Chronic Pain Management Flashcards
1
Q
Describe Acute pain
A
- Results of trauma, surgical or infectious events
- Starts abruptly, resolves in days/weeks
- Self-limiting, biological purpose
2
Q
Describe Chronic Pain
A
- Persists beyond normal time of healing/absence of healing
- > 1-3 months in duration or beyond healing time
- Disease
3
Q
Define Allodynia & Hyperalgesia
A
- ALLODYNIA = Pain sensation in response to a non painful stimulus
- HYPERALGESIA = an exaggerated or prolonged response to a noxious stimulus
4
Q
What examples of chronic pain?
A
- Cancer pain : Inflammation, Tissue Distortion, Nerve injury, Neuropathic pain
Visceral obstruction/distension, Ischemia - Osteoarthritis/DJD
- Oro-facial pain
- Intervertebral disc disease
- Tail/limb amputation
5
Q
Arthritis case - how could we assess pain?
A
- QoL scale
- Liverpool OA Dogs (LOAD) questionaire
- Chronic pain assessment
6
Q
What can be used for chrponic pain assessment?
A
- PRessure mats/ force plane for gait analysis
- Accellerometry
- Quantitative sensory testing (resp to stimuli)
- Pain trace
7
Q
Describe NSAIDS as pain tx option (adverse effects)
A
- ≠ reaction to ≠ NSAIDs possible
- Washout period (7-14 days ??)
- Blood works + urine analysis before/ during treatment
- Constant monitoring
- Lean body weight dose
- Pair with food (some exceptions)
- Lowest effective dose if long term administration/ administration every other day
8
Q
AEs of NSAIDS?
A
- Vomiting, diarrhoea, anorexia, gastro-intestinal ulceration & perforation
- Hepatotoxicity
- Renal Disease
- Coagulation
9
Q
Describe Paracetamol for tx of pain?
A
- Licensed (dogs) with codeine for up to 5 days
- COX-3 inhibition (brain): antipyretic effect
- Use with NSAIDs or Corticosteroids??
10
Q
What analgesic MOA for paracetamol?
A
- Prostaglandins inhibition
- Serotoninergic pathway activation
- Endocannabinoids enhancement
- L arginine/NO pathway
11
Q
What category of pain meds do Frunevetmab (cats) / Bedinvetmab (dogs) fall into?
A
Anti-nerve Growth Factor (NGF) Monoclonal antibodies
12
Q
How do we use Monoclonal antibodies?
A
- Inhibition of NGF mediated cell signalling to reduce pain
- Monthly subcutaneous injection
- Only licenced for treatment of PAIN associated with OA
- Relatively new product?
13
Q
AEs & CI of Monoclonal antibodies?
A
- Contraindicated with NSAIDs (In humans)
- Allergic reaction, injection site reactions
- Safety with long term exposure & other medication unknown
14
Q
What drugs can we use for neuropathic pain/ seizures?
A
Gabapentin/ Pregabalin
15
Q
Describe use of gaba/pregaba
A
- Oral formulation
- Blockage of Ca2+ channels presynaptic neurons →↓ Ca2+ influx→ ↓ excitatory
neurotransmitters - Use in association with NSAIDs, opioids…
