Translational Aspects of Pain Management Research
Panelists B. Duncan X. Lascelles, BVSc, PhD, DACVS, and Margaret Gruen, DVM, MVPH, PhD, DACVB, provide insight on areas of veterinary pain management research that translate well to human research, and suggest future directions in this area of study.
B. Duncan X. Lascelles, BVSc, PhD, DACVS: Can we measure anxiety and cognitive function in relation to pain in dogs and cats?
Margaret Gruen, DVM, MVPH, PhD, DACVB: I think that’s one of the most exciting areas. That’s what I was thinking about when hearing this question about pain management research, and those questions about risk factors and early recognition. In humans, we see this spectrum of conditions where we have depression, anxiety, fear of pain, and cognitive dysfunction. It’s an attention drawer, so executive functioning can go down. And then, that becomes a very vicious cycle—social withdrawal.
So, we see all of these things. There is some evidence that it’s a 2-way street. Sometimes, people with a tendency for anxiety or depression may be more likely to develop very serious chronic pain; and chronic pain may contribute to anxiety and depression.
So, I think that this is something where we really need to be getting on the ball for with dogs and with cats. I think, potentially, starting with dogs is the easiest place to do it because we’re starting to get the tools for cognitive testing. We have some that we can use in laboratory house dogs, but developing those in which we can use in a clinically expedient way to look at cognitive functioning and early signs of cognitive dysfunction in dogs can be beneficial—particularly, as we talked about, these older dogs have all these comorbidities, including cognitive dysfunction. But, I’m also talking about looking at younger dogs who have chronic pain. This may be a place where we can really start to pull that apart, without those comorbidities.
B. Duncan X. Lascelles, BVSc, PhD, DACVS: Moving on from that, Mark, you mentioned the other species: Humans. You brought that up, Margaret, as well. And we often hear this term “One health,” thrown around. Maybe, in this context, we could call it “One pain?” But, just in thinking about this idea of interdisciplinary collaboration between the human and veterinary side, Margaret, what areas of veterinary pain management do you think would translate well into research on the human side, in full human medicine?
Margaret Gruen, DVM, MVPH, PhD, DACVB: I think, certainly, central and peripheral sensitization. We’ve seen this, especially, in dogs, but there’s also some evidence in cats. That’s an area that can translate well. Developing measures of frailty, gait speed, and those sorts of things may be very useful. There’s, I think, also a really important role for pets in drug development for humans, as a proof of concept or on the pathway, because many drugs fail from rodent research into human clinical trials. Efficacy in dogs and cats may be a really important intermediate.
B. Duncan X. Lascelles, BVSc, PhD, DACVS: When you start to read about this and you read figures such as, “In the last 25 years,” there have only been 4 new novel analgesics developed, even on the human side, and those have been pretty much niche products. You realize that the translational research is somewhat failing, so I think there’s a very important role for the use of companion animals and that spontaneous naturally-occurring disease being inserted into that paradigm.