Assuming all other issues have been or
are being addressed ---  why not ask your vet for Fentanyl  patch(es), at least temporarily.  He/she can monitor them and taper the dose as improvement in
pain level is achieved? 
  Williams/Dubrow '08

Hi Martha and Coral

Fentanyl is an opioid, right?.  If this horse were here I'd personally use other avenues. 

If this is neurological pain, and not  just from incorrect mechanism, the use of ALCar (Acetyl-L-Carnitine) may be a better option. Did you ever get that Coral?  ALCar can also help with insulin sensitivity.

I just bought a new tube of Capsaicin cream to put on the back of the fetlock just above the coronet band (thank you Dr Kellon for the reminder). 

http://www.ncbi.nlm.nih.gov/pubmed/12892309

Equi-Block or Uckele Capsa-Cream.  There's a human one you can probably find locally at a drug store:

Capzasin HP Arthritis Pain Relief Creme

 

Can get at most large drug stores, Walmart and other big box stores. Make sure you use gloves to apply, do not cover with wraps, and wash the leg thoroughly before your farrier comes to trim.  Let him/her know you have used capsaisin on the fetlock(s).

Nancy C in NH
ECIR Moderator 2003
FACT: Sensory nerves in the foot can be activated via tactile light pressure receptors and can affect vascular perfusion through the foot bringing more comfort to the horse. See RM Bowker, VMD, PhD, Nerves, Nerves, Nerves: Why Are They So Important To The Horse?  2013 NO Laminitis! Proceedings, Equine Cushing's and Insulin Resistance Group Inc.

 

Hi Nancy

We got no response from the use of acetyl-l-carnitine.  Since NSAIDS are
out of the question for this horse (two episodes of severe bute-generated gastroenteritis), relief of serious foot pain
was dealt with by use of Fentanyl patches which were carefully monitored
by Dr., and subsequently tapered.
     Yes, this is a narcotic, but does Dr. Kellon or the group object to the use of this drug?   When nothing else is appropriate, relief of intransigent pain is sometimes of supreme importance. Maybe I'm missing something?
    Williams/Dubrow.  '08

Speaking only for personal experience and following of many many experiences here, too often sledge hammer pain relief is used when other methods are not, ie diagnosis, diet, trim, movement. 

We have seen many times that removing the trigger - diet especially - brings relief within days. Same for trim and inappropriate use of appliances. With diagnosis issues like ACTH and lyme disease, control may take longer but control still brings relief when the diagnosis is addressed.

As far as the group recommendations go,  use of NSAIDs are recommended only for short period of time for acute founder situations - horse always recumbent, not drinking or eating.    While opioid receptors have been discussed in links about ALCar, and Chaste Tree Berry,  the use of narcotics for pain have rarely, if ever, been discussed. Dr Kellon will know better obviously, but I can't think of any time they were recommended by this group.

This post has good summary advice

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/113524

It kills us as "moms" to see the pain, but blocking that to the point
they move around freely can only increase the damage. It's like
giving enough narcotics to somebody with a broken leg that they walk
on it and make the fracture worse. If your horse with laminitis is
eating and drinking normally, passing manure and urine normally -
even if they're down most of time - that's fine. Worry about movement
after they have some true healing.

The post above concludes with what we are trying to do here is true healing.

Nancy C in NH
ECIR Moderator 2003
FACT: To diagnose IR, the ECIR Group recommends a non-fasted, simple blood draw for serum insulin, glucose and leptin and the use of VA Polytechnic Proxies. See E. M. Kellon, VMD, Diagnosis of Insulin Resistance and PPID, 2013 NO Laminitis! Proceedings, www.ecirhorse.org
http://www.freil.com/~mlf/IR/ir.html

Hi 

Hi Corinne

You have been through  lot in the past months and, since this appears to be a new laminitis case as a result of injections you probably have a constellation of things going on that contribute to pain.  ALCar may help if, when you have diagnosis, diet and trim in place.  Adding it now, may be less likely to do so but I could be wrong.

IOW -- if the triggger(s) for his lamintis have not bee addressed and removed if possible, if his pain is mainly from mechanical foot issues s a result of unaddressed laminitis, rotation or sinking or even abscess (with or without appliances), the AlCar will be less effective.  It can help with insulin sensitivity so I would be thinking bout adding it to your diet when you have things balanced.

Would like to hear from Dr Kellon re: using PQ while on doxy, however, I think in this case I would be looking at using the Phyto Quench (hopefully available today at Uckele) to get you through to your hopefully excellent upcoming farrier/trimmer visit.  PQ is expensive.  You may need to use as much as three times the recommended amount but if pain is affecting his willingness to eat and drink, if he is recumbent most of the day, then that is where I would go.

Beau had a very bad time with abscess all winter.  I used the PQ at double strength.  He had begun to not finish eating, and was lying down most of the time.  The PQ helped me help him get through the abscess pain and blow quite a large solar abscess. Now waiting on PQ to help us help him with the compensating foot and hind end.  At this time he needs movement to help shed excess sole and develop the back of the foot and to help his hind end.

The problem with sledge hammer pain relief is it makes them feel better when most often they should not be feeling better.  The human feels better too.  But the other aspects critical to long term rehab are not in place -- especially hoof mechanics, IMO.  Letting pain relief do the work of getting them to feel better while not addressing the core of DDT+E is setting yourself up for potentially more heartache down the road.

All NSAIDs - including Previcox - have issues in the GI system.  Been discussed here a lot lately so take a peak at message archives.

Corinne, I know you are looking only for a little break for Jasper while you work to get all other things in place.  I truly understand that feeling.  IME that is where the rest of DDT+E can truly help.  Working towards getting the the diet is spot on, as I know you are doing, will help him address what he needs to do to repair.  He's working as hard as any dressage or endurance horse trying to get well.   Massage, grooming, and just being with the horse is a big boost to their well-being too.   It also helps the human learn to recognize the sometimes very tiny signs that you are making progress.

It needs to be said again  the trim is critical for pain relief. For those of you thinking of coming to the NO Laimintis! Conference in Texas, November, trim will be a big part of the program.

This is a long answer to your quick questions.  :-)  Pain relief comes up all the time and we've got many folks worried like you, so thanks for allowing me to go on.

Hang in there.

Hi Nancy

I know you are working hard Corrine.  Been following.  I may have missed if you are using them, but anti-fatigue mats a life-saver for trimming sometimes. Many but not all trimmers know to work on the worst foot first.  You may know this too.  Sometimes working on the hind first is in order if they have not been trimmed in a long time.  Give him a place to go while you work on the fores.

The trim is the hardest part.  While many are reluctant, owners have to own that part of the process too.

I know you know that.

Hang in there.  Hugs for Jasper.

Nancy C in NH
ECIR Moderator 2003
FACT: Sensory nerves in the foot can be activated via tactile light pressure receptors and can affect vascular perfusion through the foot bringing more comfort to the horse. See RM Bowker, VMD, PhD, Nerves, Nerves, Nerves: Why Are They So Important To The Horse?  2013 NO Laminitis! Proceedings, Equine Cushing's and Insulin Resistance Group Inc.

 

Hi Lorna

Hi Corrinne

You have probably heard this before or in reading posts from others.

Standlee pellets are not tested to know what teh ESC and Starch levels are.  They could be too high.

You've probably heard you can use mag ox instead of remission but the amount you are using is probably okay for now.

You are basically on the emergecy diet for now until your hay is tested.  The emergency diet is designed to cover ust teh real glaring holes in supplementing these hoses until you can move to what you need for your hay.

I bet you know that.  Am I missing something else?

Nancy C in NH
ECIR Moderator 2003

FACT: With knowledge of the nutrient profile of the forage and the animal's weight and level of work, one can supplement only what is needed to target nutritional needs.  See  Smithey and Gustafson, Nutrition Complexities and Mineral Profiles of Hay 2013 NO Laminitis! Proceedings, Equine Cushing's and Insulin Resistance Group Inc.

 

Hi Nancy & Lorna

Hello Corrine,