Pain management

Question 1

What is pain?

Answer 1

A sensory experience that is associated with tissue damage

Question 2

Why do we want to avoid pain?

Answer 2

stress to patient 
Prolonged recovery 
Poor/delayed wound healing 
impairs respiratory and cardiovascular function 
Reduced food intake 
Self trauma 
Reduced mobility 
Is our ethical responsibility

Question 3

How does the body respond to intra-operative pain?

Answer 3

Increased HR and RR
Dilation of bronchi
Adrenaline release leads to cardiac arrhythmias
Dilation of blood vessels in skeletal muscle
Constriction of BVs in GI tract

Question 4

How does the body respond to acute pain?

Answer 4

ASsociated with injury/trauma
Usually abates as healing occurs
Does not usualy outlast the initaial painful stimulus

Question 5

How does the body respond to chronic pain?

Answer 5

Pain that outlasts the initial painful stimulus
Can be defined as pain lasting longer than anticipated
British pain society defines as ‘pain lasting longer than 12 weeks’
Significane: chronic pain can lead to changes ein the pain pathways of the central and peripheral nervous system

Question 6

What is analgesia?

Answer 6

loss of sensitivity to pain/absence of pain

Question 7

What is hypoalgesics?

Answer 7

More accurate term, due to absolute analgesia being achieved by local anaesthetics - pain transmission completely blocked

Question 8

What is pre-emptive analgesia?

Answer 8

admin of analgesics prior to pain stimulation preventing neuron sensitization

Question 9

Describe the physiology of pain

Answer 9

Painful (noxious) stimulus associated with tissue damage and release of inflammatory mediators leading to activation of pain receptors in pain fibres (nociceptors)
Nociceptors transmit pain signals to the CNS via pain pathways
Repeated stimulus of pain pathways can lead to heightened sensitivity

Question 10

Describe the pain pathway

Answer 10

Pain is detected by nociceptors that then convert the painful stimulus into a nervous signal (transduction)
The impulse is transmitted via pain fibres into the dorsal horn of the spinal cord
The signal is modulated in the CNA
Information is sent to the brain where perception of pain occurs

Question 11

What are the types of pain?

Answer 11

Physiological
Inflammatory
Neuropathic

Question 12

Describe physiological pain

Answer 12

Pain that goes when stimulus removed, protective pain

Response is proportionate to stimulus e.g. thorn in paw

Question 13

Describe inflammatory pain

Answer 13

Clinical pain e.g. caused by surgery

Question 14

Describe Neuropathic pain

Answer 14

Caused by direct damage to nervous system e.g. phantom limb

Question 15

Describe ongoing pain

Answer 15

Continuing or severe pain can cause sensitisation of both peripheral and central pain pathways and can eventually change the way an animal responds to a stimulus. This can lead to a chronic hypersensitivity to pain that can outlast the actual painful event.

Question 16

What is allodynia?

Answer 16

sensitive to stimuli that would not normally cause pain

Question 17

What is hyperalgesia?

Answer 17

Greater insentity and duration of pain than expected

Question 18

What is pre-emptive anallgeisa and what is it used for?

Answer 18

The admin of analgesic prior to tissue trauma

Used to: Prevent pain pathway, easier pain management post-op

Question 19

Give examples of analgesic drugs

Answer 19

Opiods
NSAIDSs
Alpha 2 adrenoceptor agonists
Local anaesthetics
Ketamine 
Gabapentin

Question 20

where do opioids act upon?

Answer 20

centrally and peripherally

Question 21

what are the types of agonists?

Answer 21

Full and partial

Question 22

Give an example of a full opioid agonist and what are they used for?

Answer 22

morphine, fentanyl, methadone, pethidine and butorphanol

Used for moderate-severe pain, can be topped up, increased dose increases analgesia

Question 23

Give an example of a partial opioid agonist

Answer 23

buprenorphine

Used for mild-moderate pain

Question 24

What are the most commonly used opiods?

Answer 24

Methadone and buprenorphine

Question 25

How do NSAIDs work?

Answer 25

they inhibit the production of inflammatory mediators i.e. prostaglandins via the inhibition of COX enzymes Some drugs are COX 2 selective as COX 1 is considered to have a protective effect on the gut lining and kidneys. NSAIDs work at the transduction stage of the pain pathway

Question 26

What do you use NSAIDs for?

Answer 26

peri-operative pain relief | Management of chronic pain

Question 27

Give examples of NSAIDs

Answer 27

``` meloxicam Aspirin Carprofen Robenacoxib Ketoprofen Paracetamol Phenybutazone ```

Question 28

What are some side effects of NSAIDs?

Answer 28

Renal - prostaglandins play a role in maintain GFR and renal blood flow in the face of low BP. Therefore inhibition of PGs may lead to renal dysfunction or failure. GIT - cox 1 enzymes are responsible for mucous secreting and maintain blood flow to the gut. Therefore NSAIDs may cause gastric ulceration.

Question 29

When should you avoid the use of NSAIDs

Answer 29

``` dehydrated hypotensive pre existing renal disease liver disease animals already on corticosteroids or other NSAIDs ```

Question 30

What are local anaesthetics considered to provide?

Answer 30

total analgesia as they block the conduction of nociceptive impulses

Question 31

Give examples of local anaesthetics

Answer 31

``` lignocaine Bupvicaine Mepivicaine Alpah 2 adrenoceptor agonsits - at lowr doses Ketamine ```

Question 32

What is gabapentin used to treat?

Answer 32

neuropathic pain in adult animals

Question 33

What is acupuncture used for?

Answer 33

used to complement pharmaceutical measures in painful patients More often in chronic pain Variable response between induvial patients

Question 34

What is multimodal analgesia?

Answer 34

Multimodal analgesia is the use of multiple drugs. Incorporating different pharmacological actions to produce optimal analgesia

Question 35

What are some examples of drugs used in multimodal analgesia?

Answer 35

NSAIDs with opioids, alpha-2 agonists and local anaesthtitic techniques

Question 36

Describe 'milk infusions'

Answer 36

This is a method that is increasing in use in canine patients. Includes: -500ml of either NaCl or Hartmann's -10mg morphine -150mg lidocaine -30mg ketamine This is given by infusion and avoided in cats due to sensitivity to lidocaine

Question 37

What does pain behaviour vary depending on?

Answer 37

Species, breed, age, sex and temperament

Question 38

What are signs of pain in cats/dogs?

Answer 38

``` Chewing/licking wound Aggression or change of temperament Vocalisation Cowering at back of cage Anorexia Panting Hunched Prayer stance Altered facial expression Limping ```

Question 39

What are the signs of pain in small mammals?

Answer 39

``` 'prey' species will attempt to mask pain Anoerxia Teeth grinding Reluctant to move Limping Squinting Hunched up Dull Aggression Chewing of wound Vocalisation if severe ```

Question 40

Why do we need to recognise pain?

Answer 40

To maintain animal welfare by both recognising pain and being prepared to act upon these findings

Question 41

What are examples of pain scoring systems?

Answer 41

``` Simple descriptive scale Numerical rating scale Visual analogue scale Glasgow composite pain scale Colorado state pain scale for cats ```

Question 42

What happens if a patient has a painful/stormy recovery?

Answer 42

Palpation of wound should elict painful or heightened response Painful animals may be temprerily distracted unlike these who are dysphoric Notify the VS, if concerns, may require further anagleisa/sedation

Question 43

What is the vital role od VN?

Answer 43

Monitor, record and report signs of pain behaviour Vital role in pain management and assessment VN is main care for hospitalised patients

Question 44

What jobs are involved as a VN?

Answer 44

Admin of appropriate analgesic drugs Good nursing care Clean warm bedding Use and care of bandages Comfortable environment Allow toileting and eating as close to normal as possible Psychological support (talking, stroking and reassuring patient)