Help reduce opioid reliance in horses with chronic pain using integrative, multimodal strategies that combine evidence-based therapies to improve long-term outcomes.
Every experienced equine practitioner knows how it feels to have a patient who has been on Bute for months with only partial relief. Or a laminitis case whose quality of life is slipping. Or a sporting horse whose back pain doesn’t show up on radiographs but is plainly written in his movement and eyes. These are the cases that push us beyond the prescription pad and toward a more complete treatment plan.
Chronic pain in horses is both common and undertreated. The conditions driving it, including osteoarthritis, laminitis, navicular syndrome, back pain, and soft tissue injuries, are woven into the fabric of equine athletic life. For decades, the default response has leaned heavily on non-steroidal anti-inflammatory drugs (NSAIDs) and, when those fell short, on opioids.
But opioids present a unique set of challenges in the horse: the risk of gastrointestinal dysmotility, the potential for excitement or dysphoria rather than calm, and regulatory restrictions in performance contexts. Perhaps most importantly, opioids are primarily a tool for acute and perioperative pain in horses, with inconsistent and limited evidence supporting their use in chronic pain management.1,2
What the equine field has been building toward, and what practitioners at the leading edge are already doing, is something different. A truly integrative, multimodal approach to pain that layers targeted pharmacology, interventional techniques, manual therapies, acupuncture, photobiomodulation, and nutraceutical support into individualized plans. None of these modalities alone is a silver bullet, but thoughtfully combined, they can offer chronic pain patients something opioids rarely deliver: lasting relief with meaningful improvements in quality of life.
This article is a practical guide to that approach, covering what the science supports, how the modalities work, and how to start building integrative pain plans in your own practice.
Recognizing the problem: chronic pain is subtle
Before we can treat chronic pain, we have to notice it. And in horses, this is not always straightforward. Unlike acute pain, which announces itself with pawing, sweating, and dramatic behavioral changes, chronic pain tends to be quieter. It shows up in posture, performance, and personality.
A horse with chronic back pain may pin his ears when groomed, resist the girth, or show subtle asymmetry at the trot. A horse with laminitic pain may stand with his weight shifted, spend more time recumbent, and lose the bright engagement with his environment that healthy horses show. Research has found that horses sufferingfrom back pain actually pay less attention to their surroundings, which is a simple but powerful observational cue for practitioners and owners alike.3
Several validated pain assessment tools now exist for horses, including composite pain scales, the Horse Grimace Scale, and musculoskeletal pain indices that integrate facial expression, posture, weight-bearing, and weight-shifting behaviors.2 Their implementation in daily practice remains inconsistent, but incorporating even informal pain scoring into routine examinations can meaningfully improve our ability to identify and track chronic pain.
One of the most important conceptual shifts in equine pain management over the past two decades has been the recognition that chronic pain is not simply ongoing nociception. It can involve peripheral sensitization, where injured tissues become hypersensitive, and central sensitization, where the spinal cord and brain amplify pain signals even in the absence of ongoing tissue damage. This wind-up phenomenon helps explain why some horses remain in pain long after an injury has healed, and why imaging findings often correlate poorly with clinical signs. Signs of chronic pain may occur in the absence of anatomical lesions, and may be absent in their presence, a reality that makes an integrative, function-based approach both logical and necessary.3
The pharmacological foundation: non-opioid options
Integrative does not mean abandoning pharmacology. It means using it more strategically. NSAIDs remain the workhorse of equine analgesia, and for good reason: they are effective, accessible, and well-understood. Phenylbutazone and flunixin meglumine have decades of clinical use behind them, while the newer COX-2 preferential agents, meloxicam and firocoxib, offer comparable efficacy with meaningfully lower gastrointestinal and renal side effect profiles, particularly for horses requiring long-term administration.1 For horses where systemic NSAID toxicity is a concern, topical diclofenac cream provides a useful localized option.1
When conventional NSAIDs provide insufficient relief, the bisphosphonates tiludronate and clodronate offer a valuable tool for bone-origin pain. These agents inhibit osteoclast and macrophage activity to reduce bone resorption, and have demonstrated improvement in lameness associated with distal hock OA, navicular disease, and vertebral pain.1 They are given as a one-time or periodic treatment rather than as daily medication, and their effects can persist for months, which makes them an appealing option for long-term pain management. Side effect risks, primarily colic and potential renal effects, should factor into their selection for individual patients.
For horses with evidence of central sensitization, the wind-up that keeps pain alive past its original cause, low dose ketamine delivered as an infusion has shown promise. Ketamine is an NMDA receptor antagonist; NMDA receptor activation is central to the development of hyperalgesia and central sensitization. Studies in laminitic horses have shown analgesic benefit, and the low doses used in these protocols do not produce the behavioral effects associated with anesthetic doses.1
Interventional techniques: getting to the source
When systemic medications provide incomplete relief, interventional techniques that directly target specific pain generators are the logical next step.
- Intra-articular therapy remains one of the most powerful tools available for joint pain. Corticosteroids combined with hyaluronic acid have a long track record for osteoarthritic joints, while biologic options such as platelet-rich plasma (PRP) and interleukin-1 receptor antagonist protein (IRAP) represent a growing area of evidence-based practice. IRAP, which delivers anti-inflammatory cytokines directly into the joint environment, has been shown to improve lameness scores in horses with osteoarthritis compared to placebo.1 These biologic therapies are particularly appealing from an integrative standpoint because they work with the body’s own healing mechanisms rather than simply suppressing inflammation.
- Two injectable disease-modifying osteoarthritis drugs (DMOADs) deserve mention as valuable components of a long-term joint pain management strategy: polysulfated glycosaminoglycan (Adequan) and sodium hyaluronate (Legend).
- Adequan, given intramuscularly on a loading schedule and then maintained periodically, works by inhibiting destructive enzymes within the joint, supporting cartilage matrix integrity, and reducing synovial inflammation. It is one of the few FDA-approved drugs specifically indicated for the treatment of non-infectious degenerative joint disease in horses, and many practitioners use it as a foundational part of chronic OA management.
- Legend, administered intravenously or intra-articularly, replenishes synovial hyaluronic acid, improving joint fluid viscosity and providing both lubricating and anti-inflammatory effects.
Both products are well-tolerated with excellent safety profiles, making them practical choices for horses requiring ongoing joint support. Used together or independently, Adequan and Legend complement intra-articular therapies rather than replacing them, and their systemic or multi-joint reach makes them particularly useful in horses with OA affecting multiple sites.
- Extracorporeal shockwave therapy (ESWT) deserves mention as a bridge between interventional and physical medicine. Applied to specific musculoskeletal lesions, focused shockwaves induce neovascularization and tissue remodeling. Broader evidence supports its use for desmitis, navicular syndrome, and a variety of soft tissue injuries.1
Manual therapies: hands as healing tools
The use of touch, massage, and joint manipulation for pain relief is arguably one of the oldest forms of therapy in existence, and the science behind it is considerably more sophisticated than its ancient origins might suggest.4
Manual therapy encompasses a spectrum of techniques, each with different biomechanical and neurophysiologic mechanisms of action. At one end, therapeutic touch and massage work primarily through superficial proprioceptor stimulation, promotion of relaxation, and modulation of local blood flow. Massage has been shown to reduce stress-related behavior in horses and lower mechanical nociceptive thresholds in the thoracolumbar region.4 These effects are modest but meaningful, particularly in horses whose chronic pain is compounded by the anxiety and tension that comes with restricted movement and stall rest.
Soft tissue mobilization and joint mobilization use graded manual forces to restore movement to restricted tissues and joints, reduce central sensitization of dorsal horn neurons, and facilitate normal neuromuscular function. The gate control theory offers one mechanism: stimulation of large-diameter mechanoreceptor fibers has an inhibitory effect on nociceptive pathways within the spinal cord.4 Manual therapy can also increase pain thresholds through the release of endorphins and serotonin, and may activate descending pain inhibitory systems projecting from the brain to the spinal cord.4
Spinal manipulation, characterized by high-velocity, low-amplitude thrusts, operates on articular structures with the intent of reducing pain, decreasing muscle hypertonicity, and restoring joint range of motion. In horses, two randomized controlled clinical trials using pressure algometry have demonstrated that both manual and instrument-assisted spinal manipulation can reduce back pain and increase mechanical nociceptive thresholds in the thoracolumbar region.4 Additional studies have shown improvements in spinal flexibility and longissimus muscle tone following chiropractic treatment.4
A key clinical principle from complementary medicine literature is that soft tissue dysfunction and joint restriction are deeply interrelated, and sequence matters. When muscle tone prohibits joint movement, the soft tissue must be addressed first.6 Any joint manipulation performed in the presence of significant muscle spasm is both less effective and more uncomfortable for the patient. This is why skilled integrative practitioners often begin a session with electroacupuncture or massage to achieve muscle relaxation before proceeding to manipulation.
Active stretching, particularly carrot stretches that induce flexion, extension, and lateral bending of the cervical spine and trunk, is a practical, owner-applicable component of any chronic pain management plan.4 Passive stretching of the limbs and axial skeleton, performed slowly and at low load to respect tissue viscoelastic properties, can improve joint range of motion and reduce secondary soft tissue contracture.4
Because of the potential for harm when these techniques are applied incorrectly, manual and manipulative therapies should be performed only by specially trained veterinarians or certified human manual therapists working in a veterinary context.4
Acupuncture: beyond endorphins
Of all the integrative modalities, acupuncture has arguably the deepest research base. In equine practice, it is experiencing a well-deserved expansion grounded in neuroscience rather than simply tradition.
The mechanisms of acupuncture are considerably more complex than the endogenous opioid release that early 1970s research identified as its primary action. Contemporary understanding includes serotonergic descending inhibition, local opioid receptor upregulation, adenosine release that dampens the local inflammatory soup, and suppression of C-fos expression in the spinal cord associated with central wind-up.3,5
Functional MRI studies in humans have revealed that acupuncture’s de qi response, the needle-grasp sensation felt when a needle is correctly placed, deactivates the limbic system and restores functional connectivity with the default mode network. These brain activity patterns are directly associated with chronic pain relief.3 The same limbic and default mode network architecture has been identified in functional MRI studies of primates, rodents, and rabbits, supporting its likely relevance in horses.3
There is growing evidence that acupuncture’s anxiolytic effects on the limbic system may actually be more important than its direct analgesic actions, a finding with significant clinical implications for horses whose chronic pain is amplified by stress, stall rest, and training pressure.3
In equine practice, one of the most valuable and underappreciated applications of acupuncture is in the diagnosis and treatment of myofascial pain syndrome (MPS). MPS is considered common in horses but significantly underdiagnosed because it is not consistently taught in veterinary curricula and does not show up on standard imaging or in serum biochemistry.3 It does not respond to NSAIDs or corticosteroids.
It is identified by skilled palpation: finding abnormally taut bands of muscle with discrete, hyperalgesic loci that elicit obvious pain responses and a local twitch response to cross-fiber manipulation. These myofascial trigger points (MTrPs) have been electromyographically documented in horses, showing the same spontaneous electrical activity seen in human and rabbit myofascial pain syndrome.3,5 MTrPs have a high correlation with traditional acupuncture point locations, which explains why acupuncture needling, particularly with electroacupuncture, is so effective in addressing them. Needle stimulation of the trigger point elicits a local twitch response and a reflexive reset of the dysfunctional motor end plate.3
A 2016 study conducted at the Royal Veterinary College found that palpation-based acupuncture treatment, as commonly performed in equine practice, produced positive improvements in both objective and subjective gait parameters in pastured horses.3 The clinical relevance is clear: acupuncture examination and treatment can identify and address a layer of pain, whether myofascial, segmental, or functional, that conventional diagnostic workups routinely miss.
For competition horses, acupuncture carries an additional practical advantage in that it carries no medication restrictions.3 In a sport where drug-free rules increasingly govern the field, this truly matters.
The TCVM (Traditional Chinese Veterinary Medicine) dimension of acupuncture adds another layer of clinical utility for practitioners who have pursued advanced training. Chinese herbal formulas for musculoskeletal pain, particularly those targeting qi/blood stagnation, wind-cold-damp obstruction, and qi deficiency, have a rich empirical history and an emerging evidence base.5 Herbs such as Yan Hu Suo (Corydalis) for analgesia, Ru Xiang (Boswellia) for its anti-inflammatory and analgesic properties, and Du Huo (Angelica pubescens) for lower limb and back pain are among the most commonly employed.5
Acupuncture mechanisms at a glance
- Endogenous opioid release: enkephalins and beta-endorphins activated in spinal cord and brain5
- Serotonergic descending inhibition: activates brainstem pain-suppressing pathways3
- Adenosine release: local anti-inflammatory effect at needle site3
- C-fos suppression: reduces central wind-up in the spinal cord3
- Limbic system modulation: reduces stress and anxiety amplification of pain via the default mode network
- Myofascial trigger point reset: local twitch response resets dysfunctional motor end plates3
- Gate control: large-fiber stimulation inhibits nociceptive input at the dorsal horn.5
Photobiomodulation: light as medicine
Over the past decade, photobiomodulation (PBM), also called laser therapy or low-level laser therapy, has moved from fringe to mainstream in equine rehabilitation. The proposed biological mechanisms are plausible, the clinical applications are broad, and the safety profile is excellent.
The mechanism of action centers on photon absorption by mitochondrial chromophores, specifically photodissociation of inhibitory nitric oxide from cytochrome C oxidase, which enhances electron transport, ATP production, and downstream cellular repair and proliferation.7 In practical terms, targeted light energy appears to give damaged or inflamed tissue a metabolic boost that supports healing and reduces pain.
A 2023 systematic review of laser therapy in veterinary medicine evaluated 45 studies in horses, dogs, and cats, covering musculoskeletal conditions, wounds, pain, and neurologic disease.7 For equine back pain, the most relevant study was a randomized controlled trial of 61 Quarter Horses: it found that laser therapy produced significant reductions in back pain, epaxial muscle hypertonicity, and trunk stiffness.7 A combined laser-and-chiropractic protocol produced similar results, while chiropractic alone showed no significant changes, suggesting that laser may serve as a useful primer that amplifies the effects of subsequent manual therapy.7
The evidence picture for laser therapy has some limitations. Study quality is variable, treatment protocols differ widely in wavelength, dose, and frequency, and results are sometimes conflicting.7 Penetration into deeper equine tissues, particularly tendons and ligaments, is significantly limited by the horse’s coat and skin pigmentation, and clipping the treatment area improves light delivery.7 These are practical realities worth communicating to clients.
Pulsed electromagnetic field therapy (PEMF) is frequently used alongside laser in integrative equine practice, with reported benefits for musculoskeletal pain and tissue healing. Controlled equine-specific data remains limited, but PEMF is widely adopted and well-tolerated. Additionally, its proposed mechanisms of modulating cell membrane potential and reducing inflammatory mediators are biologically credible.
Nutritional support: the long game
Nutritional and nutraceutical support is rarely sufficient as a standalone pain strategy, but as one layer within a multimodal plan it offers safe, well-tolerated, long-term background support that many horses benefit from.
Before reaching for any supplement, it is worth stepping back to consider the foundation: what the horse is eating every day. A species-appropriate, forage-based diet is one of the most powerful and underutilized tools in managing systemic inflammation. Horses evolved as continuous grazers on fibrous, low-starch grasses, and their digestive and metabolic systems are calibrated accordingly.
Many modern feeding programs, particularly those relying heavily on processed concentrate feeds, introduce significant quantities of refined starches and low-quality vegetable oils high in Omega-6 fatty acids. These ingredients can drive systemic inflammation through multiple pathways, working directly against any anti-inflammatory treatment plan we put in place.
In the author’s clinical experience, transitioning a horse to a diet built around quality forage, with concentrates used sparingly and selected carefully for ingredient quality, can have a meaningful impact on whole-body inflammatory tone, often as significant as anything that comes in a supplement bucket. For horses with chronic pain conditions, getting the diet right is not optional. It is the foundation everything else is built on.
- Omega-3 fatty acids have the strongest evidence base for nutraceutical anti-inflammatory support. They compete with arachidonic acid for COX and LOX enzyme pathways, reducing the production of pro-inflammatory prostaglandins and leukotrienes. For horses, ground flax seeds and chia seeds are more species-appropriate Omega sources than fish or algae based products.
- Joint nutraceuticals including glucosamine, chondroitin sulfate, methylsulfonylmethane (MSM), and hyaluronic acid, remain the most widely used supplements in equine practice, with plausible mechanisms related to cartilage matrix support and synovial fluid quality. Evidence quality is variable and clinical effects are modest, but in a chronic pain context where every layer matters, their safety profile makes joint nutraceuticals a reasonable inclusion.
- Curcumin (turmeric) has drawn considerable interest for its potent anti-inflammatory activity. Research has suggested its effects may exceed those of some conventional anti-inflammatory drugs, with inhibition of both COX and 5-lipoxygenase pathways.5 The clinical challenge is bioavailability: curcumin is poorly absorbed from the equine gut, and formulations that address this are still being evaluated. It is a promising adjunct rather than a proven analgesic at this stage, but it is widely used and well-tolerated.
- Body weight management is itself a form of pain management for horses with laminitis. Reducing mechanical load on compromised laminae is an essential element of any analgesic plan.
- Cannabidiol (CBD) is one of the more intriguing additions to the equine integrative toolkit, and the evidence base is beginning to catch up with the clinical interest. A 2024 randomized controlled study evaluated oral transmucosal CBD oil administered at 0.03 mg/kg daily as an adjunct to a standard phenylbutazone protocol in horses with mild osteoarthritis.8 Horses receiving CBD alongside the NSAID showed significantly greater reductions in pain scores on the validated Horse Chronic Pain Scale compared to those receiving phenylbutazone alone, along with reductions in heart rate, respiratory rate, white blood cell count, and serum markers of oxidative stress.8 No adverse effects were observed at the dose used.8
The proposed mechanisms involve both CB1 and CB2 receptor activity, with CB2 receptors, located peripherally in synovial tissue, dorsal root ganglia, and joint structures, appearing particularly relevant to joint pain modulation with minimal psychoactive effects.8 Regulatory status for CBD varies by jurisdiction and competition rules, and practitioners should verify local guidelines before recommending it, but the early data in horses are genuinely promising.
Why opioids fall short in horses
- Horses have fewer mu-opioid receptors in the brain than dogs, contributing to inconsistent analgesia and paradoxical excitement with systemic administration 1
- Full mu-agonists (morphine, fentanyl) frequently cause GI dysmotility; long-term morphine use (more than 24 hours) raises post-operative colic incidence to 34% 2
- Regulatory restrictions apply in performance horses
- Evidence for efficacy in naturally occurring chronic pain conditions (OA, laminitis) is weak and inconsistent 1,2
- Intra-articular and epidural opioid delivery shows more consistent local analgesic effects with reduced systemic concerns 1
Equine pain recognition: what to look for
Behavioral indicators:
- Pinning ears, tail wringing, or resistance during grooming/saddling
- Reduced engagement with environment; inattentiveness or dullness
- Changes in appetite, stall behavior, or time spent recumbent
- Reluctance to move forward under saddle; training resistance
- Uncharacteristic aggression or irritability
Postural indicators:
- Weight shifting or abnormal limb loading at rest
- Altered head/neck carriage
- Asymmetric hip drop, shortened stride, or stiffness at the walk
Facial expression:
- Tension around the eyes and muzzle (Horse Grimace Scale)
- Ears back or rotated laterally
- Tense jaw and tightened nostrils
Performance indicators:
- Inconsistent lameness that worsens under saddle
- Loss of engagement, impulsion, or collection
- Resistance to lateral work or frame changes
Building your integrative team
Effective multimodal pain management rarely happens in isolation. Consider building referral relationships with:
- Certified equine rehabilitation practitioner for structured exercise prescription, hydrotherapy, and physiotherapy
- Veterinary acupuncturist for acupuncture, electroacupuncture, and myofascial pain management
- Veterinary chiropractor for spinal manipulation and joint mobilization
- Equine massage therapist for soft tissue work between veterinary visits
- Farrier with lameness awareness, because corrective shoeing is pain management
- Saddle fitter, since poor saddle fit is a genuine cause of back pain and top line dysfunction6
- Trainer with biomechanical knowledge, as training methods that force the head and neck against resistance can create or worsen cervical segmental dysfunction6
Find practitioner directories through the following organizations: International Veterinary Acupuncture Society (IVAS), Chi Institute of Traditional Chinese Veterinary Medicine, Association of British Veterinary Acupuncturists (ABVA), American Holistic Veterinary Medical Association (AHVMA), and American Veterinary Chiropractic Association (AVCA).
A sample integrative protocol: chronic hock OA
Tier 1 – Foundation (ongoing):
- Meloxicam (COX-2 preferential; monitor GI and renal function with long-term use)
- Omega-3 supplementation (flaxseed or chia)
- Corrective shoeing consultation
- Adequan loading series, then monthly maintenance injections
- Controlled exercise program (structured movement is itself analgesic; avoid stall rest unless necessary).
Tier 2 – Targeted interventions (every three to six months or as needed):
- Intra-articular corticosteroid/HA or IRAP
- Spinal manipulation and soft tissue therapy if secondary back pain or myofascial component is identified.
Tier 3 – Integrative modalities (regular maintenance):
- Acupuncture/electroacupuncture (every four to six weeks for maintenance; more frequently during flare-ups, or proactively to prevent flare-ups during times of increased physical activity)
- Photobiomodulation to affected joints and surrounding muscles; clip coat over treatment areas
- PEMF or ESWT as adjunct to laser or standalone for maintenance.
Owner-directed home care:
- Carrot stretches (cervical flexion, extension, lateral bending daily)
- Passive limb range of motion stretches as instructed
- Monitoring with pain scoring using grimace scale, movement quality, and behavioral checklist.
Looking ahead: emerging therapies
- Anti-NGF monoclonal antibodies are highly effective in dogs and cats with OA; equine studies are not yet published but the approach represents a compelling future option.1
- Soluble epoxide hydrolase (sEH) inhibitors show early promise as analgesic adjuncts in laminitis, targeting fatty acid-derived pain mediators.1
- Grapiprant (prostaglandin receptor antagonist) is well-tolerated orally in horses; its COX-independent mechanism avoids NSAID side effects; efficacy studies are pending.1
- Stem cell and PRP therapies continue to build an evidence base for joint and soft tissue applications.
Putting it all together: the integrative mindset
The greatest shift towards an integrative mindset is not simply adding new modalities to our toolkit. It is changing how we think about pain itself.
An integrative approach doesn’t mean you abandon conventional treatments. NSAIDs, steroids, and injections have a place. But so do modalities like acupuncture, laser, manual therapy, targeted exercise, and nutraceutical support. The power of this approach lies in its layering, with each modality simultaneously addressing a different component of the pain experience rather than a single agent trying to suppress the whole.
A useful clinical framework is to think in tiers: a pharmacological foundation that provides reliable background analgesia, interventional techniques that address specific structural pain generators, and integrative modalities that work on the nervous system, soft tissue, and metabolic levels while reducing the total pharmacological burden. Monitoring should be built into every plan, and not just lameness grades but behavioral assessments, pain scores, and owner-reported quality of life changes over time.2
Communication matters here. Clients who understand that chronic pain is a multifactorial, nervous-system-level phenomenon are more likely to commit to the long-term management these horses need. It’s necessary to set realistic client expectations upfront around timeframes, cost of treatment, and prognosis.
The horse’s comfort and quality of life is ultimately the guiding principle of everything we do. A horse who is moving better, engaging with his environment, tolerating work with ease, and showing none of the subtle behavioral distress of undertreated pain is a result of successful treatment. And that kind of success is increasingly achievable for more horses when we offer an integrative approach.
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References
1Mama KR, Hector RC. “Therapeutic developments in equine pain management.” Vet J. 2019;247:50-56.
2Chiavaccini L, Reed RA, Spadavecchia C. “Editorial: Advancements in equine pain management.”
Front Pain Res. 2025;6:1547764.
3von Schweinitz DG. “Using acupuncture to treat pain in horses.” In Practice. 2017;39(8):372-377.
4Haussler KK. “The role of manual therapies in equine pain management.” Vet Clin Equine. 2010;26(3):579-601.
5Fleming P. “Nontraditional approaches to pain management”. Vet Clin Equine. 2002;18(1):83-105.
6Wolf L. “The role of complementary techniques in managing musculoskeletal pain in performance horses.” Vet Clin Equine. 2002;18(1):107-115.
7Millis DL, Bergh A. “A systematic literature review of complementary and alternative veterinary medicine: laser therapy.” Animals. 2023;13(4):667.
8Interlandi C, Tabbì M, Di Pietro S, D’Angelo F, Costa GL, Arfuso F, Giudice E, Licata P, Macrì D, Crupi R, Gugliandolo E. “Improved quality of life and pain relief in mature horses with osteoarthritis after oral transmucosal cannabidiol oil administration as part of an analgesic regimen.” Front Vet Sci. 2024;11:1341396.
AUTHOR PROFILE
Meghan Barrett, DVM, cVMA, CCRT, CVNN, CFVT, FFCP
