Cannabis et douleur - Syringomyélie et Maladie de Chiari - Douleurs chroniques chat

 


DOULEUR CHEZ LES CHIENS ET CHATS

1/ A survey of veterinary student attitudes concerning whether marijuana could have therapeutic value for animals

Vogt NA, Sargeant JM, Stevens CPG, Dunn JN (2019) PLoS ONE 14(7): e0219430.

Résumé : 
Marijuana is increasingly recognized for its therapeutic value in human medicine. Although most veterinary research to date has been concerned with marijuana toxicity, there is some interest in the potential therapeutic value of marijuana in veterinary medicine. With the recent legalization of marijuana for recreational use in Canada in October 2018, there is a need for veterinarians and veterinary students to be in a position to address client questions and concerns on this topic. We distributed a questionnaire to current veterinary students at the Ontario Veterinary College in Guelph, Ontario, to determine their attitude(s) towards marijuana as a potential therapeutic agent in animals. The overall response rate for the questionnaire was 43.5% (207/476).
Most students felt that marijuana has potential therapeutic value in animals (53.6%; 111/207), fewer were unsure (38.6%; 80/207), and a small number of students felt that marijuana does not have potential therapeutic value in animals (7.7%; 16/207). Data generated by this questionnaire identified an important distinction between two major active compounds found in marijuana: cannabidiol (CBD) and tetrahydrocannabinol (THC). Potential barriers to use in veterinary practice were also identified, including stigma and toxicity. Finally, many respondents showed an awareness of the limited scientific research regarding the safety and efficacy of marijuana in animals. Until a body of scientific literature on marijuana in animals becomes available, veterinarians may benefit from having an awareness of the different physiological and pharmacokinetic effects produced by different strains (including any adverse effects, and half-life), and a general understanding of current therapeutic applications of marijuana in humans.


2/ Behavioral and clinical signs of Chiari‐like malformation‐associated pain and syringomyelia in Cavalier King Charles spaniels

Clare Rusbridge, Angus K. McFadyen, Susan P. Knower J. Vet. Intern. Med., First published: 09 July 2019

Résumé : Diagnosis of Chiari‐like malformation‐associated pain (CM‐P) or clinically relevant syringomyelia (SM) is challenging. We sought to determine common signs. Animals: One hundred thirty client‐owned Cavalier King Charles spaniels with neuroaxis magnetic resonance imaging (MRI) and diagnosis of CM‐P/SM. Dogs with comorbidities causing similar signs were excluded with exception of otitis media with effusion (OME).
Methods: Retrospective study of medical records relating signalment, signs, and MRI findings. Dogs were grouped by SM maximum transverse diameter (1 = no SM; 2 = 0.5‐1.99 mm; 3 = 2‐3.9 mm: 4 = ≥4 mm). Differences between all groups—groups 1 versus 2‐4 and groups 1‐3 versus 4—were investigated. Continuous variables were analyzed using 2‐sample t‐tests and analysis of variance. Associations between categorical variables were analyzed using Fisher's exact or chi‐square tests.
Results: Common signs were vocalization (65.4%), spinal pain (54.6%), reduced activity (37.7%), reduced stairs/jumping ability (35.4%), touch aversion (30.0%), altered emotional state (28.5%), and sleep disturbance (22%). Head scratching/rubbing (28.5%) was inversely associated with syrinx size (P = .005), less common in group 4 (P = .003), and not associated with OME (P = .977). Phantom scratching, scoliosis, weakness, and postural deficits were only seen in group 4 (SM ≥4 mm; P = .004).
Conclusions and Clinical Importance: Our results suggest any tool developed for ascertaining quality of life in CM-P and SM should have specific questions on signs suggesting discomfort, scratching/rubbing (including character/site), sensitivity to touch, activity, ability to jump and climb stairs, emotional state, and sleep. The study further suggests that SM-specific signs are phantom scratching, scoliosis, and sensory and motor signs that can be related to spinal cord damage by the syrinx and are associated with large syringes (transverse width ≥4 mm). Non-SM-specific signs include vocalization (described as without obvious trigger, when shifting position when recumbent and when being lifted under the sternum to a height), spinal pain, head and ear rubbing or scratching, aversion to touch, refusal or dif- ficulty jumping or doing stairs, exercise intolerance/reduced activity, sleep disruption, or behavioral change described as becoming more anx- ious, timid, aggressive, or withdrawn. These non-SM-specific signs could reflect CM-P. Although possible variables for the tool have been identi- fied, interrelationships between them would have to be taken into account in a multivariate sense when modeling.

Signs of pain are common in CM/SM but are not SM‐dependent, suggesting (not proving) CM‐P causality. Wide (≥4 mm) SM is associated with signs of myelopathy and, if the dorsal horn is involved, phantom scratching (ipsilateral) and torticollis (shoulder deviated ipsilateral; head tilt contralateral).


3/ Chronic pain in cats: Recent advances in clinical assessment

Beatriz P Monteiro, Paulo V Steagall J. Fel. Surg. Med., First Published June 25, 2019

Résumé : Chronic pain is a feline health and welfare issue. It has a negative impact on quality of life and impairs the owner–cat bond. Chronic pain can exist by itself or may be associated with disease and/or injury, including osteoarthritis (OA), cancer, and oral and periodontal disease, among others. Clinical challenges: Chronic pain assessment is a fundamental part of feline practice, but can be challenging due to differences in pain mechanisms underlying different conditions, and the cat’s natural behavior. It relies mostly on owner-assessed behavioral changes and time-consuming veterinary consultations. Beyond OA – for which disease-specific clinical signs have been described – little is known regarding other feline conditions that produce chronic pain. Recent advances: Knowledge of the subject has, however, greatly improved in the past few years, informed by study of the mechanisms of pain in cats with OA and the development of pain scales that can be used by owners or veterinarians. Pain scales may facilitate the diagnosis and follow-up evaluation of chronic painful conditions, providing a basis for therapeutic decision-making. Assessment of quality of life is also recommended in cats with chronic pain, and its improvement can be used as a positive outcome in response to therapy. Aims: This article reviews recent advances and presents the challenges and some future perspectives on clinical chronic pain assessment. The most common feline chronic conditions associated with pain are also described.