that different classes of analgesic drugs can have additive or synergistic effects, while
the dose of the individual drugs can be lowered which
in turn might reduce side effects and increase safety. Another important aspect to increase the ef cacy of analgesic therapy is preemptive analgesia. It has been shown that previous experiences of pain can increase the aversiveness of subsequent painful events, pain might be treated best before it is actually present.
The broad range of analgesic drugs used in more common companion species such as dogs and cats are also used in the exotic companion mammal species.
NSAIDs exert their analgesic effects by inhibiting the enzymes cyclo-oxygenase 1 and 2 (COX-1 and COX-2). The COX enzymes are responsible for the production
of prostaglandins which play an important role in in ammatory processes, but also in regulating renal and gastro-intestinal mucosal perfusion. In addition, they have an antipyretic activity.
Frequently, warnings are given for using NSAIDs for long term treatment and in animals with hepatic, renal or gastro- intestinal disorders. It is good to be cautious when using NSAIDs and make sure hydration of the patient is in order. Addressing chronic pain, however, may be more important than the perceived potential side effects. It is good to realize that people with, for instance, rheumatoid arthritis, use NSAIDs for years in a row, even when minor renal disease is present. When hepatic or renal failure is present, it has been advised in elderly to reduce the dose of pain medication to adjust for the impaired clearance of these drugs.
Meloxicam and carprofen, both potent COX-2 inhibitors, are currently the most frequently used NSAIDs in exotic companion mammal species.
Opioids and Tramadol
Opioids are used for the management of moderate
to severe pain. They exert their analgesic effects by binding to the opioid μ-, κ-, and/or δ-opioid receptors. These drugs inhibit ascending nociceptive input, activate descending inhibitory pathways, and decrease neurotransmitter release. They might also be active peripherally in in amed tissues. General side effects which can be seen after use of opioids include sedation, respiratory
An Urban Experience
are observed by people spending a fair amount of time with the animal. General behavioral characteristics frequently seen in animals with pain are: diminished general activity, altered posture, altered gait such as lameness, aggression in animals that are otherwise
very friendly, apathy in animals that are otherwise  erce, vocalizations which differ in pitch and pattern from the normal interactive sounds, hiding in the back of the cage facing away from the observer, lack of grooming behavior resulting in ruf ed and unkempt appearance
of the hair coat, diminished food and water intake, bruxism especially in abdominal pain, and  nally aversive response to external palpation of the animal. Prey species will attempt to hide pain to avoid predation.

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