Pain and inflammation in horses: natural treatment
In nature animals have always been threatened by inflammation and pain. Inflammation and pain often go hand in hand. Often pain and inflammation are natural strategies of animals to survive: pain indicates and acts as an emergency signal, and inflammation kills bacteria and viruses.
However, there are types of pain and inflammation who are no good for survival. In man we know these states as auto-immune disorders, diseases such as rheumatoid artritis, inflammatory bowel disorder and the like.
In these cases the body itself attacks the tissues of the body itself, for no obvious reason at all. Inflammation without infection, without bacteria or viruses attacking our body we call aseptical inflammation. Chronic inflammation and pain are the base for a variety of disorders leading to unhappy horses. Some of these are: synovitis (inflammation joint membranes), artritis, tendinitis, colitis, skin hypersensitivity and eczema and many non-bacterial inflammations more.
Inflammation is a natural defence mechanism against tissue injury and usually leads to successful tissue healing. Sometimes, the inflammatory process itself actually causes further injury. In such circumstances it is appropriate to intervene with analgesic (pain-killing) and anti-inflammatory drugs. We will demonstrate the usefulness of a natural painkiller and anti-inflammatory compound, which is regarded as a breakthrough in the treatment of pain and inflammation.
These chronic pain states and chronic aseptical inflammation we try to decrease by administering painkillers and anti-inflammatory drugs.
This strategy however, does not always lead to success and new approaches in the treatment of these states are highly needed.
Blocking pain and inflammation with chemicals
However, the drugs in these classes are isolated chemical molecules, and these drugs are developed to block one specific pathway within the pain and inflammation.
But, as chronic pain and chronic inflammation are extremely complicated biological situations, the efficacy of these drugs very often is insufficient, especially after long time use, and the side-effects can be quite bothersome.
The drawback of many current anti-inflammatory and painkilling drugs
For instance, the most often prescribed drugs to kill pain and reduce inflammation block one specific enzyme, the so called COX enzyme. These drugs are the NSAIDs. Aspirin, phenylbutazone, dipyrone, flunixin, meglumine, meclofenamic acid and ketoprofen are well known examples often used in horses.
Each year many thousands of patients die due to severe gastric bleeding or other complications of these drugs. This of course has been carefully monitored in man. Moreover, for chronic pain the painkilling properties of these drugs seem also to wear off. But also other painkillers are leading to many deaths: in man we know of a 2012 report from the Centers for Disease Control and Prevention; it was found that nearly 40 Americans die per day — about 15,000 per year — from overdoses of painkillers such as Vicodin and OxyContin, more then the number of deaths caused by heroin and cocaine combined.
In horses the use of the NSAIDs lead tor a eduction in blood flow and protective mucus production in the gastrointestinal tract resulting in ulcers, colic and diarrhea.
NSAIDs even have a higher incidence of toxicity in foals because their kidney function is not fully developed
For instance, phenylbutazone is used extensively in horses for a variety of common musculoskeletal disorders including navicular disease, laminitis, osteoarthritis and degenerative joint disease. The use of phenylbutazone in performance horses however, is very controversial, due to drug accumulation from the slow excretion of oxyphenbutazone, giving rise to intoxications, and for long-term therapy for chronic lameness conditions even dosing each day with the lowest effective dose is troublesome. 
Corticosteroids are also frequently used. These drugs have multiple shortcomings, among which one of the major concerns: the risk of inducing laminitis! The consequences of laminitis for a horse are so devastating, that it is a consideration with administration of any corticosteroid product to horses! Laminitis is sometimes referred to as a horses worst nightmare!
Natural modulation versus chemical blockage: follow were nature leads
Some twenty ears ago several key-scolars, such as the Nobel price winner professor Levi-Montalcini, and the famous neurologist professor Erminio Costa decided that one needs a whole new approach for treating chronic pain and chronic inflammation.
Their innovative approach in essence was quite simple. They put emphasis on a whole new direction in biological research, namely on the exploration of natural molecules, already available which have the function of modulators. Modulators rather than blockers.
Because, so they foresaw, these molecules are already having a natural function in the body, the side-effects will be small if not absent, and the biological efficacy will be impressive, as the evolution itself created these molecules and not man in his laboratory.
Drug development time to create a new effective painkiller is around 10 years, but nature could take many million years to create such molecules and test these in the evolution itself on efficacy and safety.
Palmitoylethanolamide: the pain and inflammation modulating natural drug, around 300.000.000 years old!
In the process of their work, professor Montalcini in 1993 discovered the biological significance of a body own molecule with the difficult name palmitoylethanolamide (we will call it PEA).
She described in a milestone paper
in 1993 the fact that PEA can modulate chronic inflammation by bringing to rest the overactive inflammatory cells, such as the inflammatory cell named the mast cell. She believed the modulation of inflammation and pain by PEA could open a whole new window of opportunities in the treatment. In the years to follow, her insight was proven to be correct.
Meanwhile more than 200 scientific papers have been published on the modulatory properties of PEA and many thousands of mammals, from human to dogs, cat and horses have been treated successfully by this compound.
Since her work we know much more about PEA.
This molecule has been discovered by nature many millions of years ago, probably even 300 million years ago, by primitive sea-animals. These animals were cold-blooded and were called sea-urchins. One of the problem the sea-urchin in the ancient oceans had to face is how to survive attacks from bacteria and fungi, as the sea-urchin had only very simple counter-attack forces in its body.
Once activated often the simple system over-reacted and the urchin died from too much inflammation. Most probably due to a mutation in the sea-urchin’s body a natural occurring simple molecule, resembling a fatty substance and occurring in the membranes of the sea-urchin’s cells emerged.
This was palmitoylethanolamide or a prototype of PEA. Once this molecule occurred in the body, quickly it gave a tremendous survival advantage to the sea-urchins who possessed this mutation. Why? Because this simple fatty molecule could leave the cell membrane easily and move to the cell nucleus, were it could switch on a master-gene which regulates inflammation. By docking on this gene, the overactive inflammation could be modulated again to the equilibrium and this helped the urchin in its survival.
Whether or not this really happened we will never know, but fact is, PEA is a natural modulating molecule, present in all cold blooded and warm blooded animals, apart from the insects.
In the insects PEA plays no role. Insects developed a whole different system of modulating inflammation, independent of PEA.
PEA thus must have given quite an evolutionary advantage and the molecule was tested in many millions of years, Due to its success it was implemented in all animals but the insects.
PEA: natural own answer to chronic inflammation and painstates
So during the evolution all animals started to make use of the modulation of PEA in inflammation. Since the last 20 years we have gathered a lot if insight in the properties of this natural modulator. We have tested PEA in a great variety of animal models for inflammation and pain, and in all models PEA could inhibit inflammation and counteract painstates.
By administering PEA the inflammatory and damaging activity during shock could be stabilized and the function of the kidney could be preserved.
In models of chronic severe pain, in models of multiple sclerosis, models of gut inflammation, and of chronic and allergic skin inflammation, in all these models PEA clearly inhibits chronic pain and modulates inflammation into a state of balance.
In all models PEA is active in a dose-range of 10-30 mg for each kg bodymass. PEA thus plays a key-role in the physiology of our body and of the body of our companion animals.
Its properties are many, based on all these 200+ studies we again and again see that pathological inflammation can be inhibited and pain decreases. And, very important in relation to modern other painkillers: although PEA has been used by around 1 million patients world wide, not one death emerged. Even more so, side effects are rare, serious side effects are unknown and there are no negative drug interactions known.
So based on the above, PEA has an unique profile as a natural painkiller and modulator of inflammation. It can be stated that treatment of pain and inflammation, due to PEA’s unique profile, should always start with trying this molecule. Furthermore, in a number of studies PEA could enhance the painkilling effects of chemical painkillers such as oxycodon and pregabaline.
Palmitoylethanolamide is currently the only well documented alternative drug for painkilling and anti-infklammation, with, as said, hundreds of clinical and animal data published. It stands alone as a evidence proved alternative for drugs such as NSAIDs and corticosteroids. Other neurtraceutical alternatives, for instance methylsulfonylmethane (MSM) is also thought to have some benefit in horses with degenerative joint disease. However, there are no published scientific studies documenting a beneficial effect from feeding MSM to horses.
PEA can best be given in the excipient free formulation PeaPure , a fine granulate in capsules; capsules can easily be openend and the PEA can be sprinkled over the animal food.
Most Authorative Sources on pain and inflammation in horses, and palmitoylethanolamide
Patricia M. Dowling, DVM, MS, Dipl. ACVIM, Dipl. ACVCP Myths and Truths About Controlling Pain and Inflammation in Horses
Jan M. Keppel Hesselink, MD, MSc, PhD New Targets in Pain, Non-Neuronal Cells, and the Role of Palmitoylethanolamide
 Soma LR, Uboh CE, Maylin GM. | The use of phenylbutazone in the horse. | J Vet Pharmacol Ther. | 2012 Feb;35(1):1-12. doi: 10.1111/j.1365-2885.2011.01299.x. Epub 2011 Jun 14.