Pain Management in the Wild Avian Trauma Patient
By Dr Peta-Danielle Muller-Deibicht
It’s a typical, crazy Saturday in private practice and a good samaritan drops off a baby dove in a shoe box. (If you are really lucky – it will be something more glamorous – like a Falcon). You are freaking out because you don’t have time, your practice manager is throwing their toys because no one is going to cover the cost of treating this wild animal… and after all “’ it’s just a bird…and it’ll probably die the second you look at it.” Sound familiar? Well, take a deep breath and gather yourself, because every life matters and good deeds matter. You CAN help this patient. In a perfect world, one should stabilize this patient and send it through to your closest avian hospital (via their ambulance; in an Uber as a package or via said good Samaritan). At Johannesburg Wildlife Vet, we receive wildlings from all over the country and will see to all the treatment, rehab and release of these creatures. If you are living in Pof Adder and the closest avian clinic is a full day’s drive away, or you just need to get through your shift before you can drop the bird off, you will find a pretty decent guide on how to deal with pain in birds below.
This article will focus on pain management and thus assume there is a basic understanding of stabilizing a trauma patient- the ABCs of triage, fluid therapy etc. Pain can be tough to identify in the avian patient, even in pet birds, and for this reason, pain is often under-recognized and inadequately treated in birds. Unmanaged pain can cause a cascade of debilitating neuro-hormonal responses and this stress response can not only impair healing but also lead to the death of our patients.
The Recognition of Pain
The IASP (International Association for the Study of Pain) defines pain as not just a sensory experience; but also as an emotional experience, associated with actual or potential tissue damage. Managing pain in our patients, will therefore also decrease their stress.Birds experience pain in a similar way to mammals with painful stimuli following the same route of transduction, transmission, modulation and perception in the nervous system.
The inability to verbally communicate that there is pain does not negate its presence. We need to deal with the pain in these trauma patients to prevent physiological changes such as alterations in blood pressure, endocrine dysfunction, tachycardia, dysrhythmias, fluctuations in blood glucose, decreased immunity, and poor wound healing. Wild animals typically hide their pain as much as possible, as an injured or hurt animal is likely to become food for another animal.
Assessment of Pain in Wild Birds:
1. Behavioral observations: When it comes to avian patients, knowing the normal behaviour of a species is very useful (remember Google is your friend). For example, if you can pick up a Lapwing or a Hadeda and they are not screaming and trying to peck you to death- they are in big trouble. If a wild animal is not fighting to get away from you – there is a problem. Does it look like it wants to die? Can the patient stand? Can it fly? Does it have a “pain face?’’
2. Physical examination: Start with a hands-off exam. Pain and stress go hand in hand. Trying to do too much or being too hands-on immediately can stress critical patients to death. Let them have a little breather before you start to fiddle. Then give them some Dextrose, electrolytes and hydration.
Now assess for signs of trauma, including guarding, stiffness, or swelling. Are there open wounds? Is there a wing drop? Is the foot hanging off? Is there deep and superficial pain? Is there evidence of head trauma? Do the feathers look like the bird was grounded for some time? Are there changes in physiological parameters such as hypoglycemia, tachypnea, and tachycardia?
3. Pain scoring systems:
Pain is considered the 4th vital sign in animals and I firmly believe that a pain score should be included in every clinical exam. Recognizing pain in birds is challenging as they naturally hide their pain for as long as possible. Utilize pain scoring systems, such as the Avian Pain Score (APS) or the Glasgow Composite Pain Scale (GCPS), to evaluate the severity of pain. Diagnostic testing such as radiography is helpful, but again – I would wait until you have a stable patient.
Choosing The Right Analgesic
Deciding on what drugs to use is a challenge for the avian patient given the diversity of the bird family, with around 10,000 species recognised globally. Several scientific publications have shown that there are different drug dose requirements amongst the avian family and as such, analgesic provision for a Hadeda, a chicken or a raptor, may differ. Analgesia relieves pain without blocking the conduction of nerve impulses as it affects the sensory perception of pain (Tully, 2017); however, it can also affect the conscious state of a patient and in bird species that perch and need to feed frequently, these factors also need to be considered.
Commonly Used Pain Medications in an Avian Crisis
The main routes of drug administration in birds are intramuscular injection, intravenous and oral. Intra-osseous injection (including for fluid therapy) may also be used. Intra-osseous and IM injections can be painful and cause localised tissue trauma, resulting in the need for analgesia when there was no need before. I always aspire for the least stressful and least painful route of drug administration for the patient. Several drugs may be administered intranasally in birds and I have found this particularly useful for sedation/ premedication.
Opioids (for severe pain – fractures, deep wounds). Opioids act on the kappa, mu or delta receptors to block the perception of pain in an individual. Birds have a higher presence of kappa receptors when compared to mu receptors in most species. As such, the use of butorphanol
in birds is the most commonly used analgesic as it provides decent pain relief (when compared to its poor analgesic properties in mammals). Recent studies in chickens suggest that poultry may not have distinct mu and kappa receptors, or perhaps the receptors have similar functions. Most opioids are rapidly absorbed and eliminated in birds. Most opioids also have poor oral bioavailability in birds (associated with a first-pass effect in the liver), making oral opioid administration generally ineffective.
Butorphanol (0.5–4.0 mg/kg IM q1–4h): Synthetic kappa receptor agonist & mu receptor competitive antagonist.
Morphine (0.6 mg/kg IM q6h): Pure mu-agonist; effective in some species but has a short duration of action in birds.
Tramadol (5–11 mg/kg PO q12h in raptors, 15–30 mg/kg q6h in parrots): Tramadol is a synthetic mu-opioid agonist that also inhibits reuptake of norepinephrine and serotonin, as well as having NMDA antagonist effects. In birds, it is recommended not to use it as the sole analgesic. Larger birds require lower doses at decreased frequency compared to smaller birds. Tramadol tablets taste terrible thus I recommend a flavoured compounded paste or using the IM injectable.
Ketamine (1–10 mg/kg intranasal, SC, IM, IV)
Ketamine is an NMDA receptor antagonist and is very effective at reducing central sensitization.
Gabapentin (1–10 mg/kg PO q12h)
Gabapentin has analgesic effects and can prevent allodynia. It also serves to reduce stress in patients. Gaba’s mechanism of action appears to be binding to voltage-gated calcium channels to decrease calcium influx, which inhibits the release of excitatory neurotransmitters such as Substance P, glutamate and norepinephrine. The human Gabapentin formulations should not be used in birds, as they contain Xylitol. V-tech compounds a palatable (xylitol-free) syrup which I find very useful as it is easy to administer via a feeding tube or injected into food.
Non-steroidal anti-inflammatory Drugs (NSAIDs)
NSAIDs target the cyclooxygenase (COX) enzyme in the arachidonic acid pathway. COX-2 inhibitors are preferred, given the reduction in the physical side effects seen with COX-1. In particular, the reduction of side effects seen within the renal and gastrointestinal systems is marked (Hawkins, 2006).
NSAIDs should not be given to patients who are dehydrated or have questionable kidney function as they reduce renal blood flow. Meloxicam is my hospital’s NSAID of choice (1-1.5mg/kg q 12 h); via IM injection or oral suspension (it’s easy to administer via tube feeding or injected into the food itself ). It is important to note that birds require BID administration of Meloxicam.
Adjunctive therapies
I believe in a multimodal pain approach and the use of modalities such as acupuncture and laser therapy. In small avian patients, a Photizo is of great benefit and a safe modality in accelerating healing in such small patients with pneumatic bones. Cold compresses are recommended in acute phase injuries (up to 3 days post-injury/surgery), 15-20 min at a time up to 3-4 times per day, if the patient will tolerate it.
Conclusion
Pain management in birds is often overlooked but is crucial for recovery. Recognizing pain early through behavioural and physical assessments improves treatment outcomes. Opioids and NSAIDs are the mainstay of avian analgesia, but species-specific dosing is required. A multimodal approach using medications, supportive care, and adjunctive therapies ensures the best possible recovery. Our ethical responsibility: Even if you can’t fix every bird, reducing pain and suffering is always within reach.
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