The Modern Equine Vet - December 2020

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Break the Back Pain Cycle, Then Hit the Gym By Paul Basillio

Most of the work in the management of equine back

pain comes down to the diagnosis. After a thorough history, physical exam and imaging, it’s important to not let all of that important diagnostic work go waste with an incomplete or improper treatment plan, according to Erin Contino, MS, DVM, DACVSMR. The 2 pillars of that treatment plan are breaking the pain cycle and increasing or restoring strength, function, and stability, according to Dr. Contino, assistant professor in equine sports medicine at the Colorado State University College of Veterinary Medicine and Biomedical Science’s Equine Orthopaedic Research Center.

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“For me, the cornerstone of breaking the pain cycle is corticosteroids,” she said in a virtual presentation at the 66th Annual AAEP Convention. “They’re potent, they’re effective, they’re great anti-inflammatories, and I find them to be one of the most effective ways to get ahead of the game in treating back pain.” The diagnosis will dictate where steroids should be injected. For impinging or overriding spinous processes,

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the drug could be injected between the affected processes, although in some cases the interspinous ligament might not be injectable. “You can’t typically inject into a healthy ligament, so sometimes you have to go just a bit abaxially with your needle placement,” Dr. Contino explained. “You’re diluting the corticosteroid out in enough volume that it will diffuse to the entire area.” A combination of corticosteroid injections and the muscle relaxant methocarbamol is another common treatment in Dr. Contino’s practice. She gives it twice daily for 2 weeks, then tapers once daily for another 2 weeks. Keep in mind the dose allowed under US Equestrian Federation (USEF) rules, because often doses used to treat back are higher than what is permitted by USEF. For thoracolumbar articular facet joint osteoarthritis, she typically uses triamcinolone diluted with saline instead of hyaluronic acid with or without amikacin. Nonsteroidal anti-inflammatories (NSAIDs) are a staple treatment for back pain in humans, but Dr. Contino hasn’t found that to be the case in horses. “I typically only use a nonsteroidal if I’m combining