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44 Cards in this Set
- Front
- Back
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____% plus of non-healthy patients are painful. ______ % of post surgery patients are painful and post trauma patients are painful.
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90%
100% |
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What causes pain to get worse with time after the injury?
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CNS sensitization, "facilitated" CNS transmission
-get ramping up of sensitization |
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What is the "sensitizing soup" that causes increased pain with time?
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Inflammatory mediators
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Do animals feel pain under anesthesia?
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NO, no pain
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What are 2 anesthestics are poor analgesics?
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1) Gas anesthetics
2) Induction drugs -ketamine/diazepam -telazol -propofol -barbiturates |
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Before anesthesia was discovered in 1847 a good surgeon was based on _____.
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How fast they can operate
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What are 6 myths of why not to treat pain?
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1) Fear of drug side effects
-anorexia -respiratory depression 2) Inability to assess disease 3) drug toxicity 4) Controlled drug regulations 5) Lack of knowledge 6) Cost |
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Majority of pain in the first 24 hours following injury is due to ________.
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Inflammation
-so good to give anti-inflammatories post-op |
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What are the 2 sides of pain?
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1. Sensory
2. Reaction |
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What is pre-emptive pain?
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Estimate of the expected level of pain
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What are the 3 components of the sensory side of pain?
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1) Quantity
2) Tissue injury 3) Small to large |
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What is the Pre-emptive approach to pain management?
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Anticipated amount of pain
-best guess of quantity -prevent rather than treat |
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What do we mean that the sensory side of pain is a quantitative response?
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Sensory response depends on how many fibers are damaged
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What do we base medical management of pain on?
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The reaction of the animal
-quality -response -no effect to severe aversive responses |
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What is the best way to medically manage pain?
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Prevent when possible
-treatment oriented toward reaction to pain -we treat pain when it is aversive |
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What is multimodal analgesia?
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Use of multiple drugs w/ different action to produce optimal analgesia
-often interrupting pain pathway at different sites & activating/inhibiting different receptors -not necessary in all cases |
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What are the 4 strategies for pain managements?
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1) Transduction
2) Transmission 3) Modulation 4) Perception |
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Why is pre-emptive analgesia so much more effective then treating pain after injury?
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Prevents hypersensitization
-if treat after injury then goes away but as soon as analgesia wears off it gets ramped up again |
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What are 3 drugs that provide trasducive pain management?
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1) NSAIDs
2) Opioids (intra-articular) 3) Local anesthetics |
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What are 2 drugs that provide pain relief via transmission/
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1) Local anesthetics
-epidural -infiltration blocks 2) Alpha-2 agonists |
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What are 5 drugs that provide pain relief via modulation?
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1) Opioids
-systemic -epidural 2) Alpha-2 agonists 3) NSAIDs 4) Local anesthetics 5) NMDA antagonists |
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What are 4 drugs that provide pain relief management via perception?
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1) General anesthetics
2) Opioids 3) alpha2 agonists 4) Benzodiazepines |
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Acute therapy can have_____ sedation and less concern with adverse reaction sot the drugs used to make the animal comfortable.
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Greater sedation
less adverse reactions |
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What are 3 examples of adverse reactions that can be tolerated with acute therapy, but not chronic therapy?
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1) Respiratory depression
2) Sedation, depression, lethargy 3) Liver, kidney & GI effects |
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What is transduction?
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Right where the injury occurs, turns mechanical/ thermal energy into electrical impulses which goes through transmission up the nerves
-these drugs act at the site of injury |
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How does transmission pain management work?
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Prevents electrical impulse from being transmitted to the brain
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What is modulation?
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modulating signal in spinal cord, this is where prevent wind up of signal to where discrete signal goes to generalized pain this occurs along the spinal cord
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Where do drugs act that affect perception?
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Work at the brain
-not great by themselves |
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What are the 4 steps of the pain pathway?
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Transduction
Transmission Modulation Perception |
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What is physiological pain?
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-reaction to injury, tissue damage
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What is the function of physiological pain?
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Serves a protective function
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What type of pain stimulates a physiological pain response? What is the input?
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Requires noxious stimuli (high threshold)
-input is discrete (well-localized) and transient |
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What is pathological pain? What stimulates it? What is the input?
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Altered nerve pathways, requires non-noxious (low threshold) input
Input is diffuse and prolonged -**Does not serve as protective function |
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What are the 2 systems that respond to physiological pain?
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Nociceptive and autonomic
(pathologic= disease) |
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What are 2 things postural effects of pain?
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Stance, gait
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What are 2 behavior effects of pain?
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Mood, appetite
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Pain varies with what 2 factors?
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1) Anatomical sites (these are some sites w/ higher density of pain fibers)
-periosteum -cornea -pleura -peritoneum -skin 2) Physiology -age, breed, past experiences, health status |
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What are 3 components to assessing animal pain/
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1) Cause
-inflammatory, neuropathic, etc 2) Severity -mild, moderate, severe, excruciating 3) Duration -acute, chronic -ongoing "wind-up" or pre-emptive |
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What are 5 components to evaluating pain?
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1) Attitude
2) Activity 3) Appetite 4) Responses 5) Physiological parameters |
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What are 3 pain evaluation forms for pain?
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1) Linear analog scale
2) Point system 3) Happy face scale |
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What are 2 signs of pain in cats?
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Withdrawl
Guarding |
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What are 4 signs of stress in cats?
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1) Flight
2) Fight 3) Fiddle 4) freeze |
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What is the best approach to pain management?
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Combination approach
-pre-emptive -individual animal care -monitor effectiveness -treat as needed |
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Cats don't vocalize much, so what can you do to evaluate their pain?
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See how act when left alone and when handled
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