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Science Of Animal Welfare > Measuring Pain > Flashcards

Measuring Pain Flashcards

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1
Q

What is the International Association for the Study of Pain 2019 definition of pain?

A

Pain = An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage

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2
Q

True or false

We need potential tissue damage to feel pain

A

False

We don’t need potential tissue damage to feel pain

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3
Q

When thinking about pain what do you need to be aware of?

A

It’s an individual experience

It has a protective function

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4
Q

What is the pathway that lets you feel pain?

A

First in the pain pathway is a pain inducing stimulus
The pain receptors then activate and translate and transmit signals through C and A-Delta fibres
The signal travels through the C and A-Delta fibres to the Peripheral Central Nervous Systems spinal cord
This triggers a reflex to move the body part away from the pain inducing stimulus
The pain signal will then continue up to the brains thalamus to feel the pain

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5
Q

What is Molony 1997’s definition of animal pain?

A

Animal pain = “ An aversive sensory and emotional experience representing an awareness by the animal of damage or threat to the integrity of its tissues
It changes the animals physiology and behaviours to reduce or avoid damage, to reduce the likelihood of recurrence and to promote recovery”

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6
Q

What are the 4 types of pain?

A

1) Nociceptive
2) Neuropathic
3) Acute pain
4) Chronic pain

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7
Q

What is nociceptive pain?

A

Nociceptive pain is acute sharp pain
Nociceptive pain responds to the following stimuli:
- Thermal
- Mechanical
- Chemical
You can get superficial somatic vs deep somatic vs visceral

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8
Q

What is neuropathic pain?

A

Neuropathic pain is where damaged and/or sensitised nerves fire in the absence of tissue damage

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9
Q

What is acute pain?

A

Acute pain has relatively short duration of pain
It has an obvious cause
It resolves with healing
It has a protective function

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10
Q

What is chronic pain?

A

Chronic pain could have multiple causes
Chronic pain persists after healing
It’s often refractory to treatment

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11
Q

What are the consequences of pain?

A

First there’s inflammation, tissue injury and nerve damage which leads to pain
The following systems will then activate:
- Neuroendocrine systems changes
- Sympathoadrenal activation
- Neuroplasticity (spinal cord and CNS)
- Inflammatory mediators “sensitising soup”
- Central processing changes
Activation of all these systems leads to infection and impaired wound healing

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12
Q

What is neuroplasticity?

A

Neuroplasticity is changes in the somatosensory system which will generate central sensitisation and facilitated CNS transmission
The firing of these neurones then causes hyperalgesia and allodynia

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13
Q

True or false

Pain can lead to more pain if severe or prolonged

A

True

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14
Q

Sensitisation can have a persistent effect, which causes what?

A

Hyperalgesia

Allodynia

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15
Q

Define hyperalgesia

A

Hyperalgesia = “An increased response to a stimulus which is normally painful”

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16
Q

Define allodynia

A

Allodynia = Pain due to a stimulus which does not normally provoke pain

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17
Q

What types of indicators can be used to assess pain?

A 
Physiological indicators
Behavioural indicators
Pain scales/questionnaire
Threshold test and cognitive bias
Neurological indicators
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18
Q

Give examples of physiological indicators of pain

A 
Tachycardia, hypertension and cardiac arrhythmia
Pale mucous membrane
Mydriasis
Sweating, trembling, hypersalivation
Increased urination or defication
Poor body or coat condition
Changes in stress hormones such as:
              Cortisol
              Glucose
              Insulin
              Adrenaline
              Endorphins
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19
Q

What are the 3 disadvantages of physiological indicators of pain?

A 
They're unreliable and non-specific if taken as a sole parameter
We need knowledge about physiology of the species evaluated to know what's normal
Errors are increased with
             Disease
             Fear
             Stress
             Handling
             Anaesthesia
             Etc
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20
Q

True or false

Behavioural indicators generally vary between species

A

True

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21
Q

True or false
It’s hard to distinguish behaviour between species so we need to know the normal behaviour of each species in order to see if the animal is presenting pain behaviour

A

True

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22
Q

True or false

Behavioural indicators don’t vary within species

A

False

Behavioural indicators vary within species

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23
Q

True or false
Due to the behaviour indicator variations we need to rely on people who know the animal well to pick up the subtle changes

A

True

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24
Q

Give examples of behavioural indicators used to measure pain

A 
Abnormal posture 
Abnormal activity
Abnormal movement
Abnormal gait
Reluctance to move
Depression, inappetence, dullness
Manic behaviour
Not grooming
Trembling
Poor interaction with people, hiding
Non-interested in surroundings
Decreased interactions with other animals
Tooth grinding
Poor cognition
Ear-flicks
Aggression
Paying attention to the injured area or wound, hyperalgesia when palpated
Vocalisation
Whining, crying, howling
Head hanging down, low tail carriage
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25
Q

What is the main disadvantage of behavioural indicators of pain?

A

Many of the behavioural indicators of pain can also indicate:
Poor general health
Medical problems
Anxiety or fear
Normal behaviour of the animal

26
Q

How can you use pain scales/questionnaires?

A

This is where you assign scores to behaviours to quantify pain

27
Q

What are pain scales/questionnaire created for?

A

They’re created for specific:

          - pain conditions
          - species
          - environments
28
Q

True or false

With pain scales/questionnaires it’s important to know if they’re validated or non-validated for specific pain types

A

True

29
Q

What is a composite pain scales?

A

Composite pain scales combine different indicators together such as physiological and behavioural

30
Q

What are pain scales/questionnaire used for?

A

They’re used to ensure that animals are frequently checked and levels of pain are assessed
If pain is present medication can be administered

31
Q

When are pain scales/questionnaires usually done?

A

Pain scales/questionnaires are usually done alongside the animals physical examination and history

32
Q

True or false

When using pain scales/questionnaires we also need to take into account variation

A

True

33
Q

Give examples of pain scores

A

Simple descriptive scores
Numerical rating scale
Visual analogue scales

34
Q

Explain what a numerical rating scale is?

A

Numerical rating scales are a total numerical score result from the sum of sub-categories each with various descriptors
They’re more thorough than simple descriptive scores and visual analogue scales
They’re also more time consuming

35
Q

True or false

Facial expression scales of pain are also indicator of pain

A

True

36
Q

What are the 5 disadvantages of pain scales/ questionnaires?

A

1) You need to still consider individual variability in the scorer and animal
2) There is no ‘gold standard’ pain scale
3) Some of them are very time consuming
4) The majority of them have been developed for peri-operative pain

5) There’s not many of them for:
- medical pain
- ear disease
- pneumonia
- chronic pain
- neuropathic pain
- other species

37
Q

What are pain threshold tests also known as?

A

Threshold test = Quantitative Sensory Testing = QST

38
Q

What happens in a threshold test/Quantitative Sensory Testing?

A

They use a repeatable stimulus to measure the response to pain
When the animal moves away from the stimulus that is it’s threshold

39
Q

What can you use a threshold test/Quantitative Sensory Testing to detect?

A

Pain
Hyperalgesia
Allodynia
Test analgesic effects of drugs

40
Q

What are threshold test/Quantitative Sensory Testing widely used for?

A

They’re widely used in preclinical studies evaluating pain and analgesic efficacy of drugs/therapies in rodents

41
Q

True or false
Threshold tests are validated in different species
You need to know a baseline threshold for them all and what to expect when they’re feeling pain/hyperalgesia/allodynia

A

True

42
Q

True or false

Threshold test/Quantitative Sensory Testing can be used to measure chronic and acute pain

A

True

43
Q

What are the 4 disadvantages of measuring pain with threshold tests?

A

1) There are many confounding factors identified for each species
2) Training is needed to detect pain
3) Some tests need the animal to be restrained which may change the behaviour of the animal
4) They’re currently used in research situations not for clinical cases

44
Q

True or false

Motor activity & gait analysis/weight bearing can be used as pain indicators

A

True

45
Q

What are the 2 disadvantages of motor activity/gait analysis/weight bearing as an indicator of pain?

A

1) They have limited application in clinical practice

2) Some painful lesions of the foot may not result in lameness

46
Q

Give examples of neurological indicators of pain

A

Electroencephalography EEG

FMRI

47
Q

What are the disadvantages of using EEG’s to measure pain?

A

They’re invasive
The animal needs to be restrained
It’s not practical for non-research situations
It only evaluates activity of superficial cortex

48
Q

What are the disadvantages of using an fMRI as a measure of pain?

A

fMRI are invasive
It’s an indirect marker of brain activity
The animal needs to be restrained and under general anaesthesia usually
It can be misinterpreted
It’s only used for pain assessment in the laboratory animals

49
Q

What 7 things do we need to know when managing pain?

A

1) First we need to know what type of pain it is
This is because we need to treat it via the correct pain pathway/mechanism

2) We need to take into account whether the drug is short term or long term treatment
3) We need to be aware of side effects of the drugs
4) We need to think about the objective of the treatment
5) We need to be aware of the legal applications of using the drug
6) We need to be aware of the effects of the analgesic on the experiments lab animals
7) In chronic pain states you need to consider management of fear and anxiety to reduce pain perception

50
Q

How do you pharmacologically manage pain?

A

You need to do pre-emptive analgesia
As much as possible we try to use multimodal analgesia
This means you get different drugs and combine them together to target different parts of the pain pathway
This allows you to use lower drug dosages which reduces side effects

51
Q

What are the types of analgesics you can use and explain them?

A

Systemic
This means they’re taken either orally, interveneously, subcutaneously or intramuscularly

Local
This means you will administer the drug around the area of pain
Local analgesics carry less side effects

52
Q

True or false
In many experiments the animal will be put under general anesthesia
General anaesthesia causes the animal to be unconscious with no nociception

A

False
General anaesthesia causes the animal to be unconscious but nociception is still present
This means analgesics are needed with general anaesthesia if you’re going to produce pain

53
Q

True or false

With analgesics we will always try to choose the gold standard

A

True

54
Q

True or false

For severe pain opioids are the gold standard

A

True

55
Q

What 3 things must you consider when using pharmacological pain management?

A

You need to think about whether the animal can have the treatment at home or must it have the treatment in hospital

You must also consider side effects

You must also think about adjunctive therapies for chronic pain such as anxiolytics, antidepressants or antiepileptic drugs

56
Q

What do local anaesthetics do?

A

Local anaesthetics inhibit completely the transmission of the action potentials in the synapses
Local anaesthetics prevent sensitisation and hyperalgesia/allodynia

57
Q

True or false

Local anaesthetics are widely used for disbudding

A

True

58
Q

True or false

In some cases general anaesthesia is required to apply local anaesthetics due to the animal moving too much

A

True

59
Q

True or false

With non-pharmacological treatments you’ll try for a multimodal approach

A

True

60
Q

Give examples of non-pharmacological pain management treatments

A 
Acupuncture/electro acupuncture
Corrective surgery
Radiotherapy
Physiotherapy
Hydrotherapy
Cryotherapy
Environmental factors

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