Pain management in the neonatal piglet during routine management procedures. Part 2: Grading the quality of evidence and the strength of recommendations

Authors: ANTHONY, RAYMOND - University Of Alaska; BERGAMASCO, LUCIANA - Virginia Tech; COETZEE, JOHAN - Iowa State University; DZIKAMUNHENGA, RUNGANO - Iowa State University; GOULD, STACIE - Iowa State University; JOHNSON, ANNA - Iowa State University; KARRIKER, LOCKE - Iowa State University; Marchant, Jeremy; MARTINEAU, GUY-PIERRE - National Veterinary School Of Toulouse, France; MCKEAN, JAMES - Iowa State University; MILLMAN, SUZANNE - Iowa State University; NIEKAMP, SHERRIE - National Pork Board; O'CONNOR, ANNETTE - Iowa State University; PAJOR, EDMOND - University Of Calgary; RUTHERFORD, KENNETH - Sruc-Scotland'S Rural College; SPRAGUE, MICHELLE - American Association Of Swine Veterinarians; SUTHERLAND, MHAIRI - Agresearch; VON BORELL, EBERHARD - Martin Luther University

Submitted to: Animal Health Research Reviews
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/30/2014
Publication Date: 6/13/2014
Citation: Anthony, R., Bergamasco, L., Coetzee, J., Dzikamunhenga, R.S., Gould, S., Johnson, A.K., Karriker, L.A., Marchant Forde, J.N., Martineau, G.S., McKean, J., Millman, S.T., Niekamp, S., O'Connor, A., Pajor, E.A., Rutherford, K., Sprague, M., Sutherland, M., von Borell, E. 2014. Pain management in the neonatal piglet during routine management procedures. Part 2: Grading the quality of evidence and the strength of recommendations. Animal Health Research Reviews. 15(1):39-62.

Interpretive Summary: In swine production, multiple painful procedures, including castration, tail docking, teeth clipping, and ear notching, are conducted on piglets in the first few days of life. Consumers are becoming increasingly concerned about aspects of commercial production that may result in pain. In response, the National Pork Board (NPB) requested a project that would compile, review, and summarize the existing scientific literature about pain mitigation strategies in piglets and identify future research needs. Under the guidance of a steering committee, a systematic review of the scientific literature was conducted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process, which is an internationally recognized approach to developing guidelines in healthcare. This approach produced empirical evidence about research gaps and was used to reach recommendations about the use of pain mitigation strategies in piglets. The GRADE process enabled the development of recommendations for or against the adoption of identified pain mitigation strategies, a rationale for the strength of these recommendations, identification of research areas that would strengthen science-based decisions, and identification of areas where recommendations could not be made due to the absence of scientific evidence. The panel’s current position is: 1) a strong recommendation against the use of a CO2/O2 general anesthesia mixture for pain mitigation during castration in piglets between 1 and 28 days old, 2) a weak recommendation for the use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain mitigation during castration in piglets between 1 and 28 days old, and 3) a weak recommendation against the use of lidocaine as a pain mitigation strategy for piglets undergoing castration.

Technical Abstract: Piglets reared in swine production in the US undergo painful procedures that include castration, tail docking, teeth clipping, and identification with ear notching or tagging. These procedures are usually performed without pain mitigation. The objective of this project was to develop recommendations for pain mitigation in 1- to 28-day-old piglets undergoing these procedures. The National Pork Board funded project to develop recommendations for pain mitigation in piglets. Recommendation development followed a defined multi-step process that included an evidence summary and estimates of the efficacies of interventions. The results of a systematic review of the interventions were reported in a companion paper. This manuscript describes the recommendation development process and the final recommendations. Recommendations were developed for three interventions (CO2/O2 general anesthesia, non-steroidal anti-inflammatory drugs (NSAIDs), and lidocaine) for use during castration. The ability to make strong recommendations was limited by low-quality evidence and strong certainty about variation in stakeholder values and preferences. The panel strongly recommended against the use of a CO2/O2 general anesthesia mixture, weakly recommended for the use of NSAIDs and weakly recommended against the use of lidocaine for pain mitigation during castration of 1- to 28-day-old piglets.