17. Pain Flashcards
What is pain?
pain is an unpleasant sensory and emotional experience associated w/ actual or potential tissue damage
What is the consequences of untreated pain/
patient suffering, sympathetic stimulation, ummine suppression (inc risk of infection)
Delayed wound healing
CNS hypersensitivity (wind up)
Inc morbidity and mortality
What are some complications in assessing pain?
pain response is variable even among individuals, species, breed, age
must be differentiated from stress, fear, aggression, anxiety, emergence delirium, dysphoria
two main aspects of pain response are physiologic and behavioural
What is the physiologic pain response?
Release of catecholamines to cause tachycardia, arrythmias, hypertension, vasoconstriction, tachypnea, open mouth breathing, or guarded, shallow breathing
mydriasis (dilate dpupils)
In regards to physiologic pain response, what are some other causes of sympathetic stimulation?
hypoxemia, hypercapnea, stress and excitement
What is the behaviour response to pain?
facial expression (grimace scale)
Postural changes and activity lvl
changes in temp
vocalization (growl, howl, purring)
Anorexia, far more reliable indicators of pain
What are some pain-related facial expresions of cats?
- Flattened ears
- Flat, tense muzzle
- Tucked whiskers
- Fixed or staring gaze
- Squinting
- Avoiding eye contact
- Head down
What are some common pain expressions in dogs?
Most species have grimace scales now (ex. Cat, rabbit,
mouse, rat, ferret, horse, etc.)
What are some pain postural changes in cats?
hunched, or guarding abdomen, restless shifting position, abnormal/awkward body position, tense, rigid body position, lying flat out, but not sedated
What are some changes in mobility and posture in dogs?
- Changes in gait such as lameness or stiffness
- Reluctance to move or walk
- Restless and unable to find a comfortable position
- Praying stance
- Tense or guarded/hunched posture
What are some behaviour changes in cats?
dec grooming, attitude changes - friendly cat becomes aggressive after surgery, vocal, chatty cat becomes quiet and withdrawn
hiding at the back of cage, avoiding human contact
excessive grooming of sx site, guarding or protecting injury, aggression, possibly anorexia
What behaviour changes in dogs may indicate pain?
- Comfort seeking
- Compare normal behavior with post-operative changes
- Increased aggression or submissiveness
- Withdrawn from human contact
- Anorexia
- Inappropriate urination or defecation
In terms of vocalization, how might we use this to indicate pain?
- Growling, whining, whimpering, barking, crying
- Quiet can also be a sign of pain
- Purring cats can be happy or self - soothing
- Other reasons for vocalization:
- Dysphoria
- anxiety, stress
- needing to go outside to urinate or defecate
- This may be unreliable indicator of pain
Do critially ill patients show pain?
- Too sick to exhibit pain signs, flat out pain or in shock but
may also be painful - May be more sensitive to the side effects of analgesics
- Give analgesics but titrate slowly
How do we approach a pain assessment?
Distance exam
interact w/ patient
palpation of painful or potentially injured area
overall appearance of patient
How do we quantify pain?
0 non
1-3 mild
4-6 moderate
7-10 severe
Why do we use pain scales?
quantifying the degree of pain of a patient is challenging, highly subjective and varies greatly depending on each staff member assessing pain
pain scales help to standardized this assessment
reminds staff to take the time to regularly assess the patients quality of analgesia
What pain scale is used at the VMC?
short form of the glasgow composite pain scale
used for canine patients
if a patient scores a 6/24 or 5/20 indicates need for analgesia
What is the UNESP-botucatu multidimensional composite pain scale
validated pain scale, used for feline pain assessment
takes into account behavioural and physiologic responses to pain - BP, anorexia, posture, activity lvl
thorough description of sub classification, makes it easier to decide the lvl of pain
What are the 5 parameters assessed with the 2019 feline grimas scale?
ear position, orbital tightening, muzzle tension, whisker position, head position
>4/10 consider treating pain
How can we distinguish pain from emergence delirium and dysphoria?
- Emergence delirium: disorientation and excitement associated
with a patient recovering from inhalant anesthetic - Short duration (usually first 10 – 15 minutes of recovery)
- Geriatrics, blind and deaf are prone to excitable recoveries
- Dysphoria: disorientation and excitement associated with some
anesthetic drugs - Most commonly opioids but also ketamine and benzodiazepines
- Severe Symptoms of excitation can be treated with sedatives in a
quiet area to smooth out anesthetic recoveries
What is the FAS behaviour and pain assessment?
- FAS (fear, anxiety and stress) and pain can show similar
behaviors in hospital - Facial expressions of fearful patients are different than
painful - Ears and eyes are alert but may be hiding in the corner of the
kennel and avoiding eye contact - Position of the back is a low profile not hunched
- Pre-operatively obtain a thorough history and use this
knowledge to assess if aggression is pain based - Very few cats are truly aggressive without pain or being
cornered, most are fearful
Look at the changes in behaviour from pre to post op. What if the patient is normally feaful, aggressive or feral in hospital?
- Make sure patient receives adequate analgesia before waking up, as
administration for analgesics post-op may be challenging - Pain assessment may be difficult post-op and there is doubt, treat pain
and see if behavioral improvement occur
What it preemptive analgesia and why do we do it?
- Pre-emptive analgesia: administering analgesia prior to
anticipated painful procedure - ex. OHE
- Pre-emptive analgesia will decrease the amount and duration
of pain medication required instead of treating pain as it arises - Helps to prevent wind-up pain
What is the difference btw acute pain and chronic pain?
- Acute Pain: an immediate response that is beneficial to
the patient, it is protective reflex to avoid further injury
(Ex. Burn your hand on stove, you will withdrawal that
hand) - Chronic Pain: is not beneficial to the patient and results
in negative side effects (Ex. Arthritis can result in muscle
atrophy due to decreased activity)
What are some signs of chronic pain that can be observed at home?
- Trouble jumping (cats)
- Overgrown claws (cats)
- avoiding/slow on stairs
- Stiff or abnormal gait
- Decreased activity levels
- Spending more time alone,
less social - Attacking other pets or
attacking owners - Fearful, guarding site of injury
- Poor coat quality
- Anorexia
- Inappropriate
urination/defecation
What are the goals of treating acute pain?
- Patient comfort: ideally complete analgesia, but reduce
pain to a tolerable level to decrease negative side effects of
pain and return to normal behavior (hypoalgesia) - Prevent chronic pain
- Prevent adverse effects of the drugs used in treating pain
- excess sedation, agitation, ileus, c/v depression, hyperthermia
or hypothermia, nausea - Balancing negative effects of drugs with negative effects
of pain
