Pain Management

Question 1

What is pain?

Answer 1

A sensory experience that is associated with tissue damage

Question 2

List the 8 reasons for wanting to avoid pain in patients

Answer 2

1. Stress to patient
2. Prolonged recovery
3. Poor or delayed wound healing
4. Self-trauma
5. Impairs respiratory + cardiovascular functions
6. Reduces food intake
7. Reduces mobility
8. As RVNs, it is our ethical responsibility to address pain

Question 3

Describe the Physiology of pain

Answer 3

1. The nerve endings detect painful stimuli (Nociceptors)
2. The painful noxious stimulus that is associated with tissue damage releases the inflammatory mediators, called Prostaglandins
3. Which activate pain receptors in the Nociceptors

Question 4

Name the nerve endings which detect the painful stimuli

Answer 4

Nociceptors

Can be found throughout the body, including the skin, muscles, joints + internal organs

Question 5

Name the main inflammatory mediators, in the pain pathway

Answer 5

Prostaglandins

Can be found in virtually all tissues + organs, synthesized locally from arachidonic acid + affect neighbouring cells

Question 6

What can repeated stimulus of the pain pathway do to the body’s response to pain?

Answer 6

Heighten sensitivity to pain

Question 7

How does repeated stimulus of the pain pathway cause heightened sensitivity to pain in the body?

Answer 7

1. Through a process called ‘Sensitization’
2. Where the nervous system becomes more responsive to pain signals
3. Manifesting as:
   * Hyperalgesia (Inc sensitivity to pain)
   * Allodynia (Pain from non-painful stimuli)

Question 8

Sensitization is the process of a heightened nervous system response to pain and can be Central or Peripheral.

Explain what Central sensitization is.

Answer 8

1. Peripheral sensitisation is tissue damage that releases prostaglandins
2. These activate the Nociceptors
3. Which lower the pain threshold
4. Making them more easily activated
5. Leading to an increased response to pain
6. Such as Hyperalgesia or Allodynia

Question 9

Sensitization is the process of a heightened nervous system response to pain and can be Central or Peripheral.

Explain what Peripheral sensitization is.

Answer 9

1. Central Sensitisation is when repeated pain signals from the periphery cause changes in the dorsal horn of the spinal cord
2. This repeated c-fiber stimulation leads to increased excitability
3. Making them more responsive to pain
4. Then NMDA receptors amplify the response
5. Which triggers release of the neurotransmitters Glytamate or Substance P
6. Which further enhances the sensitivity of the dorsal horn neurons

Question 10

Describe the Pain pathway

Answer 10

1. Pain is detected by the Nociceptors
2. They convert that stimulus into a nervous signal, known as Transduction
3. The impulse is then transmitted via pain fibres ( Að + C)
4. Into the dorsal horn of the spinal cord
5. This is modulated in the CNS + sent to the brain
6. Where perception of the pain occurs

Question 11

What is the role of analgesia, in the pain pathway?

Answer 11

To interrupt or modify some or all parts of the pain pathway

Question 12

List the 3 ways in which analgesia interrupt or modify some or all of the pain pathway?

Answer 12

1. Reduces or blocks the transmission of painful nerve stimulus
2. Inhibiting the release of neurotransmitter stimulus
3. Alter the brain’s perception of pain

Question 13

Name 5 Physiological responses to pain

Answer 13

1. Increased HR + RR
2. Dilation of the bronchi
3. Release of Adrenaline&raquo_space; cardiac Arrhythmias
4. Dilation of BVs in Skeletal Muscle
5. Vasoconstriction of BVs in GI tract

Question 14

What is Acute pain associated with?

Answer 14

Injury or trauma
(I.e; Post-surgical)

Question 15

When should Acute pain generally subside?

Answer 15

As healing occurs

Question 16

How long should Acute pain last for?

Answer 16

It should not outlast the initial painful stimulus

Question 17

What is chronic pain?

Answer 17

Pain that lasts longer than anticipated

Question 18

How long does Chronic pain generally last?

Answer 18

• It generally outlasts the intitial painful stimulus
• Often lasting more than 1 month

Question 19

What is another name for ongoing pain?

Answer 19

Chronic Hypersensitivity

Question 20

List the 4 general effects of pain on the body

Answer 20

1. Sensory
   * Actual **sensation** + consequential physiological activity
2. Motor
   * Withdrawl or guarding actions
3. Cognitive
   * Learnt behaviour (Little movement, Lick granulomas)
4. Emotional
   * Continual pain + physiological effects, affect healing

Question 21

Name the 5 things that affect a patient’s individual response to pain?

Answer 21

1. Age
2. Species
3. Breed
4. Sex
5. Temperament

Question 22

List 4 major recognisable signs of pain

Answer 22

1. Vocalisation
2. Hunched posture
3. Facial expressions
4. Depression

Question 23

True or False.

It’s important to recognise that a patient’s signs of pain can vary not only from species, age or sex but individually.

Answer 23

True

Question 24

Stating the obvious, but why is it important to strive to recognise pain in patients?

Answer 24

To maintain animal welfare, by acting upon the signs of pain