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FA2 Anesthesiology > Lecture 22 11/25/24 > Flashcards

Lecture 22 11/25/24 Flashcards

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1
Q

What are the general characteristics of pain?

A

-unpleasant and aversive sensation
-complex and multifactorial
-emotional, subjective, and individual
-associated with damages/possibility of damages to body
-modifies animal behavior and expressions

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2
Q

What are the characteristics of transduction?

A

-conversion of noxious stimuli into action potential
-occurs at level of nociceptors of primary afferent A-delta and C fibers
-site of peripheral sensitization

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3
Q

What is transmission?

A

propagation of action potential through first order neurons

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4
Q

What is the role of A-beta fibers?

A

-touch, vibration, pressure, and innocuous stimuli
-involved in allodynia and central/peripheral sensitization

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5
Q

What is the role of A-delta fibers?

A

strong, rapid, sharp, localized, acute pain

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6
Q

What is the role of C fibers?

A

slow, burning, diffuse, dull pain

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7
Q

What are the characteristics of modulation?

A

-process by which nociceptive signal is augmented or inhibited after first order neuron synapse with second order neuron in the dorsal horn of spinal cord
-central sensitization

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8
Q

What is the role of excitatory neuropeptides?

A

facilitate/amplify pain signals in ascending projection neurons

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9
Q

What is the role of inhibitory endogenous neuropeptides?

A

dampen nociceptive response through descending analgesic systems

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10
Q

What are the characteristics of projection?

A

-process of transporting nociceptive information from the spinal cord to the brain stem, thalamus, and cortex
-second order neuron sends information to brain stem and thalamus

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11
Q

What are the characteristics of perception?

A

-cortical interpretation of noxious stimulus
-cerebral cortex is also central analgesia system
-liberation of enkephalins, endorphins, and serotonin helps to decrease/abolish pain

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12
Q

What are the characteristics of adaptive pain?

A

-can be nociceptive or inflammatory
-high pain threshold
-acute pain

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13
Q

What are the characteristics of maladaptive/pathological pain?

A

-can be neuropathic or functional
-low pain threshold
-chronic pain

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14
Q

What are the characteristics of acute pain?

A

-abrupt, temporary, and predictable
-nociceptive or inflammatory
-physiological/adaptive/biological purpose
-alters animal’s behavior to be protective

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15
Q

What causes acute pain to stop?

A

-external stimulus is removed
-inflammation has resolved
-healing is achieved

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16
Q

What are the characteristics of chronic pain?

A

-beyond expected duration of disease process/injury healing
-neuropathic/dysfunctional
-no biological purpose or clear end point
-resistant to conventional analgesic therapy
-affects physical and emotional well being
-can be maladaptive

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17
Q

What are the characteristics of neuropathic pain?

A

-important primary lesion in nervous system
-persistent painful stimuli
-chronic pain
-neuropathic pain and underlying condition must be treated

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18
Q

What are the characteristics of dysfunctional pain?

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A

-pain beyond expected time of inflammation/healing
-radiates beyond original injury boundaries
-extremely difficult to treat; does not respond well to NSAIDs or opioids
-previous tissue damage can cause severe inflammation
-changes at molecular/cellular level amplifies pain
-central hyperalgesia and allodynia

19
Q

What are the characteristics of tissue damage and peripheral sensitiziation?

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A

-release of inflammatory mediators
-stimulate nociceptors

20
Q

What are the characteristics of inflammation and peripheral sensitization?

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A

-reduces the activation threshold of nociceptors
-primary hyperalgesia

21
Q

What are the characteristics of central sensitization/wind-up pain?

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A

-increased transmitter release pre-synaptically
-increased response to transmitter post-synaptically
-modulation/recruitment of A-beta fibers to transmit painful influx
-increased pain facilitation
-decreased pain inhibition

22
Q

What is hyperalgesia?

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A

exaggerated pain to a stimulus that usually provokes pain

23
Q

What is allodynia?

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A

-pain due to a stimulus that does not normally produce pain
-inflammation causes recruitment of A-beta nerve fibers

24
Q

What are the characteristics of pain as a vital sign?

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A

-daily assessment of level of pain in any patient should be scored on physical exam sheet
-should be considered a vital sign that is measured routinely

25
What are the objective measures of pain?
-quantification of pain -physiological indicators -biochemical markers -nociceptive thresholds -measurement of animal's activity
26
What are the characteristics of subjective measures of pain?
-can be affected by variability from evaluator's side, especially if method is not specific, sensitive, reliable, and repeatable -most relevant methods use specific pain behavior such as facial expression or grimace scales
27
What are the characteristics of behavior assessment?
-key to pain assessment in animals -want to assess whether animal's behavior is normal or if it has changed -want to observe patient from a distance first and then interact with patient
28
What are pain-related behaviors in small animal?
-slow to rise -changes in using steps or jumping -going outside litter box -less interest in play -decreased grooming -irritability or hiding -licking or chewing certain spots -less energy/increased sleeping
29
What are pain-related behaviors in large animal?
-lameness/weight shifting/reluctance to move -weight loss and decreased milk production -vocalization/agitation/isolation -abdominal pain and decreased rumination -kicking/abduction of pelvic limbs -avoidance -rapid ear movement or flehming -arched hunched back and growling -position changes or rolling -aggressive behavior
30
What are the characteristics of behavior changes associated with chronic pain?
-more gradual of a manifestation -best to involve the owner; especially using questionnaires -need good knowledge of pain signs/symptoms since animals are good at hiding signs
31
What are the characteristics of pain scales?
-include specific species behavior -help integrate pain evaluation into physical exam -used to evaluate efficacy of analgesic treatment -allows for comparison of treatment -multidimensional, specific, sensitive, reliable, and accessible
32
What are the types of unidimensional pain scale?
-visual analog scale -numerical rating scale -simple descriptive scale
33
What are the characteristics of multidimensional pain scales?
-evaluates physiologic, behavioral, and interactive parameters -each parameter has a simple descriptive scale -allows observer to assign numbers based on description -total pain score helps to identify and grade pain -helps determine need for rescue analgesia
34
What are the characteristics of facial expressions?
-indicators of emotion -animals demonstrate unconscious micro-facial expressions that cannot be hidden as easily as behavior -help to identify pain in non-verbal individuals and animals
35
What are the consequences of untreated pain?
-decreased appetite -weight loss -lack of hydration -impaired intestinal and renal function -delayed wound healing -higher risk of infection and bad hygiene -disturbed sleep -aggressive/irritable behavior
36
What are the advantages of treating pain?
-earlier return to eating/less chance of weight loss -less catabolism -more rapid recuperation -better healing -better intestinal and renal function -acceptance of treatment and manipulation
37
What must be factored into an analgesic protocol?
-intensity of anticipated pain -age of patient -concomitant disease -breed and/or genetic predispositions -availability of molecules/modality, including cost
38
What are the characteristics of preventive analgesia?
-administration of analgesic prior to occurrence of painful stimulus -allows for a decrease in pain intensity pre, intra-, and post-operatively
39
What are the characteristics of multimodal analgesia?
-combination of different analgesic modalities -improves analgesic potency of protocol -minimizes side effects of each modality
40
What are the pharmacological analgesic modalities?
-local anesthetics and loco-regional analgesia -opioids -NSAIDs -alpha-2 agonists -ketamine and amantadine -tramadol -gabapentin
41
What are the non-pharmacological analgesic modalities?
-cold therapy -acupuncture -physiotherapy -weight loss
42
What should be considered when treating surgical pain?
-if any loco-regional blocks can be done -best opioid for each case -any contraindications to NSAID administration
43
What are the steps to treating arthrosis?
-weight loss -NSAIDs -modification of environment -physiotherapy -glycosaminoglycan/proteoglycans -diets rich in essential fatty acids

FA2 Anesthesiology (23 decks)

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