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ANESTHESIA > 6 – Pain Measurement > Flashcards

6 – Pain Measurement Flashcards

1
Q

Physiological indicators of pain

A
  • Related to activation of SNS
  • Increased HR, RR, BP, T, pupil dilation
  • Increased biomarkers: beta-endorphin
    *unreliable and not specific to pain (influenced by other factors: anxiety, stress, fear)
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2
Q

Pain indicators

A
  • Behaviour
  • Posture
  • Facial expression
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3
Q

Practical subject approach: observing patient

A
  • Without interaction
    o Orientation in cage, posture, activity level, facial expression, attitude
  • While interacting
  • Response to palpation of painful site
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4
Q

Interacting with patient

A
  • Call by name
  • Stroke along back from head to tail
  • Appropriate response?
  • Tense?
  • Anxious?
  • Indifferent?
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5
Q

Response to palpation of painful area

A
  • No reaction to touch, but vocalizes/tenses with pressure
  • Looking at area
  • Withdraws
  • Defensive by protecting area
  • Withdraws fast, vocalizes, bites
  • Freezing, gets rigid
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6
Q

Challenges of pain assessment in animals

A
  • Use of proxy (ex. DVM or owner: not the animal itself)
  • Variant in pain response: age, species, individual
  • Environmental or situational stressors (may mask pain)
  • Different types of pain (ex. acute vs. chronic)
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7
Q

Fearful vs. painful animals

A
  • Fearful will probably still look at you
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8
Q

Developing a pain assessment tool

A
  • User friendly
  • Score linked to an INTERVENTION level
  • Valid
  • Reliable
  • Responsive
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9
Q

Use of pain assessment tool?

A
  • Increases objectivity and accuracy
  • Improve consistency of pain recognition
  • Assess response to treatment
  • Ensure pain is PRIORITIZED
  • Quantify pain
    *NEED AN OUTCOME MEASURE
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10
Q

Preventive (pre-emptive) scoring system

A
  • Score assigned according to level of pain that they are BELIEVED to experience
    o none, mild, moderate, severe
  • not useful to treat individual patient
  • simple to use
  • allows preventative analgesic planning
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11
Q

Anticipated levels of pain: mild

A
  • early, resolving simple conditions
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12
Q

Anticipated levels of pain: mild to moderate

A
  • castration
  • minor dental procedures
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13
Q

Anticipated levels of pain: moderate

A
  • urethral obstruction
  • C-section
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14
Q

Anticipated levels of pain: moderate to severe

A
  • Osteoarthritis
  • Peritonitis
  • Ureteral, urethral obstruction
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15
Q

Anticipated levels of pain: severe to excruciating

A
  • Multiple factors
  • Limp amputation
  • Necrotizing pancreatitis
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16
Q

Subjective or unidimensional scales: examples

A
  • Simple descriptive scale (SDS)
  • Numerical rating scale (NRS)
  • Visual analog scale (VAS)
  • Dynamic interactive visual analog scale (DIVAS)
    *don’t recommend using them
17
Q

Simple descriptive scale

A
  • Most basic, easy to use
  • Not validated
  • 4-6 descriptors
  • Scales are non-linear
  • Descriptive words are open to different interpretations
  • Extremely subjective
  • Lack sensitivity to detect small changes in pain
18
Q

Numerical rating scale

A
  • Similar to SDS
  • Implies equal differences or weighting between each category
  • ‘discontinuous scale’
19
Q

Visual analog scale

A

Visual analog scale
* Horizontal line representing pain experience
* 0: no pain, 10: worst pain possible
* Extensively used in humans (completed by patient)
* Vetmed: significant interobserver variability

20
Q

Dynamic and interactive visual analog scale (DIVA)

A
  • Improvement of VAS
  • Includes dynamic and interactive assessment of patients
    o Observe from distance, interact, palpation
21
Q

Multidimensional scales

A

*recommend using
* Categorized numerical rating scales
* Multi-dimension composite pain scales

22
Q

Categorized numerical rating scales

A
  • Observe and interact
  • Different categories where certain behaviours are chosen and assigned a value
  • Sum of category scores=pain score
  • Species and situation specific
23
Q

UMPS (University of Melbourne Pain Scale)

A
  • Clinical use
  • Multiple descriptors in 6 categories
  • Total score of 27
  • Not validated, labour intensive
  • Requires baseline data
24
Q

Colorado state university canine acute pain scale

A
  • Teaching tool
  • Dogs and cats after trauma or surgery
  • 3 categories are assessed and assigned a score 0-4
  • Observation and hands on
  • Practical, user friendly
  • NOT validated
25
Q

Multi-dimension composite pain scales

A
  • Glasgow composite measures pain scale
  • UNESP: MCPS
26
Q

Glasgow composite measure pain scale (CMPS)

A
  • First validated canine acute pain scale
  • 7 behavioural categories with 47 descriptors
  • Too time consuming
  • Useful research tool, not feasible in clinical environment
27
Q

CMPS: short form

A
  • Highly practical, clear repeatable
  • Acute pain
  • Behavioural assessment
  • Reduced interobserver validity
  • Validated
  • Intervention score
  • *6 behavioural categories
28
Q

UNESP- Botucatus Multidimensional Composite Pain Scale (MCPS)

A
  • Validated for cats undergoing OHE
  • 4 broad categories
    o Psychomotor changes
    o Protection of wound area
    o Physiologic variable
    o Vocal expression of pain
  • Score 0-30
29
Q

Cow pain score

A
  • 7 behaviours evaluated
  • Intervention score=5/14
30
Q

Facial expression scoring system: grimace scale

A
  • Identify and assess severity of pain
  • Rabbits, horses, sheep, pigs
  • Easy to use
  • Often incorporated in multidimensional pain measures or standalone
31
Q

Facial action units

A
  • Orbital tightening
  • Ear position
  • Cheek bulge
  • Nose bulge
  • Whisker position
32
Q

Horse grimace score

A
  • Composite, simple descriptive scale
  • 6 facial parameters with well-defined categories
  • Good reliability and validity
  • Other emotional states don’t change score significantly
  • Easy and give to use
  • Not validated against independent data set
33
Q

Chronic pain assessment

A
  • Use owner as proxy
  • Ex. Helsinki chronic pain index (HCPI)
  • Ex. canine brief pain index
  • Liverpool osteoarthritis in dogs
  • Feline musculoskeletal pain index
  • Client specific outcome measures
34
Q

Clinical measurement instruments for chronic pain: evaluate behaviours in normal setting

A
  • Going up and down stairs
  • Eating
  • Grooming
  • Ability to jump in car
  • Difficulty in rising
  • Inappropriate urination or defecation
    *useful to assess effect of treatment
35
Q

Canine Brief Pain Inventor

A
  • Chronic pain: osteoarthritis, bone cancer
  • Record owners assessment
  • Assess pain severity and how pain interferes with daily life/function
36
Q

Feline musculoskeletal pain index: measures impact of osteoarthritis on domains of:

A
  • Pain
  • Mobility
  • Activity
  • Affective effects
37
Q

Client specific outcome measures -felines (CSOMf)

A
  • Choose 3 behaviours that the cat doesn’t do well anymore or has stopped doing
  • Easier as there is only 3 behaviours for them to have to assess
38
Q

Gait analysis: force plate, pressure mat walkways

A
  • Objective methodology to evaluate limb motion
  • Research and referral facilities
  • Not practical in everyday
  • Difficult to interpret in presence of multiple arthritic joints
  • Helpful in detection of changes in lameness but not stiffness
39
Q

Accelerometers: activity monitors

A
  • Objective, non-invasive, portable
  • Able to evaluate active movement at home

ANESTHESIA (18 decks)

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