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| many clinicians refer to pain as the |
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| : detection by the nervous system for the potential for, or actual tissue injury. Protects animal from painful or noxious stimuli |
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Ouch pain
The pain felt to warn you that you may be injured if you touched something sharp or hot
Also called adaptive pain because it promotes survival by preventing injury
Treatable and resolves when healing is complete |
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Pain that is amplified and persistent
Serves no useful function, causes suffering
Due to a malfunction in the nervous system and is called maladaptive pain, difficult to treat |
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| Occurs at the site of tissue injury due to the release of inflammatory mediators such as prostaglandins and histamine |
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| Results from injury to the nervous system (nerve damage) |
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| No identifiable cause can be determined |
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Immediate onset after injury
Resolves when healing is complete |
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Lasts weeks, months, or years
Persists after the tissues have healed or when they will not heal (such as in cancer)
More challenging to treat |
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Originates from organs
Pleuritis, colic |
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Musculoskeletal system
Further divided
• Superficial (skin)
• Deep (joints, muscles, bone) |
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| Knowing the type of pain and its origin helps us determine which drugs/methods to use |
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| Nociception: The Pain Pathway[image] |
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Definition
• Step 1: TRANSDUCTION
Transformation of noxious stimuli (mechanical, thermal, chemical) into sensory electrical signals (action potentials) by nociceptors (pain receptors)
• Step 2: TRANSMISSION
Sensory impulses conducted to spinal cord via peripheral nerve fibers
• Step 3: MODULATION
Impulses are altered by other neurons in the spinal cord (either amplified or suppressed)
• Step 4: PERCEPTION
Impulses are transmitted to the brain where they are processed and recognized |
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| Using several analgesic drugs, each with a different mechanism of action is |
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targeting two or more of the receptors results in lower doses of each drug used
decrease adverse side effects and improve safety |
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Consequences of Untreated Pain
[image] |
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• Catabolism and wasting
• Immune system suppression-predisposes to infection (increases hospitalization time and cost)
• Pain promotes Inflammation, which delays wound healing
• Anesthetic risk and increased anesthesia doses
• Patient suffering
Also stressful for owners and caregivers |
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| Central nervous system hypersensitivity is also known as |
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| increased sensitivity to a painful stimulus |
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| Peripheral hypersensitivity/primary hyperalgesia - |
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| Neurons in the spinal cord become hyperexcitableand sensitive to low intensity stimuli |
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| Central nervous system hypersensitivity or windup - |
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| Preemptive analgesia (providing analgesia before tissue injury has occurred) can help prevent |
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A receptor that is activated in windup pain, but not physiologic pain
Certain drugs can be used to block this Rc(ketamine) |
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| N-methyl-D -aspartate (NMDA) receptor |
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Pain causes physiologic changes-----
Release of ACTH, Elevation in cortisol, NE, E, and Decrease in insulin results in |
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Pain causes physiologic changes-----
________ stimulation leads to vasoconstriction, increased myocardial work, increased myocardial oxygen consumption which predisposes the patient to arrhythmias |
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Pain causes physiologic changes-----
The stress response caused by tissue injury can lead to increased |
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quality of life
•Should be a concern for every one of us and the owner
•Requires that basic needs be met
•Defined by the “5 Freedoms” |
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Freedom from hunger and thirst
Freedom from discomfort
Freedom from disease
Freedom from injury
Freedom from pain |
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What can we assess??
Behavioral responses to pain very among |
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Definition
species, breeds, age, and temperaments
May mask their pain when other animals and humans are present
Interaction level, general appearance, posture
What else besides pain can affect these items? fear, unsocialized, aggressive... |
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What can we assess??
Physiologic changes Box 8-2cardiovascularrespiratory pattern |
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| More Signs of Pain in Animals |
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Definition
•Changes in gait and levels of activity
Limping, stiffness, reluctance to move
Cats-hide, not jump as high or as often as before
•Vocalization
Dogs- whine, growl, whimper
Cats-groan, growl, purr
•Facial expressions
Dogs- glazed or fixed stare
Cats-squint and have furrowed brow |
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•Simple descriptive scales
Mild, moderate, severe
Subjective, doesn’t tell the owner what to look for
•Numeric rating scales
CSU Canine Acute Pain Scale and CSU Feline Acute Pain Scale
•Categorical numeric rating scale
Glasgow Composite Measure Pain Scale
•Evaluate dogs with acute pain
UNESP-BotucatuMultidimensional Composite Pain Scale
•Evaluate cats with acute pain |
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| no pain, mild pain, moderate pain, severe pain |
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| more generalized term for all the pain treatment modalities used before, during, and after a surgical procedure. |
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_______ analgesia
Begins in preoperative period with premedication
Transdermal fentanyl patch
NSAIDs primarily in large animals |
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type of therapy that:
The use of more than one drug to control pain
Cover multiple receptors and mechanisms of action
Reduce dose of individual drugs and anesthetic agent |
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| Pain Control Optionspp 249-268, Summary Table 8-3•Opioids•NSAIDs•Local anesthetics•Alpha-2 agonists•Ketamine•Tramadol •Tranquilizers•Gabapentin•Amantidine•Corticosteroids•Non-pharmacologic Therapies |
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| analgesic that Act on receptors in the spinal cord and brain and the synovial membrane of joints |
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| Fentanyl> Oxymorphone> Hydromorphone> Methadone> Morphine> Buprenorphine> Butorphanol |
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| Duration of action is 2-4 hours for most, so not good for postoperative pain |
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| morphine schedule __ drug |
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| Used for moderate to severe visceral or somatic pain |
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| Short duration of action (.5 –3 hours), CRI |
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| •Excitement in awake cats and horses and May cause restlessness in dogs and horses |
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| Initial increased gastrointestinal activity: nausea, vomiting, defecation |
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| Ileus and colic development in horses |
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Histamine release if given IV too quickly
fall in blood pressure, flushing, and pruritus. |
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| Greater analgesic potency and sedative effect than morphine |
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| Fewer side effects and longer duration of effect than morphine (4 hours) |
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| Respiratory depression, panting, hyperresponsiveto sound |
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| Oxymorphone is a schedule __ drug |
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| Less potency but similar duration of effect compared with oxymorphone |
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| Hydromorphone Schedule __ drug |
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| Least likely to cause vomiting in cats and dogs |
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| Antagonist at the NMDA receptor |
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| Favorable choice for treating pain when CNS hypersensitivity is present or likely to develop |
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| Characteristics similar to oxymorphoneand hydromorphone |
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| Fentanyl Schedule __ drug |
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| One of the most potent analgesics known |
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| Rapid onset (2 minutes) and short duration of effect (20-30 minutes) when administered IV |
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| Administered by continuous IV drip, transdermal patch, IM, SC, or epidural injection |
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| Used in combination with midazolam or diazepam drawn into separate syringes |
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| A partial mu agonist that produces some analgesia for mild to moderate pain |
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| Administered IV, IM, or epidural; orally to cats |
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| Delayed onset (15 min) but longer duration of analgesia (6-12 hours after IM injection) |
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| Buprenorphine Schedule __ drug |
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| New drug “Simbadol” –SQ injectable that lasts up to 3 days in cats (1 hr onset and 24-48 hr duration in studies) |
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| Butorphanol Schedule __ drug |
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| Synthetic opioid, agonist-antagonist |
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| Not as effective an analgesic as a pure agonist |
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| Produces less sedation, dysphoria, and respiratory depression |
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| Effective for mild to moderate visceral pain |
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| Administered IV, IM, SC, or orally (as tablets for long-term analgesia) |
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| Opioids as Postoperative Analgesics |
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Definition
• Administered IM or SC before animal regains consciousness
Injections repeated as necessary
Alternative routes (IV, epidural, intraarticular, transdermal patch) minimize adverse effects
• Disadvantages
Short duration of action
Potential adverse reactions: respiratory depression, bradycardia, excitement, hypersalivation, mydriasis, excessive sedation, panting, increased sensitivity to sound, gastrointestinal effects |
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| nonsteroidal antiinflammatory analgesics (NSAAs) |
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| nonsteroidal antiinflammatory analgesics (NSAAs) examples |
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Acetylsalicylic acid (aspirin)
Acetaminophen
Rebenacoxib
Carprofen
Etodolac
Meloxicam
Tolfenamic acid
Ketoprofen
Deracoxib
Firocoxib |
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| Nonsteroidal Antiinflammatory Drugs Onset of action: _-_ minutes |
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| Nonsteroidal Antiinflammatory Drugs |
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| NSAIDs that inhibit the COX-2 enzyme but not the COX-1 enzyme produce the least adverse effects |
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| Opioids and NSAIDs are the most commonly used analgesics |
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| Injectable dissociative anesthetic |
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NMDA blocker
Dose much lower than required to induce anesthesia |
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dose-related effects rarely seen at analgesic levels
Caution with HCM(Hypertrophic Cardiomyopathy ) or compromised renal function |
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| • Nonopiatedrug with activity at the mu receptor |
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| inhibits reuptake of norepinephrine and serotonin |
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| Administered orally after patient has resumed eating |
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| A postoperative alternative to opiates |
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Can be administered at home
• Don’t use concurrently with other norepinephrine or serotonin reuptake inhibitors |
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| Treats neuropathic pain and hypersensitivity |
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| Useful in dogs and cats for chronic musculoskeletal pain unresponsive to NSAID |
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| Liquid form contains xylitol, toxic to dogs and cats |
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| Few adverse effects, except drowsines |
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A NMDA receptor antagonist
• Administered orall |
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Useful for
Neuropathic pain
Chronic pain of musculoskeletal disease |
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• Side effects
Agitation
GI upset |
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• Strong antiinflammatoryproperties
Decrease prostaglandin activity, such as NSAIDs
Don’t use concurrently with NSAIDs
• Adverse effects
Ulcerogenic
Immunosuppression with long-term use
Development of hyperadrenocorticism |
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| Used sequentially for up to several months for chronic pain (dogs and cats |
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| Long-term therapy of chronic painful conditions |
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| _______ ______ in unconscious patients to prevent corneal drying |
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| May have to turn patient every |
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| Used in conjunction with/ as an adjunct to pharmacological therapy |
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Definition
Acupuncture
Massage therapy
Physical rehabilitation
Laser therapy
Pulsed Magnetic Field therapy
Cryotherapy (acute injuries)
Thermotherapy (chronic injuries)
Transcutaneous electrical nerve simulation
Extracorporeal shock wave treatment
Therapeutic ultrasound
Homeopathic or herbal remedies |
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Glasgow Composite Measure Pain Scale: CMPS -Feline:
The maximum score for the 7 categories is |
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| The total CMPS-Feline score has been shown to be a useful indicator of analgesic requirement and the recommended analgesic intervention level is _/_ |
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| Glasgow Composite Measure Pain Scale for canines has 6 categories |
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| study 13 IV fluids and Transfusion Medicine.. didn't make flashcards |
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