6. PAIN MANAGEMENT Flashcards
what is pain
=unpleasant sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage.
-unpleasant feeling,
-protection from harm
>nociception, nociceptor
nociception neural processes of
encoding noxious stimuli
nociception is physiological perception of
pain
nociception does not require
consciousness and can continue unabated during general anesthesia if techniques that interrupt or inhibit transduction, transmission, and modulation of nociceptive stimuli are not included
nociceptor sensory receptor that
generate action potential (nerve impulse) and sends signals that cause perception of pain in response to potentially damaging stimulus
nociceptors - different nociceptors respond to different stimuli:
- mechanoreceptors: pressure and strech
- thermoreceptors: heat and cold
- chemoreceptors: inflammatory mediators (H+, K+, prostaglandins)
neuron includes
-dendrite
-nucleus
-axon
-cell body
-myelin sheath
-node of ranvier
-schwann cell
-axon terminal
nociceptive impulses are transmitted in
Adelta and C fibers
> Adelta -small myelinated fibers: fast, sharp pin
> C - smallest unmyelinated fibers : slow dull pain
transduction of noxious stimulus(any damage of tissue) > primary afferent nociceptor > transmission >
modulation > thalamus > thalamocortical projections > cortex > PERCEPTION
-modulation=changing - change signal to stronger or action let signal to main brain at all
modulation of pain in
spinal cord, many receptors and mediators modulate information passing to brain
modulation of pain excitatory transmitters
=prostaglandins > propagate pain impulse
modulation of pain inhibitory transmitters
=endorphins, epinephrine, norepinephrine, GABA > reduce painful stimuli
gate theory small fibers and large fibers >
pain
hyperalgesia increased sensitivity to
pain, which may be caused by damage to nociceptors or peripheral nerves or lack of inhibitory transmitter
primary hyperalgesia (kipuaistin lisääntyminen suoraan tulehtuneessa tai vahingoittuneella alueella) describes pain that occurs
directly in damaged tissues
secondary hyperalgesia (Kipuaistimuksen lisääntyminen tapahtuu alueilla, jotka ympäröivät vahingoittunutta aluetta mutta eivät ole itse suoraan vahingoittuneet) describes pain sensitivity that occurs in
surrounding undamaged tissues
hyperalgesia is
opioid -induced
allodynia (tilaa, jossa normaalisti kivuttomat ärsykkeet aiheuttavat kipua) pain due to
stimulus that does not usually provoke pain
tactile allodynia pain caused by
touch
mechanical allodynia caused by
movement across skin
thermal (temperature-related) allodynia caused by
heat or cold that is not extreme enough to cause damage to your tissues
movement allodynia pain triggered by
normal movement of joints or muscles
nociceptive pain: acute response to
tissue damage that resolves in period of days
nociceptive pain: chronic pain lasts for
longer period of time, classically associated with chronic inflammatory disease or degenerative condition or following nerve injury or damage
>degenerative joint disease
>stomatitis
>intervertebral pathology
somatic pain: superficial somatic pain in
-skin, subcutaneous tissue
-well localized, sharp, burnin
-burns, wound, contusions
somatic pain: deep somatic pain
-muscles, joints, bones, fascia
-localized or diffuse
-dull, spastic
-arthritis, tendonitis etc
visceral pain-pain that results from
activation of nociceptors of thoracic, pelvic or abdominal organs (viscera)
visceral pain-nociceptive fibers together with
autonomic nervous system
postoperative pain form of
acute pain due to surgical trauma
> inflammatory component
>tissue irritation from extravascular blood
>peripheral and central sensitization
visceral pain etiology
-distention(strech)
-ischemia
-inflammation
-not so sensitive to cutting or burning
neuropathic pain that develops following injury to
peripheral nerves and central nervous system (spinal cord, brainstem, brain)
> accompanied by hyperalgesia and allodynia to both inflammatory and normally non-painful stimuli
>spontaneous action potential
>in humans common as postamputation pain: limbs, tail, eye
phantom pain perceptions that individual experiences relating to
limb or organ that is not physically part of body anymore
>develops after amputation of limb, eye, testicles, tail, mastectomy
> pain formed from injured nerve endings at stump site
>pain prior amputation increases risk of phantom pain
consequences of pain-cardiovascular system
-tachycardia
-hypertension
-increased myocardial oxygen requirements
-cardiac arrhythmias
-coagulation
consequences of pain-respiratory system
-hyperventilation
-atelectasis
-pulmonary edema
consequences of pain-central nervous system
-affected behaviour
-depression
-aggression
-dilated pupils
-sleep disturbances
consequences of pain-GIT
-delayed gastric emptying
-ileus
-nausea
-vomiting
-loss of appetite
consequences of pain-urinary system
-oliguria
-urinary retention
-postanesthetic kidney failure
consequences of pain-immune system
-pro-inflammatory cytokines increase
-anti-inflammatory cytokines decrease
-unfections decrease
-spread of cancer increase
pain assessment
1-5
perception of pain perceptual phenomenon requires
conscious being
=kivun havaitseminen ja kokeminen
perception of pain always includes
suffering
assessment to chronic pain
-general mobility-ease of movement, fluidity of movement
-performing activities - playing, hunting, jumping, using litter-box
-eating, drinking
-grooming
-resting.observing, relaxing
-social activities involving people and other pets
-temperament
parts of perception of pain
-sensory factors: injury, inactivity, body mechanics
-cognitive factors: focus on pain, changes in behavioral patterns
-emotional factors: depression, agression, anxiety, stress
multimodal analgesia is most
effective and due to low doses of any single drug, provides less side effects
