Pain Management with Traditional and Alternative Therapies

INTRODUCTION

Pain is certain in life, whether due to injury or infection. Pain leads to different changes, including behavioral and neuroendocrine changes. Animals cannot speak for their pain but exhibit it through behavioral changes and facial expressions (Steagall et al., 2021). According to the International Association for the Study of Pain, it is defined as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Raja et al., 2020). Assessing animal pain should be an art of the veterinarian. With increased animal welfare awareness, common practices are being evaluated and new alternative methods are being explored. Efforts are underway to identify and implement less painful alternatives (Metcalf et al., 2024). Pain can induce multiple behavioral and physiological changes like restlessness, discomfort, and reluctance to rest. Clinically few parameters are consistent and noticeable like abnormal posture, Heart rate, respiration rate, and high blood pressure. We can access pain on physiological, behavioral, and emotional levels. When animals experience pain, several parameters may change in response to pain, these include Heart rate, Respiratory rate, Pupillary diameter, and blood pressure. Moreover, plasma hormones like β-endorphin, Catecholamines, and cortisol may increase, which serve as indirect indicators of pain. Behavioral changes like aggression, vocalization, self-mutilation, restlessness, and lethargy (Hernandez-Avalos et al., 2019) indicate pain and are species-specific behavioral changes (Reid et al., 2018). Several studies indicate that facial expressions are related to harmful events to animals. However, studies on dogs and cats revealed that facial expressions are not solely linked with pain as stress can alter these expressions (de Souza et al., 2018). Several traditional and alternative methods are still used in veterinary practice for pain management. Now these methods are used and are more effective in blending form. Now advancements have been made in veterinary medicine, and different chemicals are in practice for pain management. In this chapter, traditional and alternative pain management methods in veterinary practice and their effectiveness in blending form will be discussed.

PHYSIOLOGY OF PAIN

Pain is closely linked to health and performance. The neurobiology of pain consists of five distinct phases; transduction, transmission, modulation, projection, and perception. Transduction is the process where all modes of stimuli are converted into electric impulses with the help of a nociceptor in peripheral tissues (Whittaker et al., 2023). Nociceptors activated during the transduction process of pain stimulus activate several thermal responses which cause localized inflammation. This process modulates signals in the spinal cord which amplifies or diminishes the perception of pain within the brain (Bell, 2018). The central nervous system responds to nerve signals received via the spinothalamic track by releasing epinephrine and norepinephrine. Additionally, nociceptor information is also transmitted to other parts of the brain. Pain stimulates the sympathetic system, ultimately releasing glucocorticoids. The adrenomedullary system also influences the cardiovascular system by releasing catecholamines, causing hypertension, tachycardia, and changes in peripheral and central temperature. Tissue injury prompts the release of pro-inflammatory mediators such as prostaglandin, cytokines, and interleukins and contributes to peripheral sensitization (Whittaker et al., 2023).

TRADITIONAL WAYS OF PAIN MANAGEMENT

Traditional pain management methods include several procedures, such as using herbal medicine, Acupuncture, Massage, Heat and cold therapies, Mud therapy, and leech therapy. This chapter will explain these techniques. Ethnoveterinary medicine is a term used for the traditional methods of treating ailments. Now ethnoveterinary practice is no more in metropolises, but in remote areas, herbal medicine is still used for pain management.

Herbal Medicine

Several plant families have anti-inflammatory effects and are used as analgesics. The Lamiaceae family and several species are extensively used in remote areas as analgesics. Rosmarinus officinalis is commonly known as rosemary. It is a shrubby herb widely spread in European, Asian, and American continents (Al-Sereiti et al., 1999). Rosemarinic acid, a derivative of caffeic acid, a major component of rosemary, has been traditionally used in ethnoveterinary medicine for its analgesic, anti-inflammatory, and anti-rheumatic properties. Marrubium vulgare commonly known as marimba or Marroio has analgesic and anti-inflammatory properties and is regularly used in Brazil and Europe (De Jesus et al., 2000; Meyre-Silva & Cechinel-Filho, 2010). Marrubin is a diterpenoid, a major chemical isolated from marimba leaves with potent antinociceptive properties. According to (Mohammadhosseini et al., 2016), Stachys lavandulifolia, commonly known as Mountain tea (Chay-e-Kouhi), and Stachys officinalis (wood betony or bishop wort) exhibited analgesic effects in clinical trials (Conforti et al., 2009; Öztürk et al., 2009). Teucrium hyrcanicum also known as Purple Tails, is a plant commonly found in Iran, which has shown analgesic and anti-inflammatory properties. Lavandula officinalis is used as an herbal medicine for reducing pain due to inflammation (Uritu et al., 2018). Herbal medicine is commonly practiced in Bajur Agency, Waziristan, and other remote areas of KPK, Pakistan. Gum from Prunus armeniaca (Rosaceae family), widely known as khobanaiy is mixed with jaggery and used to relieve abdominal pain. The latex from Papaver somniferum (Papaveraceae family), widely known as koknar is combined with black tea and given orally as an analgesic. Oil from Brassica Rapa (Brassicaceae family) mixed with whey is also used to treat abdominal pain (Aziz et al., 2018). According to Adebayo et al. (2015) Zanthoxylum capense, Peltophorum africanum, and Clausena anisate are used in Africa as a traditional medicine as an analgesic, but their safety level should be verified via clinical trials. Methanolic extract of Curcuma Longa L.(Turmeric) rhizome possesses analgesic and anti-inflammatory properties in laboratory models (Innocent et al., 2021).

Acupuncture

Acupuncture has been practiced for thousands of years in traditional Chinese medicine. Now, it is gaining popularity in veterinary medicine. Several clinical studies and recent experiments proved its clinical and biological effects on pain management (Dewey & Xie, 2021). Acupuncture is the placement of fine needles at defined locations, rich in neurovascular and myofascial structures (neuroanatomic points). This process stimulates an endogenous response to analgesia. Biochemical effects of acupuncture needling include Mechano-transduction and neuromodulation mechanisms (Wright, 2019). Neuroanatomic points are rich in myelinated and non-myelinated nerves, fibroblasts, and mast cells. When a Needle is inserted at specific points, nerve stimulation is initiated directly due to mechanical forces applied to the surrounding fascia. When the needle is pulled, fibroblasts are stretched, and their function is modified due to an increase in fluid flux in lymphatic channels. Needling also alters peripheral nociception input and spinal neurotransmission modulation (Monteiro et al., 2023). There are three effects of acupuncture analgesia which are local, segmental, and suprasegmental. Regional analgesia is induced through sensory nociceptors targeting afferent nerves of the dorsal root ganglia. Segmental effects (Ascending nociceptive tract) are due to targeted neurons in the grey matter of the spinal cord. Suprasegmental effects (Descending nociceptive tract) work on the same principle as segmental effects. Local acupuncture analgesic effect starts at the site of pain. Local acupuncture relieves pain by stimulating a cascade of biochemical processes (Mechano-transduction), the release of neuropeptides, and opioid activation. This process relieves pain by reducing inflammation, increases blood flow to the local pain site, and relaxes tissue. The spinal acupuncture (segmental) effect works through gate control by activating A-beta fibers that inhibit spinal cord pain signals. This effect reduces NMDA activity and releases GABA, ultimately reducing inflammatory cytokines and alleviating visceral pain. This effect also reduces musculoskeletal pain. Studies showed that the Suprasegmental acupuncture effect works by activating specific brain regions and descending pain inhibition. This effect causes the release of analgesic chemicals such as serotonin and beta-endorphins by activating the hypothalamus, limbic system, and pituitary gland. Retrospective studies revealed that acupuncture relieves pain in serious and painful conditions such as cranial cruciate ligament rupture, Hip osteoarthritis, and intervertebral disc disease (Huntingford & Petty, 2022).

Mud Therapy

Mud therapy has been used since ancient times for treating musculoskeletal disorders, but its anti-inflammatory mechanism remains complex and is not understood (Lange et al., 2018). Mud is earth or rock of pasty consistency, which is used in different remedies, it is also called Peloid-therapy. Two forms of mud are used as remedies such as clay and peloid. Mud has water and heat-absorbent properties. Mud bats, Mud packs, mud wraps, and poultice are different forms to be used to relieve inflammation and its associated pain. Hot mud therapy activates endocrine hormonal secretion stimulates the hypothalamic-pituitary-adrenal axis and causes the release of beta-endorphins. The thermal effect of mud therapy relieves pain and inflammation (Munteanu et al., 2021).

Massage and Leech Therapy

Massage therapy works on the principle of muscle manipulation and facial release techniques to relieve pain. According to (Riley et al., 2021), a cross-sectional study was conducted on canines, which revealed that massage therapy relieves pain severity, which was reported by practitioners and owners on various indicators such as performance, gait, behavior, and posture. According to (Monteiro et al., 2023), Compression and gentle pressure provide physical and physiological relief to patients. Leech therapy, also known as Hirudotherapy, involves medicinal leeches. A cohort study was conducted in which medicinal leeches were used on 57 horses with laminitis. 84% of horses showed clinical improvement, but this study showed a high risk of bias as lacking a control group (Bergh et al., 2021). Leech saliva contains active ingredients; like peptides, hirudin, collagenase, histamine-like vasodilators, and poorly analgesic-like compounds. Leech therapy has been used since 1300 BC (Mordeniz & Yardımcı, 2023).

Heat and Cold Therapy

Heat and cold therapy have been practiced since ancient times. Cold therapy is an analgesic tool that involves the topical application of ice in packs, buckets, bags, and cups. Cold therapy works on the principle of cold-induced neuropraxia. Cold therapy decreases the temperature of underlying tissues upto2-4 cm. This process slows the conduction velocity and decreases tissue nociception. Cold therapy is still used on surgical incisions. Cold therapy is used in acute injury pain whereas heat therapy relieves chronic pain (Monteiro et al., 2023).

ALTERNATIVE REMEDIES FOR PAIN MANAGEMENT

For the past decade, there has been increasing concern for alternative therapies in veterinary practice. These alternative methods are termed holistic medicine, which focuses on maintaining animals' normal and healthy functioning. Alternative techniques for pain management include Chiropractic care, Homeopathy, Aromatherapy, Hydropathy, Cold laser therapy, and many more (Taylor & Romano, 1999).

Chiropractic Care

Chiropractic care works on the principle of controlled adjustment to rehabilitate joint motion. Adjustment is a thrust on a specific location by hand or any instrument with high velocity and short lever principle. These adjustments are precise and targeted on affected parts like limbs and spine and are effective. This practice focuses on gentle and well-tolerated adjustment which stimulates the nervous system for a therapeutic response. Chiropractic care can be used in conditions like intervertebral disc disease, back pain, wobbler syndrome, post-surgical rehabilitation, and hip dysplasia (Taylor & Romano, 1999). According to Maldonado et al. (2022), a study was conducted to evaluate the effectiveness of chiropractic care in chronic lameness and axial skeleton pain. The results of this study suggested that chiropractic care has mixed effects on lameness and axial skeleton pain. Positive effects were noted in the measure of lameness and axial skeleton pain. This study had some limitations, so further studies were suggested. Chiropractic care can be applied to dairy cows with musculoskeletal disorders. Five cases of dairy cows were reported with musculoskeletal disorders and received chiropractic care. These animals recovered and showed improvement after 4 to 5 chiropractic sessions (Wagner et al., 2024).

Homeopathy

Homeopathy is a diluted herbal therapy that stimulates the patient's natural body response to illness. It works on two core principles: individualization and dilution. The main difference between herbal medicine and homeopathy is that it is formulated according to the condition of individual illness. Medications are selected according to unique symptoms and disease progression to achieve therapeutic effect (Bez et al., 2024). According to Bhardwaj et al. (2020), a study was conducted on the Swiss albino mice model to check the effect of Ruck-Pain™, a commercial product, to check its efficacy in spondylitis. The study concluded that this product has curative potency regarding anti-inflammatory and analgesic properties. Eschscholtzia californica, an ingredient of this product, has analgesic properties and is a tranquilizer. Causticum and Lachnanthes tinctoria are used to treat neck and shoulder pain. Antimonium crudum is used to relieve pain and promote healthy growth of hooves. It also prevents painful callus formation, which also causes ill positioning of the hoof (Amatucci et al., 2024). Fluoric Calcarea, Rhus Toxicodendron, belladonna, and Pulsatilla Nigricans ammona revealed positive effects in chronic laminitis cases (López et al., 1999). Hypericum can be used in tooth pain (Lennihan, 2017). A study conducted on bitch to check the efficacy of Arnica Montana as an analgesic concluded a significant effect compared to the control group (Travagin et al., 2022).

Aromatherapy and Hydrotherapy

Aromatherapy is a technique that uses plant extract and converts it into fumes to treat different disorders including pain conditions. A clinical trial was conducted using horses as animal models to assess the efficacy of aromatherapy in pain. Several parameters were noted as indicators to assess efficacy. Lavender oil and chamomile oil with a simple air humidifier as control are used for this purpose. The experiment revealed that aromatherapy reduces heart rate and respiration rate which were used as indicators of pain. The risk of Bias was high in this experimental study (Bergh et al., 2021). According to Lakhan et al. (2016), many studies suggest that aromatherapy can be used to reduce cancer pain. An aquatic treadmill is used as modern-day hydrotherapy. Hydrotherapy is an alternative method of relieving musculoskeletal and joint pain. Hydrotherapy or aquatic treadmill works on the principles and properties of water such as viscosity, resistance, buoyancy, relative density, surface tension, and hydrostatic pressure. A low water level is appropriate for the treadmill's functionality as a higher water level leads to muscle fatigue and worsens the animal's condition (Egger et al., 2013).

Laser Therapy

Laser therapy is an alternative to traditional methods of pain management. LASER stands for light amplification by stimulated emission of radiation. Low-level laser therapy, also known as cold laser therapy, works on photo-biomodulation to reduce pain and inflammation. This laser therapy uses low infrared light to promote healing and lessen pain. The initial effect of near-infrared laser light is the activation of the production of ATP, nitric oxide, and reactive oxygen species (Tata & Waynant, 2011; Pryor & Millis, 2015). These substances affect three processes such as pain, inflammation, and healing (Farivar et al., 2014). Laser therapy can be used in osteoarthritis, joint, and muscle pain. High-level laser therapy, which is also known as hot laser therapy, is used in chronic pain conditions (Fesseha, 2020). Laser therapy lowers pain signal transmission and increases the production of endorphins and serotonin to reduce pain perception. An investigation was conducted to check the beneficial effects of low-level laser therapy on musculoskeletal disorders and pain management, proving its beneficial effects.

Environmental Enrichment

A study on mice models was conducted to check the effect of environmental enrichment on alleviating chronic pain. Dim lights were used to check the behavior of mice. Spared nerve injury (SNI) was performed on mice models. This study concluded that environmental enrichment reduces the pain threshold to mechanically induced pain (Parent-Vachon & Vachon, 2018).

BLENDING OF TRADITIONAL AND ALTERNATIVE METHODS

Traditional and alternative therapies are used in blend form (Integrated medicine) for pain management. Integrated medicine practice is gaining popularity as it is used in pre-operative, post-operative, and intra-operative phases to alleviate symptoms and for well-being. Integrative medicine provides various surgical care advantages, especially pain management (Hakami, 2024). Acupuncture and chiropractic care can be used simultaneously for back pain, but acupuncture has proved more efficient in alleviating back pain (Urits et al., 2021). Fresh ginger can be used for colic to relieve pain and its use as fumes has medicinal importance. Aromatherapy and herbal medicine (ginger) can be blended for well-being (Shahrajabian et al., 2019). Acupuncture and chiropractic can be provided simultaneously to relieve back pain in horses. A blend of traditional and alternative therapies lacks research so further studies are suggested (Bergh et al., 2021).

FUTURE PERSPECTIVE

Traditional and alternative techniques proved to be effective to some extent, but a deeper understanding of the physiology of pain can be gained by conducting research studies before applying traditional and alternative remedies (Maldonado et al., 2022). Alternative methods such as chiropractic care should be implemented at the herd level with the help of professionals alongside conventional methods (Wagner et al., 2024). As a result of the opioid crisis and opioid-related deaths in the US, there is a clear need for alternative methods for treating chronic pain. Long-term use of alternative opioid pharmacological substances causes GIT bleeding. Other methods which are described as holistic approaches should be adopted such as acupuncture, tai chi, and chiropractic care for chronic pain (Urits et al., 2021). Further trials involving control groups should be conducted to assess the efficacy of traditional and alternative methods and determine their side effects (Bergh et al., 2021). When alternative methods are not available then husbandry practice should be conducted. There is a gap between legalization, recommendations, and regulations in pain mitigation strategies which should be addressed (Steagall et al., 2021).

CONCLUSION

In conclusion, the Traditional and Alternative methods both offer valuable approaches to alleviating the pain and well-being. Each of these methods has its benefits and limitations. A blending of these methods such as acupuncture and chiropractic, herbal medicine, and aromatherapy enhance the well-being and a chance to alleviate pain. Further studies and trained professionals in the industry validate the efficacy and safety of this method, leading to its adoption in veterinary medicine.