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ArticleIdentifyingBarrierstoImplementingPainManagementforPigletCastration:AFocusGroupofSwineVeterinariansBrooklynWagner1,* ,KennethRoyal2 ,RachelPark1 andMoniquePairis-Garcia1 1DepartmentofPopulationHealthandPathobiology,CollegeofVeterinaryMedicine,NorthCarolinaStateUniversity,Raleigh,NC27606,USA;rmpark@ncsu.edu(R.P.);pairis-garcia@ncsu.edu(M.P.-G.)2DepartmentofClinicalSciences,CollegeofVeterinaryMedicine,NorthCarolinaStateUniversity,Raleigh,NC27606,USA;kdroyal2@ncsu.edu*Correspondence:bwagner2@ncsu.eduReceived:27May2020;Accepted:11July2020;Published:15July2020

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olinaStateUniversity,Raleigh,NC27606,USA;kdroyal2@ncsu.edu*Correspondence:bwagner2@ncsu.eduReceived:27May2020;Accepted:11July2020;Published:15July2020 SimpleSummary:SurgicalcastrationisapainfulhusbandryproceduretypicallyperformedonpigletsintheUnitedStates(US)withinthefirstweekoflife.Castrationisusedtoimprovemeatquality,andasaresult,nearlyallmalepigsdestinedforslaughterintheUSwillbecastrated.Inrecentyears,consumersandretailershavequestionedtheethicalityofcastrationasaproductionpractice,giventhatitresultsinpainexperiencedbythepiglet.However,eliminatingcastrationisnotpracticalatthistimeintheUS,andtheadoptionofpainmanagementprotocolsremainsthemostviablesolutiontomanagingpainassociatedwithcastration.Giventhatveterinariansoftenhavedirectoversightregardingthedevelopmentofanimalcareprotocols,theobjectiveofthepresentstudyistoidentifyfactorsinfluencingswineveterinariandecision-makinginregardtopainmanagementforpigletcastrationusingfocusgroupmethodologies.Threemainareasoffocuswereidentifiedandincluded(1)thelackofapprovedproductsvalidatedfore cacy,(2)economiclimitationsandchallenges,and(3)deficientguidelinesandtrainingforveterinarianstodevelopprotocols.Thesebarriersmustbeaddressed,movingforward,tosupporttheuseofpainmanagementprotocolsforcastratedpigletsthroughouttheUSswineindustry.Abstract:SurgicalcastrationisapainfulhusbandryprocedureperformedonpigletsintheUnitedStates(US)toimprovemeatquality.Veterinariansplayacrucialroleindevelopingpainmanagementprotocols.However,providingpainmanagementforcastrationisnotcommonpracticeinUSswineproductionsystems.Therefore,theobjectiveofthepresentstudyistoidentifyfactorsinfluencingswineveterinariandecision-makinginregardtopainmanagementprotocolsforpigletcastrationusingfocusgroupmethodologies.Swineveterinarians(n=21)wererecruitedtoparticipateinoneofthreefocusgroups.Audiorecordingsweretranscribedverbatimandanalyzedbytwoindependentcoderswhoidentifiedthreeareasoffocus,including(1)thelackofapprovedproductsvalidatedfore cacy,(2)economiclimitationsandchallenges,and(3)deficientguidelinesandtrainingforveterinarianstodevelopprotocols.Althoughparticipatingveterinariansacknowledgedtheimportanceofpainmanagementfromananimalwelfarestandpoint,thesebarriersmustbeaddressedtoensurethatcastrationpaincanbesuccessfullymitigatedon-farm.Keywords:pig;piglet;drug;painmitigation;NSAID

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elfarestandpoint,thesebarriersmustbeaddressedtoensurethatcastrationpaincanbesuccessfullymitigatedon-farm.Keywords:pig;piglet;drug;painmitigation;NSAID 1.IntroductionSurgicalcastrationisapainfulhusbandryproceduretypicallyperformedonpigletsintheUnitedStates(US)withinthefirstweekoflife[1–3].CastrationisperformedtoimprovemeatqualitythroughAnimals2020,10,1202;doi:10.3390/ani10071202www.mdpi.com/journal/animals

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Animals2020,10,12022of10theeliminationofboartaint,anundesirableodorpresentinthemeatofintactmales[4].Asaresult,nearlyallmalepigsdestinedforslaughterintheUSwillbecastrated[5].Inrecentyears,consumersandretailershavequestionedpigletcastrationasaproductionpractice,giventhatitresultsinpainexperiencedbythepig[6].Theseconcernshaveresultedinthedevelopmentandimplementationofstrategiesthataimtomitigateoreliminatecastrationpainentirely[7–11].However,evenwhenpoliciesandlegislationareenactedtosupporttheuniversaladoptionofon-farmpainmanagementprotocolsforpigletsatcastration,enforcementischallenging.Forexample,in2010,the“EuropeanDeclarationonalternativestosurgicalcastrationofpigs”wasagreedupon,stipulatingthatby2012,pigletcastrationcanonlybeperformedwithprolongedanalgesiaand/oranesthesia,andby2018,surgicalcastrationshouldbephasedoutaltogether.However,inasurveyconductedin2016byDeBriyneandcolleagues,morethan80%ofmalepigswerestillcastrated,andonly5%ofthiscastratedpopulationreceivedanesthesiaandanalgesia[11].Thisunresolveddiscrepancycontinuestorepresentananimalwelfarechallengeforswineproductiononagloballevel.DataprevalenceforUSswinefarmsislackingbutislikelytohaveasimilarprevalenceofcastratedpigsintheEU,withalowerprevalenceofanalgesia/anestheticuse[5].SuchdiscrepanciesmaybeevenmoreextensiveintheUSthaninitiallyexplicated,impactinganestimated94millionpigletsannually.Todate,theUSmaintainsnostateorfederallegislationrequiringthatpainreliefbeprovidedtopigletsatcastration.Inaddition,approvalfromtheFoodandDrugAdministration(FDA)isrequiredinorderforproducersorcaretakerstoadministersuchpainreliefdrugswithoutoversightbyaveterinarian.Giventhesechallenges,painmanagementprotocolsvaryacrosstheUSswineindustry,andremainlargelyunderexamined,whencomparedwithfellowpork-producingcountries.Withintheswineindustry,veterinariansplayacrucialroleinimplementingpainmanagementprotocolson-farm.Veterinariansareoftenresponsiblefordirectoversightregardingthedevelopmentandexecutionofanimalcareprotocols.Inaddition,veterinariansareviewedbythepublicasanimalwelfarestewards[12,13],particularlyinregardtoalleviatingpainandsu ering.However,intheUS,swineveterinariansdonothaveaccesstoanFDA-approveddrugforpainreliefinswine[14].Infact,swineveterinarianscanonlyprescribepharmaceuticalsregulatedundertheAnimalMedicinalDrugUseClarificationActof1994tomitigatepaininanextralabelmanner[15].Althoughthisoptionisavailable,implementingpainmanagementprotocolsforcastrationisnotcommonpracticeinUSswineproductionsystems[16].Therefore,additionalbarriersarelikelyimpacting,andultimatelyimpeding,theuseofpainmanagementforpigletsatcastration.Therefore,theobjectiveofthepresentstudyistoidentifyfactorsinfluencingswineveterinariandecision-makinginregardtopainmanagementprotocolsforpigletcastrationusingfocusgroupmethodologies.2.MaterialsandMethodsAllresearchwasreviewedandapprovedbytheNorthCarolinaStateUniversityInstitutionalReviewBoardCommitteeforHumanSubjectsResearch(Protocol#20299).2.1.ParticipantRecruitmentandFocusGroupFormatSwineveterinariansattendingtheMarch2020AmericanAssociationofSwineVeterinarians(AASV)AnnualMeetingweretargetedforthisstudy.Focusgroupswereheldatthisconference,giventhelargenumberofswineveterinariansthatattendthemeetingonanannualbasis.TheAASVwaschartedin1969andisbasedoutofPerryIA,withapproximately1548members,309ofwhicharestudents.Thesemembersareinvolvedinpractice,industry,andacademiaspecifictotheswineindustryandarefrommorethan40countries;thus,veterinariansfromoutsideoftheUSweregiventheopportunitytoparticipate.Withsupportfromtheconferenceorganizers,arecruitmentadvertisementwassenttoAASVmembersviatheAASVweeklye-lettertorecruitparticipationinoneofthreefocusgroups.AllmembersoftheAASVhaveaccesstothee-letter;therefore,theopportunitytoparticipatewasprovidedtoallAASVmemberswhoreadthee-letter.Informationregardingthefocusgroupswasincludedin10e-lettersfrom15November2019to5February2020.Toencourageparticipation,

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Animals2020,10,12023of10a$100VISAgiftcardwasprovidedtoanyindividualwhoparticipatedinthefocusgroups.Interestedindividualswererequiredtosignaconsentformpriortoparticipation.Topromoteconfidentiality,participantswereencouragedtomaintaintheprivacyofotherfocusgroupparticipantsandrelateddiscussions.Thesamplesizewasjustifiedbyconductingfocusgroupsuntildatasaturationwasreached(i.e.,nonewinformationcouldbeobtained)[17,18].Demographicinformationwascollectedpriortothestartoffocusgroupdiscussionandincludedgender,age,race,currentrole,andthenumberofyearsengagedintheswineindustryandtotalsowinventoryunderdirectoversight.Discussionswerepromptedusingsixpredeterminedbasequestions(Table1)askedbyonetrainedmoderatortopromoteconsistencyandeliminateanye ectsofinterindividualvariability.Inaddition,eightpredeterminedfollow-upquestionscouldalsobeusedtoexpanddiscussionpointsatthediscretionofthemoderator.ModeratortrainingwasprovidedthroughtheCollaborativeInstitutionTrainingInitiative(CITI).Thisprogramis“dedicatedtopromotingthepublic’strustintheresearchenterprisebyprovidinghighquality,peer-reviewed,web-basededucationcoursesinresearch,ethics,regulatoryoversight,responsibleconductofresearch:::andothertopics”[19].Themoderatorwasrequiredtocompletetrainingprogramsandreceiveapassingscoreof80%beforebeingeligibletomoderatethefocusgroups.Table1.Primary(Q)andfollow-up(F)questionsutilizedinfocusgroupdiscussionsonpigletcastrationandpainreliefonswinefarmsintheUnitedStates. QuestionType#Question

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1.Primary(Q)andfollow-up(F)questionsutilizedinfocusgroupdiscussionsonpigletcastrationandpainreliefonswinefarmsintheUnitedStates. QuestionType#Question Q1Whatcomestomindwhenyouthinkaboutcastratingpigletson-farm?Q2Whatarethemainreasonstoprovidepainrelieftopigletsforcastration?Q3What,ifany,aretheadditionalbenefitsofprovidingpainrelieftopigletsforcastration?Q4WhatarethemainreasonstoNOTprovidepainrelieftopigletsforcastration?Q5What,ifany,aretheadditionaldrawbackstoprovidingpainrelieftopigletsforcastration?Q6Whatotherfactorsmightyouconsiderwhenmakingthedecisiontoimplementaprotocolthatinvolvesprovidingpainreliefforcastrationon-farm?F1Canyousaymoreaboutwhatyouhavejusttoldme?F2Canyouelaborateonthatstatement?F3Youmentioned[briefsummaryofparticipantstatement].Canyoudiscussthispointfurther?F4Canyougivemeanexampleofthisissue?F5Whatdoyouthinkconsumerswouldsayiftheyfoundoutpigletswere/werenotprovidedpainreliefforcastration?(forquestions3and5)F6Aretherebenefits/drawbacksforcaretakersthatprovidepainrelieftopigletsforcastration?(forquestions3and5)F7Arethereeconomicbenefits/drawbacks?(forquestions3and5)F8Whatdoyouthinkthelegalconsiderationsareforprovidingpainrelieftopigletsforcastration?(forquestions3and5)

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economicbenefits/drawbacks?(forquestions3and5)F8Whatdoyouthinkthelegalconsiderationsareforprovidingpainrelieftopigletsforcastration?(forquestions3and5) 2.2.DiscussionAnalysisAudiorecordingsoffocusgroupdiscussionsweretranscribedverbatim.Tworesearchersusedagroundedtheory[20],qualitativedataapproachforanalysis.Coder1isanassociateprofessorwithaPhDinmeasurementandevaluation.Coder2isapostdoctoralresearchscholarinanimalwelfarewithaPhDandexpertiseinanimalproductionandphysiology.Anemergent–systematicfocusgroupdesignwasemployed,inwhichthefirstgroupservedastheexploratorygroup,andtheothertwogroupsservedacombinationpurposeofexplorationandverification[21,22].Constantcomparisonanalysistechniqueswereusedtoassesssaturationacrossthethreegroups.Opencoding,aprocessinwhicheachtranscriptwasreadbyeachresearcherindependently,andkeywordsandphraseswereidentifiedandnoted,wasutilizedoncodeddata.Forexample,thestatement“:::ifit’sarequirementforthefarmtodoit,theywillprovidethelabor.Anditwouldincreasecost:::atsomepoint,youhavetogetpaidbackforyourinvestment,”generatedthefollowingcodes:“Protocol/Procedure”,“Time/Labor”,and“Economics”.Fromopencoding,selectivecodingwasemployedtoprovidericherdimensionstotheresearchproblembygroupingcodestogetherintocategories.Forexample,“Economics”andseveralothercodesformedanareaof

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Animals2020,10,12024of10focuscategorizedas“LogisticalFactors”.Researchersthendiscussedandcomparedresultstoensurethatcommonconceptualizationsofthedataoccurred.Next,selectivecoding,inwhichtheresearchersdevelopedareasoffocusthatemergedbasedonthesynthesizeddata,wasconducted.3.Results3.1.DemographicsTwenty-oneswineveterinariansparticipatedinoneofthreefocusgroups(7,8,and6participants/group,respectively;n=21).Amajority(66.7%)offocusgroupparticipantsweremaleandindicatedtheirraceas“White”(95.2%).Participantage,yearsofexperience,andprimaryrolewithintheswineindustryarepresentedinTable2.Themediannumberofsowsinwhichtheparticipantshaddirectoversightwas2000(rangingbetween80to1,000,000sows).Table2.Focusgroupparticipantdemographicinformation. QuestionResponseOptionsParticipant# Whatisyourage?29yearsoryounger230–39years740–49years450–59years260yearsorolder6 Whatisyourcurrentprimaryroleintheswineindustry?(Practitioner)Veterinarianworkinginprivatepracticewithorwithoutownershipofpigs5(Practitioner)Veterinarianworkingwithinproductionsystems5(Public/Corporate)Veterinarianworkinginacademia5(Public/Corporate)Veterinarianworkingwithinthealliedporkindustry3Other,pleasespecify(textlineprovided)3 Howmanyyearshaveyoubeeninvolvedwiththeswineindustry?1year02–5years26–10years611–15years316–20years221–25years0Over25years8

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especify(textlineprovided)3 Howmanyyearshaveyoubeeninvolvedwiththeswineindustry?1year02–5years26–10years611–15years316–20years221–25years0Over25years8 3.2.FocusGroupDiscussionWhenasked“Whatcomestomindwhenyouthinkaboutcastratingpigletsonafarm?”,themajorityofparticipantsnotedthat,althoughcontroversial,itisanimportantandnecessarypractice.Othersnotedthatpigletcastrationasaneconomicallydrivenprocessistime-consumingandlabor-intensive.Severalparticipantsalsonotedthattheprocedureisbothriskyandstressfulfortheanimal.Whenasked“Whatarethemainreasonstoprovidepainrelieftopigletsforcastration?”,theparticipantsprimarilystatedthatitimprovesanimalwelfareandwellbeing.Numerousparticipantsnotedtheprovisionofpainrelieftopigletsatcastrationisthe“right”thingtodofromanethicalperspectiveandindicatedthatithasbecomeaconsumerexpectation.Inaddition,theparticipantsevennotedthatprovidingpainreliefmaysendapositivemessagetocaretakersandemphasizethatanimalwelfareistakenseriously.Othershighlightedthepotentialbenefitstopighealthandproductivity.Whenasked“WhatarethemainreasonstoNOTprovidepainrelieftopigletsforcastration?”,mostparticipantsstatedtheprimaryreasonsasthelackofprovenbenefitandthefactthattherearecurrentlynopainreliefproductsapprovedforuseinpigletsintheUS.Furthermore,provingdruge cacy,andsubsequentlyobtainingapproval,remainsdi cultbecausemeasurementsofpainhavenotbeenvalidated.Theparticipantsalsonotedthattherearenospecificguidelinesthatincludesizeorageconsiderations.Otherparticipantsstatedthatprovidingpainreliefisalabor-intensivepracticewithoutaworthwhilereturnoninvestment,withoneparticipantspecificallynotingthattherearecurrentlynofinancialbenefitsfrompackersorretailerstojustifytheadditionaloperatingcost.Severalparticipants

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Animals2020,10,12025of10notedtheimportanceofminimizingthenumberofhandlingeventsandmentionedconcernsregardingthepotentialforunintendedconsequences(e.g.,sidee ectsofthedrug,greaterinjuryrisktothepigletswhilemedicated).Whenasked“Whatotherfactorsmightyouconsiderwhenmakingthedecisiontoimplementaprotocolthatinvolvesprovidingpainreliefforcastrationon-farm?”,theparticipantsexpressedawiderangeofresponses.Severalparticipantsnotedbeinguncertainifveterinariansorfarmsta wouldbetaskedwithprovidingoversightshouldpainreliefprotocolsbeimplementedforcastrationon-farm.Aneedfortraining(e.g.,drugadministration)andtheassociatedcostswerealsonotedaschallengeswithinfocusgroupdiscussions.Theparticipantsparticularlynotedthechallengesassociatedwithdemonstratingproductivityandeconomicbenefits,aswellasensuringcaretakersafety.Inaddition,withdrawaltimesandfoodsafetyconsiderationswerealsodiscussed.Severalparticipantsnotedpotentialissueswithcross-compatibilitywithotherproductsadministeredconcurrentlyandtheneedtobasedecisionsonoutcome-basedparameters.Severalparticipantsagainnotedtheparamountneedfordruge cacytobeestablishedandthedurationofpainreliefe ectstobedefined.Lastly,severalparticipantsalsostatedaneedforpiglet-specificdosageguidelines.4.DiscussionAnimalpainisanaversivesensoryexperiencethatresultsinbothphysiologicalandbehavioralchangestotheanimal[23].Preventionandmitigationofpainandsufferinginanimalsisanethicalobligationforveterinarians,asdemonstratedbytheVeterinarians’Oathtakenuponenteringtheprofession(“Beingadmittedtotheprofessionofveterinarymedicine,Isolemnlysweartousemyscientificknowledgeandskillsforthebenefitofsocietythroughtheprotectionofanimalhealthandwelfare,thepreventionandreliefofanimalsuffering,theconservationofanimalresources,thepromotionofpublichealth,andtheadvancementofmedicalknowledge...”[24]).Castrationisacommonproductionpracticeimplementedon-farmacrossmultiplespecies(e.g.,pigs,cattle,smallruminants)andisconsideredpainfulbasedonphysiologicalandbehavioralresponsesindicativeofpain[5].However,painmitigationisnotroutinelyimplementedforpigletsundergoingcastrationincommercialoperations.Giventhatveterinariansplayakeyroleinthedevelopmentofon-farmprotocolstomanagepain,understandingthebarrierstoimplementingpainmanagementisakeysteptoensuringpaincontrolforcastrationinthefuture.Therefore,theobjectiveofthepresentstudyistoidentifyfactorsinfluencingswineveterinariandecision-makinginregardtopainmanagementprotocolsforpigletcastrationusingfocusgroupmethodologies.Castration-associatedpainadverselyaffectstheindividualpig’saffectivestateandcannegativelyimpactbehaviorandproductivity[25].Veterinariansserveastheprimaryresourceineducating,training,andsupportingproducerswithimplementingpainmanagementon-farm.Forswineveterinarians,opportunitiestomitigatepainincludedevelopingpharmaceuticalprotocolstomanagepainassociatedwithcommonproductionpracticessuchascastration.However,observationalexperiencesintheindustrysuggestitisuncommonforpainmanagementtobeprovidedbeforeorduringthecastrationprocedureintheUS,andtherearenostudiestodatethatprovideprevalencedataonpainmanagementpracticesforcastrationintheUS[16,26].Therefore,theobjectiveofthepresentstudyistoidentifyfactorsinfluencingswineveterinariandecision-makinginregardtopainmanagementprotocolsforpigletcastrationusingfocusgroupmethodologies.IncontrasttothelegislativeapproachusedinCanadaandtheEuropeanUnion[10,27],theUShasaddressedtheneedforpainmanagementasaresultofpolicydevelopmentbyretailersinresponsetoconcernedcitizensandconsumers[28,29].Veterinariansdoandwillcontinuetoplayakeyroleinhighlightingtheimportanceofusingappropriateproductionpracticesthatoptimizeanimalwelfareinlivestockspecies[30].Inthepresentstudy,participatingveterinariansconsideredpainmanagementtobeacriticaltoolforensuringgoodwelfareforpigson-farm.Numerousparticipantsvoicedtheirbeliefthatmanagingcastrationpainwasthe“rightthingtodo”andpostulatedthatimplementingpainmanagementdemonstratestheimportanceofanimalwelfare,totheveterinarianand/orthecompany,fromacaretaker’sperspective.Oneparticipatingveterinarianstatedthat“:::providingpainreliefto

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Animals2020,10,12026of10theanimalssendstherightmessage:::wespendalotoftimetalkingaboutthemtreatingtheanimalsrightandweaskthemtodothispainfulprocedurethattheyknowhastohurt:::Ifwereallywantthemtoembracetheidealswethinkareappropriate,weshouldbemodelingthatifpossible,iftheoptionsareoutthere.”Inaddition,severalparticipantshighlightedthepotentialbenefitstopighealthandproductivity.Forexample,oneparticipantstatedthataneffectiveproductwouldinvolvephysiologicalimprovementssuchas“:::quickernursing,betterweightgainspost-castration:::”,whileanotherhighlightedtheactionbehindpainreliefdrugs,statingthat“:::alotofNSAIDs[nonsteroidalanti-inflammatorydrugs]couldpotentiallyhelpinthedifferentpathwaysofinflammation:::[leading]tothepigletcomingbacktonormalbehaviorandpotentialperformance”.Resultsfromthisstudyareinagreementwithpreviousworkaddressingveterinarianattitudestowardspainmanagement.AstudysurveyingveterinariansintheUKreportedthatveterinariansbelievethatprovidingpainreliefallowsanimalstorecovermorequicklyandviewtheadditionofpainreliefasapositiveoutcomeforbothanimalsandfarmers[31].Althoughparticipatingveterinariansacknowledgedtheimportanceofpainmanagementfromananimalwelfarestandpoint,theparticipantsalsovoicedsignificantconcernsoverimplementingpainmanagementforcastration.Threemainareasoffocusthatwereconsistentacrossallfocusgroupsandspecifictobarrierstopainmanagementimplementationwereidentifiedandincluded(1)thelackofapprovedproductsvalidatedfore cacy,(2)economiclimitationsandchallenges,and(3)deficientguidelinesandtrainingforveterinarianstodevelopprotocols.Objectivelyevaluatingpaininlivestockspeciesremainsachallengeduetovariationsinindividualanimalpainperception[32],aswellasprocedure-dependentdi erencesinpainsensitivity[33].Quantifyingpainassociatedwithcastrationhasbeenprimarilyconductedbyevaluatingbehavioralandphysiologicalresponsestotheprocedure,includingchangesincortisol, -endorphins,vocalizations,andpain-relatedbehavioralendpoints[1,25].Althoughtherearewelloverfiftypublicationsthatevaluatecastrationpaininpigs,nostudiestodatehavevalidatedtheseendpointmeasurementsusedtoquantifycastrationpain[1,2,34].Whenrecommendingpharmaceuticalinterventionforpain,thelackofvalidatedmeasures,combinedwithpoor-qualityevidencedemonstratingdruge cacy,haspreventedthedevelopmentofnationallyacceptedindustryguidelinesforpainmanagement[2].Veterinariansparticipatinginthisfocusgroupwerehesitanttoprovidepainreliefduringcastrationwithoutstrongscientificevidenceofdrugefficacy,asindicatedbyanFDA-approvedlabel.Oneveterinarianstated,“Productapprovalhasbeenahugedetrimenttoourindustryingettingsomethingdoneaboutpainmitigation”.Anotherveterinarianadded,“Oneofthechallengesisfindingpainmedicationthat’strulyeffective:::andtoday,we’relackingdatatomakethosedecisions:::orwedon’thaveanapprovedproduct”.Todate,theUShasnoFDA-approveddrugslabeledforpaincontrolinpigs.InordertoachieveFDA-labelapproval,methodsusedtoassesspainanddrugefficacymustbewell-definedandvalidated[35].Futureworkisneededtodeveloparesearchprotocolutilizingwell-defined,reliableendpointsthatmeasurecastrationpaininpiglets.PreliminaryworkconductedbythePainMitigationAssessmentProtocolConsortium,fundedthroughtheNationalPorkBoardandIowaPorkProducersAssociation,hasbegunthefirststepsinthisprocess.Thisconsortium,composedofindividualswithexpertiseinassessingpaininswine,wasestablished,andobjectivesareunderwaytovalidatebehavioral,physiologic,andbiomarkerendpointsthatreliablymeasurepainassociatedwithsurgicalcastrationinneonatalpiglets[35].InadditiontotheabsenceofanFDA-approvedproductformanagingcastrationpaininpiglets,economicconstraintswerealsoidentifiedasamajorbarriertoimplementingpainmanagement.Forexample,oneveterinarianstated,“Cost.Imean,thisisimportant.Iwanttodoit,butI’mnotgonnagobankrupttryingso...”,andanotherspecified,“You’dhavetoo setthatcost:::whenanewprocesscomesup,youhavetoevaluateit:::”.Flunixinmeglumine,meloxicam,andketoprofenarethreeNSAIDsthathavebeenstudiedmostfrequentlyinregardtocastrationpainmitigation[16,26,36,37].Onaper-pigletbasis,eachofthesedrugsyieldsatreatmentcostofapproximately$0.05to$1.32perpiglet.Inadditiontothedrugcost,

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Animals2020,10,12027of10laborandequipmentcostsneededtoadministerthedrugwouldneedtobetakenintoaccountaswell.AdetailedexampleandbreakdownoftheadditionalcostscanbefoundinFigure1.

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aborandequipmentcostsneededtoadministerthedrugwouldneedtobetakenintoaccountaswell.AdetailedexampleandbreakdownoftheadditionalcostscanbefoundinFigure1. Figure1.Anexamplescenarioofpainmanagementimplementationcosts(presentedasUSdollars).Theseadditionalcosts,coupledwiththelackofprovenhealthandperformancebenefitsthatmayhelpo setsuchcosts,makeitdi cultforveterinarianstomakeastrong,economicallygroundedargumentforproducerstoimplementpainmanagementprotocols[38].TheseresultsareinagreementwithresearchconductedbyHewsonandcolleagues[39]whosurveyedCanadianswineveterinarians’attitudestowardspainmanagement.InthisCanadianstudy,veterinariansnotedalackofcost-e ectivedrugsavailableforlivestockandvoicedconcernsregardingadditionalcostsassociatedwithprofessionaltimespentimplementingpainmanagementon-farm[39].ItisthereforeunlikelythatintheUS,painmanagementwillbedrivenbyeconomicbenefitsfortheproducer,andethicalconsiderationsandconsumerdemandwilllikelybethedrivingforce[40].Producersrelyheavilyontheirveterinarianstodevelopfarm-specificprotocolsforpainmanagement[40].Thisrelationshipcanbebeneficialastheproducercanimplementeffectivepainmanagementwithaprotocolthatclearlyoutlinestheprocessforcaretakersresponsibleforadministeringthedrug.However,painmanagementprotocolsmustbescientifically-validatedandincludeinformationspecifictodosage,administrationroute,andfrequency.Todate,veterinarianshavelimitedaccesstoscience-basedresourcestohelpguideprotocoldevelopmentandselecttheappropriatepharmaceuticalinterventiontomanagepainspecifictopigletageand/orsize.Forexample,oneveterinarianstated,“Ihaven’tseenanydatathathasdemonstratedtome,withanydegreeofcomfort,aboutwhatIamsupposedtobeusingforababypig.Theproductsthatarelicensedareformature,largeanimals,andthemetabolisminapigletisdifferent.”Anotherexpressedfrustrationregardingthelimitationsofavailablepharmaceuticals,specificallystating,“:::isitataconcentrationthat’sformulatedtogivetosuchasmallbodyweight:::injectable,oral,topicalapplications:::canyougetthatintoavolumethatwouldworkforthesizeofanimalthatweactuallywannagiveitto”.Irrespectiveofdrugapprovalstatus,veterinariansconsistentlydiscusseddeficienciesindrug-useguidelinescurrentlyavailabletodirectprotocoldevelopment.Inadditiontoprotocols,interactivetrainingtoolsmaybebeneficialtotheindustrytohelpswinecaretakersunderstandtheimportanceofpainmanagement.Interactivetrainingtoolsareoftenmoree ectiveforcaretakers[41,42]astheydonotrelyheavilyontexttodelivercomplexinformationoruse

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Animals2020,10,12028of10high-leveltechnicaljargonthatisconfusingtocaretakers[43,44].Therefore,futureworkisneededtoprovidescience-basedinformationtosupportveterinariansindevelopinge ectivepainmanagementprotocolsthatarespecifictotheprocedureandthepiglet.Thisstudye ectivelyhighlightssomeofthemajorchallengesperceivedbyveterinariansinregardtoimplementingpainmanagementforpigletsundergoingcastration.However,resultsfromthisstudymaybebiased,giventhatveterinarianswhoparticipatedinthefocusgroupsarelikelytobeeducatedonthistopicgiventheirinterestinparticipatingandmayrepresentamoreproactivesubpopulationofswineveterinarians.Futureworkisneededtorecruitalargerpopulationofswineveterinarianstoencompassallperceivedbarrierstopainmanagement.5.ConclusionsInconclusion,managingpainspecifictocastrationisviewedimportantlybyveterinariansinregardtosafeguardinganimalwelfare.However,thelackofanapprovedproductforcontrollingpigletpain,coupledwitheconomicchallengesandinsu cientscience-basedguidelines,makesitchallengingforswineveterinarianstoadvocateforanddeveloppainmanagementprotocolsforcastrationonUSswinefarms.ValidationofphysiologicalandbehavioralendpointstoquantifypainisthefirststepneededtoobtainFDAapprovalforadrugspecificforpainreliefinpiglets.Inaddition,developmentandaccesstoscience-basedguidelinesinwhichveterinarianscanusetodeveloppainmanagementprotocolsisneededtoensurepainassociatedwithcastrationcanbesuccessfullymanagedandmitigated.AuthorContributions:Conceptualization,M.P.-G.;methodology,B.W.,K.R.,R.P.,andM.P.-G.;formalanalysis,B.W.andK.R.;investigation,B.W.,R.P.,andM.P.-G.;resources,M.P.-G.;datacuration,B.W.andK.R.;writing—originaldraftpreparation,B.W.andM.P.-G.;visualization,B.W.andM.P.-G.;supervision,M.P.-G.;projectadministration,R.P.andM.P.-G.;fundingacquisition,M.P.-G.Allauthorshavereadandagreedtothepublishedversionofthemanuscript.Funding:ThisresearchwasfundedbytheNationalPorkBoardunderawardnumber18-037.Acknowledgments:ResearchreportedinthispublicationwassupportedbytheNationalPorkBoardunderawardnumber18-037.ConflictsofInterest:Theauthorsdeclarenoconflictofinterest.References1.Dzikamunhenga,R.S.;Anthony,R.;Coetzee,J.;Gould,S.;Johnson,A.;Karriker,L.;McKean,J.;Millman,S.T.;Niekamp,S.R.;O’Connor,A.M.Painmanagementintheneonatalpigletduringroutinemanagementprocedures.Part1:Asystematicreviewofrandomizedandnon-randomizedinterventionstudies.Anim.HealthRes.Rev.2014,15,14–38.[CrossRef][PubMed]2.O’Connor,A.M.;Anthony,R.;Bergamasco,L.;Coetzee,H.;Gould,S.;Johnson,A.K.;Karriker,L.A.;Marchant-Forde,J.N.;Martineau,G.S.;McKean,J.;etal.Painmanagementintheneonatalpigletduringroutinemanagementprocedures.Part2:Gradingthequalityofevidenceandthestrengthofrecommendations.Anim.HealthRes.Rev.2014,15,39–62.[CrossRef][PubMed]3.Yun,J.;Ollila,A.;Valros,A.;Larenza-Menzies,P.;Heinonen,M.;Oliviero,C.;Peltoniemi,O.Behaviouralalterationsinpigletsaftersurgicalcastration:E ectsofanalgesiaandanaesthesia.Res.Vet.Sci.2019,125,36–42.[CrossRef]4.Mörlein,D.;Trautmann,J.;Gertheiss,J.;Meier-Dinkel,L.;Fischer,J.;Eynck,H.J.;Heres,L.;Looft,C.;Tholen,E.InteractionofSkatoleandAndrostenoneintheOlfactoryPerceptionofBoarTaint.J.Agr.Food.Chem.2016,64,4556–4565.[CrossRef]5.Rault,J.-L.;Lay,D.C.;Marchant-Forde,J.N.Castrationinducedpaininpigsandotherlivestock.Appl.Anim.Behav.Sci.2011,135,214–225.[CrossRef]6.Molony,V.;Kent,J.E.AssessmentofAcutePaininFarmAnimalsUsingBehavioralandPhysiologicalMeasurements.J.Anim.Sci.1997,75,266–272.[CrossRef][PubMed]

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18,45,405–412.[CrossRef]44.Coleman,G.;Rea,T.;Hall,M.;Sawyer,A.;Hemsworth,P.H.Multimediatraininginthepigindustry.Comput.Educ.2001,37,257–271.[CrossRef] ©2020bytheauthors.LicenseeMDPI,Basel,Switzerland.ThisarticleisanopenaccessarticledistributedunderthetermsandconditionsoftheCreativeCommonsAttribution(CCBY)license(http://creativecommons.org/licenses/by/4.0/).