Topic 10: Pain Management Flashcards Preview

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Flashcards in Topic 10: Pain Management Deck (28):

What is pain?

highly unpleasant physical sensation caused by illness or injury.

Pain occurs when tissues are injured or swollen, either due to trauma or surgery.


What is analgesia?

means by which we achieve relief from pain. Controlling pain is important as it reduces stress, improves the rate of healing and improves the overall quality of life. 


What are signs to observe when looking for pain?

  • animal's orientation in the cage
  • posture
  • level of movement
  • exercise tolerance and activity level
  • facial expression
  • attitude
  • vocalising
  • difficulty standing, walking, taking stairs, jumping, or getting up.
  • changes in urination and defecation habits
  • decreased grooming (especially in cats).


Common signs of pain in dogs?

  • Decreased social interaction
  • Anxious expression
  • Submissive behavior
  • Refusal to move
  • Whimpering
  • Howling
  • Growling
  • Guarding behavior
  • Aggression; biting
  • Decreased appetite
  • Self-mutilation (chewing)
  • Changes in posture


Common signs of pain in cats?

  • Reduced activity
  • Loss of appetite
  • Quiet/loss of curiosity
  • Changes in urinary/defecation habits
  • Hiding
  • Hissing or spitting
  • Lack of agility/jumping
  • Excessive licking/grooming
  • Stiff posture/gait
  • Guarding behavior
  • Stops grooming/matted fur
  • Tail flicking
  • Weight loss


What is acute pain?

pain that comes on immediately in the short term, and can often be quite severe.


What is chronic pain?

pain that develops over time, greater than a period of 10-14days, and can sometimes be mistaken for aging.


What is wind-up pain?

  • phenomenon where untreated pain becomes worse.
  • Nerve fibers transmitting the painful impulses to the brain become "trained" to deliver pain signals better.
  • Furthermore, the brain becomes more sensitive to the pain



what does this stand for in relation to pain management plants?

  • PLan
  • Anticipate -know we may cause pain, give analgesia prior
  • TreaT
  • Evaluate
  • Return


What non-pharmacological analgesia techniques can nurses perform?

  • hot/cold compression
  • managing weight
  • therapeutic excersise
  • acupuncture, laser, ultrasound
  • phys rehab
  • massage
  • nursing care
  • TLC
  • gentle handling


What are opiods?


 act centrally to reduce the perception of pain


What are NSAIDS?

act locally at the site of pain to reduce inflammation.


How may pharmacological analbesia (opiods/NSAIDS) be given?

  • orally
  • parenterally (injection)
  • transdermal
  • local injection eg epidural


What is CRI?

  • Constant Rate Infusions
  • means of delivering analgesia drugs (usually opioids) constantly through an intra-venous drip


Describe opiod agonists

  • those that bind and stimulate opioid receptors in the CNS
  • VERY powerful and are most commonly used for ACUTE pain for a short period of time
  • eg morphine, methadone, pethadibe, fentanyl
  •  associated with side effects
    -resp. depression
    -urinary retention


Describe opiod partial agonists

  • bind to receptors, but only partially stimulate
  • provide good analgesia with few side effects
  • have a ‘Ceiling effect’, which means that the degree of analgesia cannot be increased, even with increasing doses of the drug.

  • eg buprenorphine (temgesic)


Describe opiod mixed agonists/antagonists

  •  bind and stimulate some receptors, but bind, block and inhibit other receptors
  • side effects are reduced, although the level of pain relief is only moderate
  • work well for visceral pain
  • eg butorphanol  (Torbugesic, Dolorex)


Describe opiod antagonists

  •  bind, block and inhibit opioid receptors
  • used for treating agonist opioid overdoses.
  • eg Naloxone.


How do NSAIDS work?

  •  act specifically at the site of pain or inflammation at the site of injury or disease NOT AT THE CNS
  • by interfering with prostaglandin production, which are chemicals made in response to inflammation. 
  • BOTH pathways produce prostaglandins that promote inflammation, pain and fever, but ONLY COX-1, produces prostaglandins which protect the stomach lining and support platelet activity
  • Some NSAID’S inhibit BOTH COX 1 & COX 2, by blocking the COX 1 pathway we have the potential to damage stomach lining 


Contraindications for the use of NSAIDs (especially long term use) include?

  • renal insufficiency
  • dehydration
  • hypotension
  • low effective circulating volume e.g. congestive heart failure and shock
  • platelet and clotting factor problems,
  • gastrointestinal problems especially gastric ulceration
  • haemorrhage (e.g. trauma)


Examples of NSAIDs include?

  • ketoprofen (Ketofen)
  • carprofen (Rimadyl)
  • salicylic acid (Asprin)
  • meloxicam (Metacam)
  • firocoxib (Previcox)


A bit about Steroidal Anti-inflammatory Drugs (Corticosteroids)?

  • reduce inflammation by suppressing prostaglandin production, thereby providing analgesia
  • suppress the immune system and they also delay healing
  • should never be administered concurrently with NSAIDs 


Alpha-2 drugs do what?

  • suppress spinal cord pain transmission to the brain
  • fantastic sedative effects,
  • produce a pronounced hypotension and bradycardia
  • Due to these profound side effects they are used rarely and with caution.
  • eg xylazine, domitor


What is general anaesthesia?

 effects the entire body and results in a loss of consciousness i.e. commonly used for involved/invasive surgical procedures.


What is local anaesthesia?

Focal anaesthetic provided to a particular area of the body ONLY e.g. superficial stitch-up.


What is a nerve block?

An anaesthetic that is used to effect only a single nerve so that it cannot innervate a particular part of the body and the animal will subsequently feel pain no pain e.g. commonly used during dentals to extract teeth.


What is a epdirual?

An anaesthetic agent that is introduced into the epidural space of the spinal cord so that pain cannot be felt e.g. Calving down cow