Dogs Can't Say No

Dogs Can't Say No

I am not a PETA kind of person, but I do not like to see any life form suffer needlessly. Adults, as a rule, have a choice in participating in medical studies and the potential for adverse effects. Children and animals do not, and the ethics of inflicting worthless pseudo-medical procedures on dumb animals is suspect at best and creepy at worst.

Take Comparison of intrarectal ozone, ozone administered in acupoints and meloxicam for postoperative analgesia in bitches undergoing ovariohysterectomy as an example. First, I was relieved to see the title was not using derogatory street patois, but referring to female dogs. Although not being in veterinary medicine, I initially found the title oddly off-putting.

What what was the study? They

investigated the postoperative analgesic effects of ozone administered either intrarectally or into acupoints in bitches undergoing ovariohysterectomy (OH). Twenty-four healthy adult bitches were randomly assigned to one of the three treatments 10 min after sedation, as follows: 0.2mg/kg of intramuscular (IM) meloxicam (M); rectal insufflation of 10 mL of 30 μg/mL ozone (OI), or acupoint injection of 0.5 mL ozone (30 μg/mL; OA). Following sedation with acetylpromazine, anaesthesia was induced with propofol and fentanyl and maintained with isoflurane/O2. Pain was assessed using the modified Glasgow pain scale (MGPS) and the visual analogue scale (VAS) on the day before surgery, before anaesthesia, and at 1, 2, 4, 6, 8, 12 and 24h after surgery. Rescue analgesia was performed using 0.5mg/kg of morphine IM if MGPS was >3.33 points. No statistically significant differences in pain scales were found among the three analgesic protocols or the time points in each group (P>0.05).

While there are many animal studies using meloxicam for pain control, in humans there is a lack of qualtiy efficacy studies  as of a 2009 review:

In the absence of evidence of efficacy, at present, for oral meloxicam in acute postoperative pain, its use in this indication is not justified. Because trials clearly demonstrating analgesic efficacy in the most basic of acute pain studies is lacking, use in other indications should be evaluated carefully.

as well as  in 2011.

In human hysterectomies,

Our study demonstrates a significant opioid sparing effect after abdominal hysterectomy with diclofenac, but not with meloxicam.

and meloxicam was equally useless in human dental extractions:

The results of this study showed no significant differences between efficacy of meloxicam, piroxicam, and placebo

Although there are other studies to suggest pain relief if meloxicam is given pre-op in human hysterectomies and one study suggests it has less efficacy in females.

My take from my review is that there is contradictory data that meloxicam is effective for surgical pain relief in a species that can give you relatively reliable feedback as to analgesic effect, as long as there is adequate blinding. Our pharmacy does not stock meloxicam and rarely sees prescriptions.  I suspect this is because test of time has shown meloxicam to be inferior to other NSAIDS or the company who makes it lacks a good advertising budget. For post surgical pain relief in humans, meloxicam does not appear to be best in breed. I also suspect its popularity in veterinary medicine may be due to the inability of animals to complain. 

In my opinion, ozone therapy is not reality based. Ozone acupuncture? Doubly so and potentially fatal. I still challenge someone to find me two disparate pseudo-medical interventions that have not been combined by some Doctor Moreau wanna be. Rectal ozone therapy for surgical pain? Triple that. PubMed rectal ozone if you want to see some, lets say, peculiar studies.  But don't expect to find any data on post-surgical pain.  I would be very worried about any IRB that would allow such a study in humans. Or dogs for that matter.

Given no placebo arm (except, probably, all three interventions) and the lack of blinding of investigators, their conclusion that rectal and acupuncture ozone is an

alternative option to promote pain relief

is ridiculous. My conclusion would be that meloxicam is no better than placebo interventions and their choice for one of the placebos is, at least to me, just creepy. Poor dogs.

And the whole time I read wrote this I thought of kids pulling the wings off of flies. But I get that feeling when I read most of the animal based pseudo-medical ‘studies'. Probably just me.

Points of Interest 06/04/2014
Points of Interest: 06/03/2014