Are paracetamol and gabapentin effective equine analgesics?

The provision of effective equine analgesia remains a challenge in equine practice. It relies upon a number of processes including recognition and assessment of pain severity, understanding of the type of pain (visceral, musculoskeletal, neuropathic etc), knowledge of available drugs and their mechanisms of actions, consideration of drug side effects and interactions and basic knowledge of pharmacokinetics. The overall aim is to provide adequate analgesia often using a multi-modal approach. Veterinary understanding of many of these processes remains incomplete and how analgesic drugs are used is often extrapolated from other species, which creates challenges with regards to effective dosing strategies. This review considers the evidence behind two analgesic medications which are commonly used in practice. Paracetamol and gabapentin are attractive for use in horses because they have an oral route of administration, low cost and few perceived side effects. This review discusses the published evidence regarding the likely efficacy of these drugs, and how best to maximise their use.