Pain from non-active abscess?

Logically you'd presume that a jaw abscess would be painful...right?

Well...I'm now reasonably sure that Vernon's jaw is not causing him pain. He has 2 walled off, non-active abscesses either side of his jaw bone, and osteomylitis in the jaw bone itself. Over the past few months I've been experimenting with pain relief, and have come to the conclusion that it isn't causing him pain?!?

His behaviour is exactly the same irrespective of whether he has pain relief or not (he's a happy, lively rabbit who loves to run and binky )...and even with no pain relief he will happliy allow me to prod and poke at his abscess.

I wonder if it has anything to do with the fact that Vernon's abscess has never been operated on or opened up for treatment? :?

Anybody else have any observations or opinions to add? TIA :wave:

Daisy has an abscess which has walled off. She has been on metacam for 15 months and it appears to control any pain.

raine said:

Daisy has an abscess which has walled off. She has been on metacam for 15 months and it appears to control any pain.

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What dosage do you give Daisy? Do you think she benefits from it? Where is Daisy's abscess? (sorry for all the Qs )

Pain is often related to inflammation and pressure, especially in a fixed space cavity such as the skull, any increase in space occupied tends to press on soft tissue and pain receptors causing pressure and nerve pain. There was a discussion about abcesses back on rabbit chat a month or so ago where you mentioned inactive abcesses and I vehemently disagreed with you! So I asked my dad about it (he's a doc) and he actually agreed with you I think you may be right and if the abcess is significantly walled off and inactive there is little or no surrounding tissue inflammation and no sensory nerve receptors involved or pressure pain. :?

It would be nice to hear Thumps explain this far better than me :wave:

I suppose the danger with buns is that they are so highly adapted to mask pain and soldier on through it. A friend of mine has a bun with osteomyelitis of the jaw and a very active abcess being constantly drained and little or no pain relief and only on baytril, as it is in SA, and yet her bun tolerates wound cleaning and flushing and is eating through it all. I suppose I would always be inclined to err on the side of caution with any 'infective' situation - osteomyelitis is extremely painful, I have seen it in humans, and simply because of the risks of adrenaline release causing gut hypomotility in rabbits would be wary about not providing pain relief for the osteomyelitis, if not for the abcesses. I'm not disagreeing with your observations of your bun though :wave:

prettylupin said:

Pain is often related to inflammation and pressure, especially in a fixed space cavity such as the skull, any increase in space occupied tends to press on soft tissue and pain receptors causing pressure and nerve pain. There was a discussion about abcesses back on rabbit chat a month or so ago where you mentioned inactive abcesses and I vehemently disagreed with you! So I asked my dad about it (he's a doc) and he actually agreed with you I think you may be right and if the abcess is significantly walled off and inactive there is little or no surrounding tissue inflammation and no sensory nerve receptors involved or pressure pain. :?

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I can't remember the discussion, but big thanks to your dad! :lol:

I don't have any medical knowledge/background at all, so my observations tend to be purely from my own experience (I've kept pet rabbits all my adult life...about 13 years)

prettylupin said:

I suppose the danger with buns is that they are so highly adapted to mask pain and soldier on through it. A friend of mine has a bun with osteomyelitis of the jaw and a very active abcess being constantly drained and little or no pain relief and only on baytril, as it is in SA, and yet her bun tolerates wound cleaning and flushing and is eating through it all. I suppose I would always be inclined to err on the side of caution with any 'infective' situation - osteomyelitis is extremely painful, I have seen it in humans, and simply because of the risks of adrenaline release causing gut hypomotility in rabbits would be wary about not providing pain relief for the osteomyelitis, if not for the abcesses. I'm not disagreeing with your observations of your bun though :wave:

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Yes, that's always a concern. Despite the fact that I know rabbit behaviour pretty well, I've only had Vernon for a few months...so I'm not totally au fait with the signs to watch out for when he's feeling unwell just yet

I agree with pretty lupin. It's the pressure caused by pus & inflammation which causes the pain. If the surrounding tissues are loose & stretch easily there is far less pain from the same sized abscess than in situations where the tissues can't stretch. This is why pus in bone is excruciatingly painfull.

If the abscess cavity is truly inactive, no more pus will be forming. In fact in humans the normal body process will be to remove the pus gradually = reduced pressure & pain relief.
[I add that the human abscess has very liquid pus, & thin walls, unlike the rabbit abscess. The better human equivalent is an infected sebaceous cyst, but for the purposes of this discussion, the differences don't matter.]

In this situation, I would expect the best index of the need for pain relief, to be food intake as assessed by a change in the size & quantity of waste poop output. [chewing increases the pressure throughout the area of the jaw, to a level which is not painful. But if pressure is increased where there is already abnormally high pressure it can become painful. Daisy will chew less if it hurts her jaw.]

This is a fascinating "case". I take my hat off to your observation of Daisy.
I agree with you that there is no point in giving medication if it is not needed.
Thank you for yet another very interesting post.

abbymarysmokey said:

Logically you'd presume that a jaw abscess would be painful...right?

Well...I'm now reasonably sure that Vernon's jaw is not causing him pain. He has 2 walled off, non-active abscesses either side of his jaw bone, and osteomylitis in the jaw bone itself. Over the past few months I've been experimenting with pain relief, and have come to the conclusion that it isn't causing him pain?!?

His behaviour is exactly the same irrespective of whether he has pain relief or not (he's a happy, lively rabbit who loves to run and binky )...and even with no pain relief he will happliy allow me to prod and poke at his abscess.

I wonder if it has anything to do with the fact that Vernon's abscess has never been operated on or opened up for treatment? :?

Anybody else have any observations or opinions to add? TIA :wave:

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Hiya,
Maddie has osteomyelitis in her jaw too and has had any abscess that have appeared removed so far - last one 5 weeks ago. I too presumed that it was a painful condition based upon human medicine reports, and I thought that she was displaying some pain symptoms - chewing her dewlap.

She has chewed her dewlap for many many months (before any abscesses started showing) and has actually got down to the skin and chewed her flesh before now too. However, as part of her treatment to control the jaw infection, we removed her incisors, so as a side effect she can't actually damage herself anymore, but she also appeared to stop nibbling at it following that op.

About 2 months ago, an abscess formed again (and she'd started chewing the dewlap again) so we've had that removed and shes on Dupaphen injections. I've been giving her Metacam but still the chewing continued - so I came to the conclusion that either the matacam wasn't enough, or that its not actually a pain response?

Her eating, playing, pooing etc isn't effected, but don't you wish they could just tell you what is going on, sometimes??

Mad Bunster said:

Hiya,
Maddie has osteomyelitis in her jaw too and has had any abscess that have appeared removed so far - last one 5 weeks ago. I too presumed that it was a painful condition based upon human medicine reports, and I thought that she was displaying some pain symptoms - chewing her dewlap.

She has chewed her dewlap for many many months (before any abscesses started showing) and has actually got down to the skin and chewed her flesh before now too. However, as part of her treatment to control the jaw infection, we removed her incisors, so as a side effect she can't actually damage herself anymore, but she also appeared to stop nibbling at it following that op.

About 2 months ago, an abscess formed again (and she'd started chewing the dewlap again) so we've had that removed and shes on Dupaphen injections. I've been giving her Metacam but still the chewing continued - so I came to the conclusion that either the matacam wasn't enough, or that its not actually a pain response?

Her eating, playing, pooing etc isn't effected, but don't you wish they could just tell you what is going on, sometimes??

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I'm sorry to hear that Maddie is having these problems.

Re. pain in osteomyelitis; it is truly agonizing in humans & difficult to relieve. It is at it's worst when pus accumulates under the membrane surrounding the bone (periosteum) & can't get out. It takes time to produce the bone changes we see on XR in human osteomyelitis, so a normal XR does not exclude an early case. However bunnies have a much faster metabolic rate than us. I do not know how long it takes for the XR abnormalities to show in buns.

I truly believe it is reasonable to assume that any bun with active infection is in pain. AMS is describing inactive treated infection.

The other major difference with buns, is that the stress of pain causes a rapid fall in the white cells in the blood. These white cells are needed to fight any infection, & they actually need an increase in the number of white cells for a successful outcome.

So our buns need pain relief not only to relieve suffering, but to enable them to fight infection, & prevent GI stasis too.