Managing severe hoof pain in a horse using multimodal analgesia and a modified composite pain score

This report describes a clinically useful modified composite pain score (MCPS) for horses with hoof pain. The horse in this report initially suffered from acute pain from a subsolar seroma as well as suspected pain from chronic laminitis. Following surgical debridement, corium prolapsed through the wound and it became infected. During the course of conventional hoof and wound management, the pain experienced by the patient was refractory to nonsteroidal anti-inflammatory drugs. Using the MCPS as a guide, inflammatory and neuropathic pain states were identified and multimodal analgesia was employed in response to the varying pain states. Drugs used for the anti-inflammatory pain management protocol included firocoxib, butorphanol, phenylbutazone, aspirin and fish oil. Neuropathic pain modulators included parenteral and local anaesthetics, pentoxifylline, ketamine and gabapentin. Composite pain scoring in horses, which includes observational, physiological and interactive components, may have greater sensitivity for demonstrating response to therapy when multiple types and stages of pain exist.