Pain - Identifying And Assessing Pain

Front 1

Possible ways to assess pain intensity in animals

Back 1

-behaviors that are associated with pain***
-physiological responses (often don't correlate well)
-biological markers?

Front 2

Pain perception

Back 2

-what is painful and the degree of pain caused by disease varies
-perceptions of how animals perceive and "feel" pain varies

Front 3

Which is most painful?
-ovarihysterectomy
-intestinal resection and anastomosis
-femur fracture repair
-mastectomy of multiple mammary glands
-thoracotomy - sternal approach
-thoracotomy - intercostal approach
-hind limb amputation

Back 3

Probably:
-mastectomy of multiple mammary glands
-thoracotomy - intercostal approach

*think that soft tissue resection is most painful

Front 4

Behavioral assessment
-relies on

Back 4

-interpretation by an observer

Front 5

Behavioral assessment
-may be difficult because

Back 5

-too subtle or take too long to be recognized under many clinical situations
-observations are too sporadic
-observer may lack familiarity with the species, breed, or individual animal

Front 6

Behavior by itself is pathognomonic for pain (T/F)

Back 6

-False

Front 7

When trying to assess pain behavior of an animal, what is important to do?

Back 7

-familiarize yourself with the pain behaviors for the species with which you work

Front 8

Physiological data are useful in assessing response to a noxious stimulus (T/F)

Back 8

-False

Front 9

Physiological data traditionally evaluated for pain

Back 9

-changes in heart rate
-respiratory rate
-arterial blood pressure
-pupil dilation

Front 10

Physiological responses are not specific enough to differentiate from:

Back 10

other stressors or metabolic conditions
-anxiety, fear
-anemia, hypovolemia

Front 11

Current reliable, easily measurable biological markers

Back 11

-none

*use to use cortisol levels for effectiveness of analgesia but endogenous cortisol can be altered by:
-stress
-disease
-drugs
-etc.

Front 12

Pain scales
-purpose

Back 12

-should be used to ensure that pain is assessed and treated in every patient

Front 13

Pain scales
-should be used in adjunct with

Back 13

-physical exam
-thorough patient evaluation

Front 14

All pain scales have their limitations (T/F)

Back 14

True

Front 15

What prompts analgesic therapy regardless of pain score?

Back 15

-individual behaviors

Front 16

Effective analgesia should result in:

Back 16

-low pain score
-animal that appears comfortable

Front 17

Pain scale limitations

Back 17

-have components of behavioral scoring that can be very subjective
-criteria are often applicable in acute pain, but not chronic pain
-often designed to evaluate post-surgical pain, and not non-surgical pain
-may use criteria that are not applicable to the situation

Front 18

Criteria that are often applicable in acute pain, but not chronic pain

Back 18

-vocalizing
-thrashing
-attempting to escape

Front 19

Clinical signs of acute, nonsurgical pain

Back 19

-pancreatitis
-pleuritis
-vasculitis
-frequent vomiting
-myalgia

Front 20

What should pain scales not be used for?

Back 20

-should not be used to deny analgesia therapy to an animal that is likely in pain
-should not use rigid scores to prompt therapy
-should not preclude using test-doses of analgesics to evaluate a response to analgesia

Front 21

Pain scales
-types

Back 21

-preemptive scoring system
-visual analog scale
-simple descriptive scale
-numerical rating scales

Front 22

Preemptive scoring system
-describe

Back 22

-based on the amount of pain an individual feels the animal will experience from given procedure

Front 23

Visual Analogue Scale
-describe

Back 23

-relies on observer to identify and interpret pain behaviors

Front 24

Simple descriptive scale
-describe

Back 24

-No pain, mild, moderate, severe
-relies on observer and his/her interpretations and bias

Front 25

Numerical rating scale
-describe

Back 25

-multiple categories with descriptive definitions of pain for each category
-semi-objective
-prompts observer to evaluate certain aspects of the patient that might otherwise get unnoticed

Front 26

Numerical Rating Scales
-advantages

Back 26

-more thorough evaluation
-prompts observer to evaluate criteria that are often overlooked
-based on numerous categories

Front 27

Numerical rating scales
-disadvantages

Back 27

-painful animals may still go undiagnosed
-may be too insensitive to detect differences in animals that are sedated or already on analgesic therapy
-can be very species specific
-have not shown improved accuracy over other methods

Front 28

Glasgow Composite Measure Pain Score
-based on

Back 28

-specific behavioral signs believed to represent pain in the dog

Front 29

Glasgow Composite Measure Pain Score
-advantages

Back 29

-limited interpretation and bias required by the observer
-accuracy increase over other scoring systems
-observers simply identify the presence or absence of behavior
-physiological data not included

Front 30

Glasgow Composite Measure Pain Score
-disadvantages

Back 30

-limited validation in actual animal studies
-lack of numeric scoring system that would allow for comparison of scores over time
-species specific
-does not take into account the impact of demeanor/temperament or previous experience of the patient
-does not account for residual effects of anesthetics

Front 31

Glasgow Composite Measure Pain Score
-short form function

Back 31

-modified GCMPS that can be applied quickly in a clinical setting
-same advantages but adds the numeric rating scale that facilitate therapeutic decision making and comparison over time