Management of long term pain

Question 1

What is chronic pain?

Answer 1

Pain that outlasts the original injury and expected healing time or lasts longer than a specified period (>3 months in humans)

Question 2

Chronic pain may result in changes which lead to what?

Answer 2

Changes in central pain processing which may result in the development of hyperalgesia (exaggerated response to a noxious stimulus) and allodynia (non-noxious stimulus perceived as painful).

Question 3

What type of chronic pain may result in jumping/startled behaviour?

Answer 3

Neuropathic

Question 4

What is referred chronic pain?

Answer 4

Pain that is projected from the source to a distant site and can make identification of the underlying cause of pain more difficult.

Question 5

What type of chronic pain affects skeletal muscles?

Answer 5

Myofascial

Question 6

How is sympathetically medicated chronic pain characterised?

Answer 6

Cold, painful areas that may arise spontaneously or secondarily to trauma

Question 7

What are some implications of chronic pain (think sensory, motor, emotional)

Answer 7

• Feeling of suffering
• Conditioned responses due to pain
• Abnormal movements and postures
• Welfare and quality of life

Question 8

Give some example behavioural changes that would be seen in a dog suffering from chronic pain

Answer 8

• reduced enthusiasm
• reduced exercise tolerance
• changed interaction with owner
• increased separation anxiety
• more restless
• change in appetite
• mood changes

Question 9

Give some example behavioural changes that would be seen in a cat suffering from chronic pain

Answer 9

• reduced enthusiasm
• reduced jumping to high areas
• less time spent outside
• change in urination
• appetite changes
• more time spent sleeping
• tail flicking or tucked tail

Question 10

What is the ABCDE rule for treating chronic pain?

Answer 10

Analgesia
Bodyweight
Control of complications, common sense and comfort
Disease modification 
Exercise

Question 11

What is indicated with long term use of NSAIDS for chronic pain?

Answer 11

Serum biochemical testing and urinalysis every 6-12 months

Question 12

What is grapiprant?

Answer 12

A non-steroidal, non-COX inhibiting anti-inflammatory drug

- useful in dogs that don’t tolerate NSAIDS

Question 13

Which drugs became licensed in 2020 for alleviation of pain secondary to OA in dogs and cats?

Answer 13

Anti-nerve growth factor monoclonal antibodies

Question 14

How is anti-nerve growth factor administered to patients?

Answer 14

Sub-cutaneous injections every 4 weeks

Question 15

Which analgesic drug is toxic to cats?

Answer 15

Paracetamol

Question 16

When is tramadol licensed for use?

Answer 16

In dogs - acute and chronic mild soft tissue and musculoskeletal pain

Question 17

What is inhibited by tramadol?

Answer 17

Serotonin and noradrenaline reuptake - weak mu receptor agonist

Question 18

Ketamine falls into which analgesic drug catagory?

Answer 18

NMDA antagonist

Question 19

Which 2 drugs that are predominantly used as anti-convulsants can also be used off-license as analgesics?

Answer 19

Gabapentin

Pregabalin

Question 20

Why can tri-cyclic antidepressants not be used with tramadol?

Answer 20

They are both serotonin and noradrenaline reuptake inhibitors

Question 21

How does acupuncture work as an analgesic intervention?

Answer 21

Needle placement in painful muscles or close to wounds or painful joints stimulates local release of vasodilators, nerve growth factor etc that stimulate wound healing as well as stimulating nociceptive transmission to provide a competing stimulus for the chronic pain stimulus at the dorsal horn

Question 22

What is a main benefit of hydrotherapy?

Answer 22

Joints can be worked or extended without concussive pressure

Question 23

How does laser therapy work as an analgesic intervention?

Answer 23

• reduce pain and inflammation
• reducing pro-inflammatory mediators and cytokines at the treatment site
• reducing depolarisation of C fibres (slow pain fibre)
• increasing release of endorphins and serotonin

Question 24

What is the single most important thing owners can implement to help with chronic pain?

Answer 24

Weight loss

Question 25

What can help improve owner complience?

Answer 25

Make them aware of potential side effects and complications of treatment

Question 26

What are nutraceuticals?

Answer 26

Food supplements thought to modify the disease process of degenerative joint disease

Question 27

What is the first step of the rehabilitation process?

Answer 27

Rest

Question 28

What are some signs that a horse in chronic pain may show?

Answer 28

Lameness, reduced appetite, weight loss, reduced interaction, facial expression changes

Question 29

What forms the mainstay of treatment for chronic pain in horses?

Answer 29

NSAIDs

Question 30

What needs to be considered when analgesic drugs are given to food producing animals?

Answer 30

Withdrawal periods

Question 31

What are some environmental modifications that can be implemented for dogs with chronic pain?

Answer 31

• ramps for vehicle access
• non-slip rugs/mats on laminate flooring
• restrict upstairs access
• raised food and water bowls
• supportive bedding
• rests during walks

Question 32

What are some environmental modifications that can be implemented for cats with chronic pain?

Answer 32

Optimisation of core territory

• use of steps/ramps to allow access to higher areas
• provision of new hiding places
• raised food and water bowls
• modifications of cat flaps/outdoor access
• introduce new games to adapt play behaviour

Question 33

When should strict rest be implemented?

Answer 33

Acute conditions e.g. post surgical

When pain is exacerbated by exercise

Question 34

Which drugs can be given to horses with laminits?

Answer 34

NSAIDs
Paracetamol
Gabapentin

Question 35

Which drug group cannot be used in FPA?

Answer 35

Opioids