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Exam 2
Pain
78
Veterinary Medicine
Professional
04/04/2016

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Term
Definition: Pain
Definition
-an unpleasant sensory and EMOTIONAL experience associated with actual or potential damage, or described in terms of such damage
Term
Definition: Allodynia
Definition
-perception of an ordinarily non-painful stimulus as painful
Term
Definition: Analgesia
Definition
-absence of pain perception
Term
Definition: Anesthesia
Definition
-absence of all sensation
Term
Definition: Dysethesia
Definition
-upleasant or abnormal sensation iwth or without a stimulus
Term
Definition: Hypoalgesia
Definition
-diminisehd response to noxious stimulus
Term
Definition: Hyperalgesia
Definition
-inc response to noxious stimulaiton
Term
Defintiion: Hyperesthesia
Definition
-inc response to mild stimulation
Term
Definition: Hyperpathia
Definition
-presence of hyperesthesia, allodynia, and hyperalgesia usually associated with overreaction and persistence of sensation after the stimulus
Term
Definition: Hypoesthsia
Definition
-reduced cutaneous senstion
Term
Definition: Neuralgia
Definition
-pain in the distribution or group of nn
Term
Definition: nParesthesia
Definition
-abnormal sensation perceived without apparent stimulus
Term
Definition: Radiculopathy
Definition
-functional abnormality of one or more nerve roots
Term
Describe acute pain.
Definition
-from direct tissue trauma
-most intense during initial 24 hours
-resoves in days to weeks
Term
Describe chronic pain
Definition
>3m duration
-can be considered a disease state
Term
Definition: Chronic pain
Definition
-pain that exists despite normal healing time or as persistent pain caused by conditions where healing has not occurred or whicch it re-occurs
Term
What are the two types of acute pain?
Definition
-somatic: superficial or deep
-visceral
Term
What is somatic superficial pain?
Definition
-nociceptio arising from skin, SQ tissues,, and mucous membranes well localized, sharp, throbbing, or burinin gsensation
Term
What is deep somatic pain?
Definition
-muscles, tendons, joints, or bones, dull aching quality and is less well localized
Term
What is visceral pain?
Definition
-due to a disease process or abnormal function involving an itnernal organ or its covering
Term
What is nociceptive pain? Is it irreversible or reversible?
Definition
-physiologic pain
-generally reversibe
Term
The intensity of inflammatory pain relates to what two factors?
Definition
-severity and duration of tissue damage
Term
What are the 3 components of pain physiology? Describe them.
Definition
1) Sensory: temporal, spatial, thermal/mechanical
2) Affective: subjective and emotional
3) Evaluative: stabbing, pounding, mild vs severe
Term
What are the 5 types of nociceptors and what do they sense?
Definition
1) Heat
2) Mechanical: pinch and pinprick
3) Chemical
4) Silent: respond in the presence of inflammation
5) Polymodal": respond to excessive pressure and/or heat, most prevalent, noxious timulants
Term
What are the 3 primary chemical mediators of nociception?
Definition
-Substance P
-Calcitonin gene-related peptide
-Glutamate
Term
Definition: Primarily hyperalgesia
Definition
-substances released from damaged tissue
Term
Definition: Secondary hyperalgesia
Definition
-neurogenic inflammation
Term
What are some of the excitatory modulators of pain?
Definition
-Substance P (NK-1)
-Calcitonon gene-related peptide
-Glutamate
-Aspartate
-ATP
Term
What are some of the inhibitory modulators of pain?
Definition
-Somatostatin
-ACh
-Enkephalins
-Beta-endorphin
-NE
-Adenosine
-Serotonin
-GABA
-Glycine
Term
What is peripheral sensitization and what does it result in?
Definition
-inflammation starts the process and a continuous barrage of afferent flood the spinal cord
-results in non-painful stimulus being painful and nerves that were not mechano-sensitive can become mechano-sensitive
Term
What is central sensitization and what does it result in?
Definition
-prolonged firing of Ca fibers involving a range of excitatory and inhibitory neurons = release of glutamate = NMDA and AMPA
-results in pain hypersensitivity in the CNS
Term
What are the two forms of central modulation of pain?
Definition
-facilitation
-inhibition
Term
What is peripheral neuropathic pain?
Definition
-spontaneous discharge due to central sensitization of receptors
-/+ neural inflammation
Term
How does the CV system respond to pain?
Definition
-hypertension
-tachycardia
-enhanced myocardia irritability
-inc SVR
-CO inc in healthy patients
Term
How does the respiratory system respond to pain?
Definition
-inc total O2 consumption and CO2 inc pdn
-pain from abdominal or thoracic area can cause a dec in FRC
-impaired coughing and clearing of secretions
Term
How do the GI and urinary tracts respond to pain?
Definition
-inc sphincter tone and dec in intestinal and urinary motility
-ileus promotion and urinary retention
-nausea, vomiting, and constipation are common
Term
How does the Endocrine system respond to pain?
Definition
-inc catabolic hormones
-dec anabolic hormones
-most patients go into negative nitrogen balance
-inc in cortisol, renin, angiotensin, aldosterone, and ADH
Term
What are the hematological effects of pain?
Definition
-inc platelet adhesiveness
-reduced fibrinolysis
-hypercoagulability
Term
What are the immune effects of pain?
Definition
-leukocytosis and overall dec immune function
Term
What are the objective measurements of pain?
Definition
-HR
-RR
-pupil diameter
-BP
-acute pain scores
Term
What are the 4 major one-dimensional scoring systems of pain?
Definition
1) Simple descriptive scale
2) Numeric rating scale (NRS)
3) Visual analog scale (VAS)
4) Dynamic and interactive visual analog scale (DIVAS)
Term
What are the 2 primary multidimensional scoring systems for pain?
Definition
-Glasgow Composite Pain Scale
-Equine Composite Pain Scale
Term
What are some of the types of drugs that we use for pain management?
Definition
-Alpha 2 adrenergic receptor agonists
-local anesthetics
-NMDA Rc antagonists
-NSAIDs
-opioids
-Adjunctive analgesics: corticosteroids, Gabapentin and pre-gabalin, NK-1 Rc antagonists
Term
What is the analgesic site of alpha-2 agonists?
Definition
-CNS
Term
What are some examples of alpha-2 agonists used for pain?
Definition
-Xylazine
-Detomidine
-Romifidine
-Medetomidine
-Dexmedetomidine
Term
What are the sites of analgesic action of alpha-2 agonists?
Definition
-peripherally
-spinally
-supraspinally
Term
Alpha-2 agonsits induce action via which two methods?
Definition
-presynaptic terminals primary afferent neurons
-direct inhibition of spinal cord neurons
Term
What are the 3 subtypes of alpha-2 agonists? Describe them.
Definition
-Alpha 2a: act of K+ chh, analgesic is voltage dep, high proportoin in the dorsal horn
-Alpha 2b
-Alpha 2c: act of K+ chh
Term
What do local anesthetics do?
Definition
-prevents nociceptive transmission
-revesible neuronal conduction blockade
-can produce dose dependent anti-inflammatory effects
-inh pre-inflammatory mediator
-alter all stages of leukocyte migration
-may reduce free radical formation
-dec MAC in various species
Term
What are the 4 ways in which peripheral nn may vary in regards to local anesthetics?
Definition
1) size: inc size = need less drug
2) myelination = faster
3) distance from stimuli
4) depolarization threshold
Term
What is the primary NMDA Rc antagonist?
Definition
-Ketamine
Term
Generally describe Ketamine and how it works.
Definition
-somatic rather than visceral adjuntive analgesic but questionable for acute pain
-dose is much lower than used for induction
-can cause adverse side effect
-Site of action: peripherally, dorsal horn, supraspinally
Term
Other than Ketamine, what are the other two NMDA Rc antagonists?
Definition
-Amantadine: oral for chronic pain but takes up to 2 weeks to work
-Methadone
Term
What are the general characteristics of NSAIDs?
Definition
-long-acting
-non-controlled
-oral and injectable
-standard med after elective procedures
-dec COX enzyme conversion
Term
Is COX-1 or COX-2 inhibition associated with more adverse side effects? How do we avoid this?
Definition
-COX-1
-try to have selective COX-2 inhibitors but no NSAID comes without COX-1 effets
Term
Where do opioids work?
Definition
-peripherally
-spinally
-supraspinally
-pre- and post synaptic
-certain peripheral tissues can generate opioid receptors: articular, periarticular, corneal tissue
Term
What are the 3 types of opioid receptors?
Definition
-mu, kappa, delta
Term
Are opioids lipophobic or lipophilic? How are they metabolized?
Definition
-highly lipophilic (IV, IM, SQ, PO)
-Phase I and Phase II rxns
Term
Can tolerance develop to opioids?
Definition
-yes
Term
How does level of pain relate to the visible side effects resulting from administration of opioids?
Definition
-more painful = less side effects
Term
What are the overall effects of opioid administration?
Definition
-analgesia
-sedation and excitement
-antitussive effects
-resp depression: pigs most
-CV effects: enhances vagal tone
-nausea, emetic, and antiemetic efects (IV slow better than IM)
-pupil diameter: mydiasis in animals
-GI dec productivity but inc tone
-urinary retention and inc tone of sphincters
-thermoregulation is crazy
-reduction in MAC
Term
Which receptors does Morphine effect? Describe its effects and characteristics.
Definition
-full Mu agonist
-for mild to severe pain while increasing dose will increase analgesia
-less lipophilic and can last for up to 24 hours
Term
How does Oymorphone work? Describe it and its characteristics.
Definition
-full mu agonist
-more potent than morphine and causes less nausea nd vomiting
-give parenterally but very expensive
Term
Describe Hydromorphone.
Definition
-more potent than morphine
-duration and effect is similar
-minimal histamine release in dogs
-SQ administration in cats cna result in slow absorption and lag time
Term
Which opioid receptors does Fentanyl affect? Describe its effects.
Definition
-full mu agonist
-more potent than morphine
-less nausea nd vomiting
-can be given IV, IM, or SC
-short duration of action
Term
Which opioid do we absolutely not use in cats?
Definition
-Transdermal fentanyl
Term
Which opioid is topical?
Definition
-Fentanyl patch
Term
Describe the effects of Methadone.
Definition
-similar potency and effects as Morphine with NMDA antagonist activity
-acts synergistically with other opioids
Term
Which opioid do we always give IM? describe its effects.
Definition
-Meperidine
-mu agonsit with serotonergic, negative inotropic, and antimuscarinic effects
-more histamine release than morphine
Term
What are some derivatives of fentanyl (an opioid)?
Definition
-Sufentanil, alfentanil, and remifentanil
Term
What opioids are highly potent for the restraint of wildlife animals but can be lethal to humas?
Definition
-Etoprhine, carfentanil, thiafentanil
Term
Give an example of a partial mu Rc agonist. Descibe its effects.
Definition
-Buprenorphine
-25x more potent than morphine but lower maximal efficacy
-difficult to reverse
-can provide up to 12 hrs of analgesia
Term
Give an example of an opioid that is a Kappa agonist and a Mu antagonist. Describe its effects.
Definition
-Butorphanol
-for mild pain but good for sedation, very antitussive, antiemetic
-given for non-painful horses
Term
What are the effects of Tramadol? How does it work?
Definition
-analgesic
-full mu opioid agonist, serotonin and NE uptake
Term
What are 3 examples of opioid antagonists?
Definition
-Naloxone
-Naltrexone
-Methylnatrexone
Term
What is used to reverse carfentanil?
Definition
-Naltrexone
Term
What do we always need to consider while administering opioid antagonists?
Definition
-ALWAYS TITRATE
Term
What are some examples of non-pharmacologic pain modifiers?
Definition
-temp related
-tissue deformation
-modulation of metabolism and blood flow
-muscle spasms and myofascial trigger points
-immune modulation
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