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. ReferencesNielsen 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. ReferencesYang 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. LinksGreenside Referralshttps://www.stemcellsscotland.co.uk/contact-usRussell’s bookhttps://5mbooks.com/product/regenerative-medicine-in-small-animal-musculoskeletal-conditionsAndrew Armitage’s paper on stem cellsEfficacy 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. ReferencesHere 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 catsMoreno-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.