Management of long term pain Flashcards
What is chronic pain?
Pain that outlasts the original injury and expected healing time or lasts longer than a specified period (>3 months in humans)
Chronic pain may result in changes which lead to what?
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).
What type of chronic pain may result in jumping/startled behaviour?
Neuropathic
What is referred chronic pain?
Pain that is projected from the source to a distant site and can make identification of the underlying cause of pain more difficult.
What type of chronic pain affects skeletal muscles?
Myofascial
How is sympathetically medicated chronic pain characterised?
Cold, painful areas that may arise spontaneously or secondarily to trauma
What are some implications of chronic pain (think sensory, motor, emotional)
- Feeling of suffering
- Conditioned responses due to pain
- Abnormal movements and postures
- Welfare and quality of life
Give some example behavioural changes that would be seen in a dog suffering from chronic pain
- reduced enthusiasm
- reduced exercise tolerance
- changed interaction with owner
- increased separation anxiety
- more restless
- change in appetite
- mood changes
Give some example behavioural changes that would be seen in a cat suffering from chronic pain
- 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
What is the ABCDE rule for treating chronic pain?
Analgesia Bodyweight Control of complications, common sense and comfort Disease modification Exercise
What is indicated with long term use of NSAIDS for chronic pain?
Serum biochemical testing and urinalysis every 6-12 months
What is grapiprant?
A non-steroidal, non-COX inhibiting anti-inflammatory drug
- useful in dogs that don’t tolerate NSAIDS
Which drugs became licensed in 2020 for alleviation of pain secondary to OA in dogs and cats?
Anti-nerve growth factor monoclonal antibodies
How is anti-nerve growth factor administered to patients?
Sub-cutaneous injections every 4 weeks
Which analgesic drug is toxic to cats?
Paracetamol
When is tramadol licensed for use?
In dogs - acute and chronic mild soft tissue and musculoskeletal pain
What is inhibited by tramadol?
Serotonin and noradrenaline reuptake - weak mu receptor agonist
Ketamine falls into which analgesic drug catagory?
NMDA antagonist
Which 2 drugs that are predominantly used as anti-convulsants can also be used off-license as analgesics?
Gabapentin
Pregabalin
Why can tri-cyclic antidepressants not be used with tramadol?
They are both serotonin and noradrenaline reuptake inhibitors
How does acupuncture work as an analgesic intervention?
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
What is a main benefit of hydrotherapy?
Joints can be worked or extended without concussive pressure
How does laser therapy work as an analgesic intervention?
- 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
What is the single most important thing owners can implement to help with chronic pain?
Weight loss
What can help improve owner complience?
Make them aware of potential side effects and complications of treatment
What are nutraceuticals?
Food supplements thought to modify the disease process of degenerative joint disease
What is the first step of the rehabilitation process?
Rest
What are some signs that a horse in chronic pain may show?
Lameness, reduced appetite, weight loss, reduced interaction, facial expression changes
What forms the mainstay of treatment for chronic pain in horses?
NSAIDs
What needs to be considered when analgesic drugs are given to food producing animals?
Withdrawal periods
What are some environmental modifications that can be implemented for dogs with chronic pain?
- ramps for vehicle access
- non-slip rugs/mats on laminate flooring
- restrict upstairs access
- raised food and water bowls
- supportive bedding
- rests during walks
What are some environmental modifications that can be implemented for cats with chronic pain?
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
When should strict rest be implemented?
Acute conditions e.g. post surgical
When pain is exacerbated by exercise
Which drugs can be given to horses with laminits?
NSAIDs
Paracetamol
Gabapentin
Which drug group cannot be used in FPA?
Opioids
