Zero Pain Philosophy

What is fascia? Well, we think we know what it is from our dissection classes and our surgeries. But what does it do? Looks innocuous, right?

It must play a role in pain if we are talking about it?

Studies show that 30% of muscle power is related to fascia. No surprise then of the importance of fascia in our OA patients and post spinal surgery cases.

Fascia connects everything and plays a role beyond just structural - becoming particularly significant as a pain driver in disease.

In this episode we talk to Dr Doris Timmann who brings her experience of this fascinating organ to us!

Fascia Research Society (FRS): https://fasciaresearchsociety.org/

Suarez-Rodriguez V, Fede C, Pirri C, Petrelli L, Loro-Ferrer JF, Rodriguez-Ruiz D, De Caro R, Stecco C. Fascial Innervation: A Systematic Review of the Literature. Int J Mol Sci. 2022 May 18;23(10):5674. doi: 10.3390/ijms23105674. PMID: 35628484; PMCID: PMC9143136.

James G, Stecco C, Blomster L, Hall L, Schmid AB, Shu CC, Little CB, Melrose J, Hodges PW. Muscle spindles of the multifidus muscle undergo structural change after intervertebral disc degeneration. Eur Spine J. 2022 Jul;31(7):1879-1888. doi: 10.1007/s00586-022-07235-6. Epub 2022 May 27. PMID: 35618974; PMCID: PMC7613463.

Fan C, Pirri C, Fede C, Guidolin D, Biz C, Petrelli L, Porzionato A, Macchi V, De Caro R, Stecco C. Age-Related Alterations of Hyaluronan and Collagen in Extracellular Matrix of the Muscle Spindles. J Clin Med. 2021 Dec 24;11(1):86. doi: 10.3390/jcm11010086. PMID: 35011824; PMCID: PMC8745670.

Llewellyn J, Fede C, Loneker AE, Friday CS, Hast MW, Theise ND, Furth EE, Guido M, Stecco C, Wells RG. Glisson's capsule matrix structure and function is altered in patients with cirrhosis irrespective of aetiology. JHEP Rep. 2023 Apr 7;5(9):100760. doi: 10.1016/j.jhepr.2023.100760. PMID: 37534230; PMCID: PMC10393548.

(not open access) Stecco C, Pirri C, Fede C, Fan C, Giordani F, Stecco L, Foti C, De Caro R. Dermatome and fasciatome. Clin Anat. 2019 Oct;32(7):896-902. doi: 10.1002/ca.23408. Epub 2019 May 28. PMID: 31087420.

And if people like to be a part of the Fascia Research Consensus and Liason Statement (FRECLS.ORG) - very welcome!!! Here is my friend Werner Klingler (Human Anaesthesiologist) with a brief explanation about our project: 

https://www.youtube.com/watch?v=7T7OeFPaJBQ

Our quick chat podcasts are snippet updates of recent literature. In this episode Matt reviews a recently reported abstract investigating subcutaneous ketamine.

References

Nielsen MB et al (2026) A randomized, double-blinded,placebo-controlled parallel-group pilot study evaluating the effect of low-dosesubcutaneous ketamine as an adjunctive analgesic in dogs with osteoarthritis.Proceedings of the Association of Vetereinary Anaesthetists meeting Liverpool.

Sam Lindley is one of the most well respected veterinary acupuncturists - both a practitioner and a teacher of what we consider to be a valuable addition to our analgesic practice.

In this episode Matt chats to Sam about her experience and approach to chronic pain cases. Sam also mentions the evidence for acupuncture in sepsis - the link below is a systematic review on the topic.

References

Yang L, Zhou D, Cao J, Shi F, Zeng J, Zhang S, Yan G, Chen Z, Chen B, Guo Y, Lin X. Revealing the biological mechanism of acupuncture in alleviating excessive inflammatory responses and organ damage in sepsis: a systematic review. Front Immunol. 2023 Sep 11;14:1242640. doi: 10.3389/fimmu.2023.1242640. PMID: 37753078; PMCID: PMC10518388.

Stem cells are an evolving and promising option for osteoarthritis management in dogs and cats. In this podcast we talk to Dr Russell Chandler from Greenside Referrals in Scotland with all the questions you may have about stem cells. We start from the view of the vet in the consulting room with an arthritic pet in front of them. 

What do we say to clients, how do stem cells work, which cases are suitable. Listen to our discussion now and understand if stem cells are the right option for your patients.

Links

Greenside Referrals

https://www.stemcellsscotland.co.uk/contact-us

Russell’s book

https://5mbooks.com/product/regenerative-medicine-in-small-animal-musculoskeletal-conditions

Andrew Armitage’s paper on stem cells

Efficacy of autologous mesenchymal stromal cell treatment for chronic degenerative musculoskeletal conditions in dogs: A retrospective study.

This represents the first study using “real-world” data to show that cell-based therapies, injected into multiple areas of musculoskeletal pathology in a targeted holistic approach, resulted in rapid and profound positive effects on the patient's pain state and quality of life which was maintained with repeat treatment for up to 2 years.

https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2022.1014687/full

How does CBD work?

Is CBD a first line option for the treatment of OA pain? 

And where in our second line options does CBD fit? 

In this episode of the Zero Pain Philosophy podcast we are joined by anaesthesia & pain specialist Dr Leon Warne to answer these questions.

If your clients are asking you about CBD, then you need to listen to this.

References

Here is the link to the CATRAS work discussed in today’s podcast:

Warne LN, Schug SA, Beths T, Brondani JT, Carter JE, Lascelles BDX, Raisis AL, Robertson SA, Steagall PVM, Taylor PM, Whittem T, Bauquier SH. Content validation of a Critical Appraisal Tool for Reviewing Analgesia Studies (CATRAS) involving subjects incapable of self-reporting pain. Pain Rep. 2018 Jul 25;3(4):e670. doi: 10.1097/PR9.0000000000000670. PMID: 30123860; PMCID: PMC6085143.

These are the COAST guidelines:

Cachon T, Frykman O, Innes JF, Lascelles BDX, Okumura M, Sousa P, Staffieri F, Steagall PV, Van Ryssen B. COAST Development Group's international consensus guidelines for the treatment of canine osteoarthritis. Front Vet Sci. 2023 Aug 3;10:1137888. doi: 10.3389/fvets.2023.1137888. PMID: 37601753; PMCID: PMC10436090.

This is a recent review of CBD in dogs and cats

Moreno-López N, Moreno-López C, Amariles P. Cannabis-based products for medicinal use in dogs and cats: a systematic review. J Small Anim Pract. 2025 Jul 14. doi: 10.1111/jsap.13913. Epub ahead of print. PMID: 40660612.

Our latest podcast discusses the newly launched DogMA app with researchers Dr Natasha Clark and Professor Eithne Comerford. 

Mobility issues from musculoskeletal diseases, like osteoarthritis, affect around 200,000 dogs annually, posing a significant challenge to their health and welfare. Although these diseases can affect dogs of any age, owners often miss early, subtle signs of gait abnormalities, leading to late diagnosis of osteoarthritis. 

The DogMA app was developed to address this by enabling early detection of mobility problems, including subtle signs of discomfort or decline often overlooked in routine care. 

DogMA is supported by scientific research led by Dr. Natasha Clark at the University of Liverpool, under the supervision of Professors Eithne Comerford and Karl Bates, in collaboration with Dogs Trust. 

By using the app for regular assessments, users can also contribute anonymized data to ongoing research at the University of Liverpool, helping to advance the understanding of canine mobility across the UK.

References

Here is the link to the paper discussed in today’s podcast:

Clark NL, Bates KT, Harris LK, Tomlinson AW, Murray JK, Comerford EJ. GenPup-M: A novel validated owner-reported clinical metrology instrument for detecting early mobility changes in dogs. PLoS One. 2023 Dec 27;18(12):e0291035. doi: 10.1371/journal.pone.0291035. PMID: 38150469; PMCID: PMC10752556.

University of Liverpool page launching DogMA

https://www.liverpool.ac.uk/life-course-and-medical-sciences/research/dogma/

Download the app for free from your app store:

Android: DogMA in the Google Play Store

iOS: DogMA in the Apple App Store

This is the paper documenting radiographic and clinical OA in 23% of dogs less than 4 years of age:

Enomoto M, de Castro N, Hash J, Thomson A, Nakanishi-Hester A, Perry E, Aker S, Haupt E, Opperman L, Roe S, Cole T, Thompson NA, Innes JF, Lascelles BDX. Prevalence of radiographic appendicular osteoarthritis and associated clinical signs in young dogs. Sci Rep. 2024 Feb 3;14(1):2827. doi: 10.1038/s41598-024-52324-9. PMID: 38310147; PMCID: PMC10838335. 

These are the COAST guidelines:

Cachon T, Frykman O, Innes JF, Lascelles BDX, Okumura M, Sousa P, Staffieri F, Steagall PV, Van Ryssen B. COAST Development Group's international consensus guidelines for the treatment of canine osteoarthritis. Front Vet Sci. 2023 Aug 3;10:1137888. doi: 10.3389/fvets.2023.1137888. PMID: 37601753; PMCID: PMC10436090.

Do you feel like to need to play detective in your behaviour cases? How many of these cases have pain as an underlying issue? Then you will love this paper!

We have the pleasure of talking through the approach taken in this series of cases where the authors describe their approach to assessing pain in the behaviour case.

Detection of maladaptive pain in dogs referred with behavioral complaints:challenges and opportunities
https://www.frontiersin.org/articles/10.3389/fnbeh.2025.1569351

Dr Robert Trujanovic is an EBVS European Specialist in Veterinary Anaesthesia & Analgesia. In our latest podcast we talk to Robert to share his experience of using botulinum toxin A in pain management in dogs. Robert is leading the field on this subject and brings his experience of interventional pain management to our Zero Pain community.

We explore

What is the mechanism of action of BT?

What sort of pain cases is BT used for in human medicine?

Can you please tell us about some cases where you have successfully used BT in dogs (any feline experience)

Are there some practical considerations you would like to mention?

References

·      Pioneering pain management with botulinum toxin type A: From anti-inflammation to regenerative therapies. Hamta Rahmatipour, Salar Mohammadi Shabestari, Soheila Zamanlui Benisi, Hamidreza Samadikhah

·      Botulinum toxin for the treatment of chronic pain. Review of the evidence. Roberto Carlo Rivera Día, Mario Andrés Arcila Lotero, María Victoria Avellaneda Suarez, Sara Echeverri Saldarriaga, Manuela Gómez Martínez

·      Botulinum Toxin in Chronic Lateral Epicondylitis, from Tendon to Muscle Approach—A Review

·      Transforaminal versus Intra-Articular Facet Corticosteroid Injections for the Treatment of Cervical Radiculopathy: A Randomized, Double-Blind, Controlled Study N.J. Bureau, T. Moser, J.H. Dagher, D. Shedid, M. Li, P. Brassard and B.E. Leduc

·      Retrodural space of Okada in the posterior ligamentous complex region: clinical and anatomical findings relevant to lumbar interlaminar epidural injection

In the latest edition of The Zero Pain Philosophy podcast Matt talks to behaviour specialist Dr Carrie Tooley about sleep in dogs and cats. How many hours of sleep should dogs and cats be getting and how can sleep disturbance influence behaviour and emotional health?

Shownotes

• Why we sleep – Matthew Walker
• Li et al review (2022): The Influence of Sleep Disturbance on Chronic Pain: https://link.springer.com/article/10.1007/s11916-022-01074-2
• Sleep questionnaires – only one validated for use in dogs SNoRE 3.0: https://www.nature.com/articles/s41598-023-40048-1
• https://www.pdsa.org.uk/what-we-do/pdsa-animal-wellbeing-report/paw-report-2024
• BSS (British Sleep Society)/ESRS (European Sleep Research Society) – memberships, webinars, conferences
• BSS have a few podcast episodes “BSS bites”

Understand how to incorporate pre visit sedation protocols with your cat or dog friendly approach

This podcast complements the pre-visit medication protocols that we have on Zero Pain Philosophy

Learn how to interpret some of the behaviours that anxious dogs are showing in the hospital and how our interactions with those pets are 90% of the solution

Review the pre-visit and hospital sedation protocols created by Dr Matt Gurney & Dr Sarah Heath first, as you listen to this podcast

Find the sedation protocols at www.zeropainphilosophy.com. Please note access is limited to veterinary professionals and we are unable to answer advice queries from pet owners. Please contact your vet. 

For information on behavioural medicine support from Behaviour Referrals Veterinary Practice please visit https://behaviouralreferrals.co.uk/

References

Mills, Daniel S et al. “Pain and Problem Behavior in Cats and Dogs.” Animals : an open access journal from MDPI vol. 10,2 318. 18 Feb. 2020, doi:10.3390/ani10020318

Tooley, Carrie, and Sarah E Heath. “Emotional Arousal Impacts Physical Health in Dogs: A Review of Factors Influencing Arousal, with Exemplary Case and Framework.” Animals : an open access journal from MDPI vol. 13,3 465. 28 Jan. 2023, doi:10.3390/ani13030465