Pain Flashcards
What are some postures that may signify if a dog is painful?
Tail between legs
Arched or hunched back
Twisted body to protect the painful site
Drooped head
Prolonged sitting
Tucked abdomen
Lying in flat, extended position
Student #11 ML
McCurnin 10th ed pg 904
What are some postures that may signify if a cat is painful?
Tucked limbs
Arched or hunched head/neck or back
Tucked abdomen
Lying flat
Slumped body
Drooped head
Student #11 ML
McCurnin 10th ed pg 904
What are the 3 phases of nociception?
Transduction
Transmission
Modulation
Student #11 ML
McCurnin 10th ed pg 906
What occurs in transduction?
Nociceptors convert mechanical, chemical, and thermal energy into electrical impulses
Student #11 ML
McCurnin 10th ed pg 906
What occurs in transmission?
When the noxious stimuli exceed the nociceptor’s threshold, a nerve impulse is generated and transmitted along the peripheral nerves to the spinal cord
Student #11 ML
McCurnin 10th ed pg 906
What is it called when a dog that has a chronic ear infection can no longer tolerate normal petting?
Allodynia
Student #14 SP
McCurnin 10th ed pg 907
What are ways you can maintain analgesic plane once pain is control is established?
Epidurals, CRI, or continued bolus dosing.
Student #14 SP
McCurnin 10th ed pg 908
What drug category is a lot of times the drug choice for chronic pain, for example osteoarthritis?
NSAIDS
Student #14 SP
McCurnin 10th ed pg 909
What drug plays an important role in reducing neuropathic pain and central sanitization?
Gabapentin
Student #14 SP
McCurnin 10th ed pg 914
What is the location of blocking the infraorbital foramen in a dog?
The left and right foramen can be located easily just above the third premolar and about midway up the gum line.
Student #14 SP
McCurnin 10th ed pg 911
Increased cortisol levels and sympathetic nervous system activity accompanying pain may have what undesired effects?
Reduced wound healing, suppression of immune function, increased catabolism and metabolic rate, anorexia, ileus, atelectasis, increased HR and blood pressure, irregular heart rhythms, and coagulopathies.
Student #6, AF, McCurnin 10th ed, pg. 905
Central sensitization or the “wind-up phenomenon” occurs when
Spinal neurons are subjected to repeating or high Intensity nociceptive impulses, leading to these neurons becoming progressively and increasingly excitable, even after the stimulus is removed.
Student #6, AF, McCurnin 10th ed, pg. 906
What is preemptive analgesia?
Providing analgesia before a noxious stimulus occurs.
Student #6, AF, McCurnin 10th ed, pg. 907
What is the duration of action of Hydromorphone?
3 to 4 hours
Student #6, AF, McCurnin 10th ed, pg. 912
What physiologic effects can be observed when a patient is experiencing emergence delirium?
Tachycardia, hypertension, cardiac arrhythmias, ventilation abnormalities, tachypnea, decreased tidal volume, cortisol release, and GI ileus and ulceration.
Student #6, AF, McCurnin 10th ed, pg. 913
What “rescue” drug is commonly used to counteract emergence delirium by providing both sedation and analgesia?
Dexmedetomidine (Dexdomitor)
Student #6, AF, McCurnin 10th ed, pg. 913
What does the Pulmonary system pain cause?
Tachypnea, Hypoxemia, Pulmonary edema, Pulmonary hypertension and raspatory acid imbalance.
Student #20
McCurnin 10th ed, pg. 906
What should you monitor when giving opioids?
Mentation, BP, RR, and nature
Student #20
McCurnin 10th ed, pg. 909
What should you monitor when you are giving alpha 2 agonists?
Femoral pulse rate and quality, HR, and BP
Student #20
McCurnin 10th ed, pg. 909
What nerve block should be used for feline declawing?
Circumferential Ring block
Student #20
McCurnin 10th ed, pg. 910
What are good local anesthesia’s?
Lidocaine, Bupivacaine and mepivacaine
Student #20
McCurnin 10th ed, pg. 918
Signs of pain in horses and other large animals?
Anorexia/lack or interest in food, lethargy, restlessness, pawing, vocalizing, bruxism, reluctance to move, lying down more frequently/longer.
#13 KM
McCurnin 10th ed. pg. 917
What does GI pain look like in large animals?
Kicking and/or looking at abdomen, violently rolling, stretched out posture (horses), tucked abdomen (cattle), “dog sitting” (foals).
#13 KM
McCurnin 10th ed. pg. 916
The cornual branch of the zygomaticotemporal nerve and the infratrochlear nerve must be blocked for dehorning procedures in ____ (species) while only the cornual branch needs blocked in ____ (species).
Goats, cattle
#13 KM
McCurnin 10th ed. pg. 921
Dysphoria
“Emotional state characterized by anxiety, depression, or unease”
#13 KM
McCurnin 10th ed. pg. 904
Mulitmodal analgesia
Synergistic effects of combining two or more classes of analgesic drugs to alter more than one phase of nociception.
#13 KM
McCurnin 10th ed. pg. 908
What procedures are a local infiltration useful in?
Small mass removal, digit amputation, arterial catheter placement, Thoracocentesis, Abdominocentesis, bone marrow sampling, and many more.
Student #8 KH, McCurnin 10th ed. pg. 910
Which pure opiod are cats sensitive to, therefore lower doses must be used?
Morphine
Student #8 KH, McCurnin 10th ed. pg. 912
What is the main advantage of using morphine CRI?
Prevents the peaks and valleys that are typically seen with an opiod bolus dosing.
Student #8 KH, McCurnin 10th ed. pg. 913
What are the principles of managing pain in large animals?
- Pre-emptive analgesia
- Multimodal analgesia
- Analgesia of a duration that covers the entire painful period- for both acute and chronic pain
Student #8 KH, McCurnin 10th ed. pg. 916
How is Firocoxib used in equine according to the FDA?
Approved for use up to 14 days to control pain and inflammation associated with equine osteoarthritis.
Student #8 KH, McCurnin 10th ed. pg. 918
Define nociception.
Is the term used to describe three neuralgic phases of the pain pathway.
AJ student # 10 McCurnin 9th edition pg 985
What are signs of pain associated with the pulmonary system?
tachypnea, hypoxemia, pulmonary edema, pulmonary hypertension, and respiratory acid-base imbalance
AJ student # 10 McCurnin 9th edition pg 984
What are signs of pain associated with the metabolic system?
cachexia, increased oxygen demand, and negative nitrogen balance
AJ student # 10 McCurnin 9th edition pg 984
What does a dog with a pin score of 1 look like?
distracted easily by surrounding, content to slightly unsettled/ restless, mild body tension, and reacts to the affected area being touched.
AJ student # 10 McCurnin 9th edition pg 895
What does a cat with a pain score of 3 look like?
constantly yowling, growling, or hissing; may bite or chew at the wound, reacts aggressively to palpation and pulls away, and moderate body tension.
AJ student # 10 McCurnin 9th edition pg 986
What are some vocalization signs of pain in dogs?
Barking, Howling, Moaning, and Whimpering
Student #3, S.C
McCurnin 10th Edition Page:903
What are some vocalization signs of pain in cats?
Crying, Hissing, Spitting, Moaning, Screaming, and Purring
Student #3, S.C
McCurnin 10th Edition Page:903
The hospitalized patient is in unfamiliar surroundings and may be comforted by a favorite ________ or ____________. This is an example of _____________ and ____________ care for treatment of pain.
Blanket, Toy Environmental, Emotional
Student #3, S.C
McCurnin 10th Edition Page:907
What two drugs are used for dental nerve blocks?
Lidocaine and Bupivacaine
Student #3, S.C
McCurnin 10th Edition Page:910
What drug could be added to reduce bleeding by coating the syringe when doing dental nerve blocks?
Epinephrine
Student #3, S.C
McCurnin 10th Edition Page:910
Behavioral changes related to pain?
-Restless, decreased appetite, lack of sleep, resistant to handling, not assuming normal positions.
Student #4, BE, Pg 983
When should a patient be evaluated for pain?
-Upon admonition and at regular intervals throughout hospitalization.
Student #4 BE, Pg 984
AAHA pain management standards?
-Pain assessment for every P regardless of complaint, assessment recorded in the medical record, use of preemptive pain management, pain management for anticipated pain level and duration, analgesia for all surgical procedures, reassessment of pain throughout surgery, medical and chronic pain treated, written protocols, client education.
Student #4, BE, Pg 986
What side effects should be monitored when local anesthetics are administered?
-None, unless given via CRI. Then monitor for nausea, vomiting, neurologic signs, and seizures.
Student #4, BE, Pg. 989
What side effects should be monitored when NSAIDS are administered?
-GI upset, GI bleeding, renal disturbances
Student #4, BE, Pg 989
Where does the pain pathway begin?
At the site of tissue damage
Student #16 ER
McCurnin 10th Edition pg 906
What differentiates nociception from pain?
Consciousness
Student #16 ER
McCurnin 10th Edition pg 906
Which receptor in the brain and spinal cord is responsible for providing sedation when opioids are administered?
Kappa
Student #16 ER
McCurnin 10th Edition pg 911
Nonsteroidal anti-inflammatory drugs provide analgesia by modifying which of the following?
Inflammatory Response
Student #16 ER
McCurnin 10th Edition pg 909
What are common side effects seen when using Alpha 2 Agonists?
Bradycardia and vomiting
Student #16 ER
McCurnin 10th Edition pg 912
The wind up phenomenon is a cumulation of which two distinct phases of change in the nervous system?
Hyperalgesia and allodynia
Student #2 vc
McCurnin 10th ed. pg 906
What are the benefits of using three different classes of drugs for analgesia?
Provides better pain control and confers the added benefit of allowing the use of lower doses of individual agents, thereby reducing side effects. Effective anaglesia can also reduce the amount of gasesous anesthetic required for a procedure.
Student #2 vc
McCurnin 10th ed. pg 908
What new NSAID has entered the veterinary market, and what are it’s benefits?
Grapiprant (Galliprant, Elanco)
Works by targeting different receptors and is proposed to successfully combat inflammation and thus be safer for the GI tract.
Student #2 vc
McCurnin 10th ed. pg 909
What procedures can topical analgesia be helpful for?
Wound suturing, arterial puncture, nasal cannulation, and urinary catheter.
Student #2 vc
McCurnin 10th ed. pg 910
What is a common side effect of opioids, particularly morphine and hydromorphone? When does this side effect most frequently occur?
Emesis
Occurs most frequently when an opioid is used as a premedication, rather than as an analgesic in an animal already in pain.
Student #2 vc
McCurnin 10th ed. pg 911
Describe neuropathic pain.
Persistent stabbing, aching, burning, itching, or tingling sensations, with or without an observable cause.
Student #17 TAS-R
McCurnin 10th ed. pg 906
Define hyperalgesia.
Less and less stimulation causes pain.
Student #17 TAS-R
McCurnin 10th ed. pg 906
Adverse effects of local anesthetics in a CRI?
nausea, vomiting, neurologic signs, and seizures.
Student #17 TAS-R
McCurnin 10th ed. pg 909
Side effect of opioids in cats and horses? How to treat?
Excitement. Treat with a sedative.
#17 TAS-R
McCurnin 10th ed. pg 922
Onset time and duration of action for lidocaine?
Onset time: 3-5 minutes. Duration of action: 60-90 minutes.
#17 TAS-R
McCurnin 10th ed. pg 910
Soft tissue procedures require how many days of postoperative analgesia?
Three to four days
#18 BKS
McCurnin 9th ed. pg. 989
Research shows that pretreatment with _______________greatly reduces intraoperative and postoperative pain from procedures on soft tissues and orthopedic procedures.
NSAIDs
#18 BKS
McCurnin 9th ed. pg. 990
How long is the contact time for topical analgesia, such as bupivicaine or lidocaine solutions, to ensure effective analgesia?
20 to 30 minutes
#18 BKS
McCurnin 9th ed. pg. 991
Which opioid is considered the “gold standard” for pure opioid agonists, used to manage severe pain?
Morphine is commonly used to provide maximal analgesia and sedation. All other drugs are compared with morphine in terms of efficacy, duration of action, and cost.
#18 BKS
McCurnin 9th ed. pg. 993
Why might it be more difficult for owners to realize or understand that their farm animals need analgesia?
There are misconceptions about animals and pain, especially when it comes to large animals. One misconception is that “animals don’t show they are in pain, so they must not feel pain.” Large animals are prey animals and by instinct will hide their pain as much as they can to not appear weak to a predator.
#18 BKS
McCurnin 9th ed. pg. 997
What should you monitor for if your patient has been given a local anesthetic?
Muscle tremors and GI upset
#19 MW
McCurnin 10th ed. pg. 909
What is the difference between an agonist and an antagonist?
agonists stimulate receptors while antagonists partially block the receptors.
#19 MW
McCurnin 10th ed. pg 911
What are two reversals for opioids?
Naloxone and Butorphanol (partial)
#19 MW
McCurnin 10th ed. pg. 912
Why is lidocaine beneficial as a CRI for GDV or other GI disorders?
It is safe and provides excellent systemic analgesia
#19 MW
McCurnin 10th ed. pg. 913
Apha 2 agonists inhibit the release of _________?
Norepinephrine
#19 MW
McCurnin 10th ed. pg. 912
What are nociceptors?
Pain receptors
#9 KJ
McCurnins 10th ed. pg 906
In which cases would severe pain be expected?
Cervical disc herniation, extensive inflammation, medical or surgical fracture repairs, limb amputations, declawing, and ear canal ablation
#1, MA
McCurnin 10th ed. pg 902
In which cases would moderate to mild pain be expected?
Cruciate repair, laparotomy, mass removal, castration, and dental procedures
#1, MA
McCurnin 10th ed. pg 902
What are the 5 basic principles which are used in designing an analgesic protocol and to effectively provide pain management?
- The best way to treat pain is to prevent it
- Using drug combinations, which often produces better pain relief compared with single agents
- Matching analgesic
- Maintaining analgesic plane once pain control is established
- Adopting the approach of “Don’t quit till the pain quits”
#1, MA
McCurnin 10th ed. pg 908
Why do horses generally receive better analgesic treatment than other large animals?
- They are more likely to be treated as a “companion animal”
- Horses generally are performance animals, and pain can affect their performance
- Horses may become violent and dangerous when in acute pain - especially with GI pain
- Unlike cattle and pigs, horses don’t have an absolute economic value; thus the owners are more likely to spend money on their care
#1, MA
McCurnin 10th ed. pg 921
Which form of analgesic is available, effective, and cheap, but underused?
Local anesthetic drugs
#1, MA
McCurnin 10th ed. pg 917
Locomotion signs for a dog in pain
Reluctance to move
Carrying one leg
Lameness
Unusual gait
Unable to walk
Chewing painful areas
#12, JL
McCurnin 10th ed pg.903
Temperament signs for cat in pain
Aggressive
Biting
Scratching
Chewing
Attacking
Escaping
Hiding
#12 JL
McCurnin 10th ed pg.903
Allodynia
Nerve fibers that normally carry pleasant or neutral information are recruited and become part of the pain process
#12 JL
McCurnin 10th ed pg.906
Local Infiltration
Injection of lidocaine or bupivacaine into local tissue
#12 JL
McCurnin 10th ed pg. 910
Why are camelids more likely to receive analgesic treatment compared with cattle, sheep, and goats?
Generally, they are constrained neither by an absolute economic value nor by entry into the human food chain
#12 JL
McCurnin 10th ed pg.923
What are common NSAIDs used in equine patients?
Phenylbutazone (Bute) and flunixin meglumine (Banamine)
Student #7, HHS
McCurnin 10th edition, pg:916
Why are few medications given orally to ruminants?
The rumen can inactivate, slow absorption, and alter drugs and the patient’s response to the drug.
Student #7, HHS
McCurnin 10th edition, pg:922
What is the most common type of anesthetic drugs used in ruminants?
Local analgesic agents such as lidocaine and bupivacaine used in blocks
Student #7, HHS
McCurnin 10th edition, pg:923
What drug in combination with lidocaine increases its effectiveness?
Epinephrine
Student #7, HHS
McCurnin 10th edition, pg:910
What are some nonpharmacologic options for pain treatment?
Massage, aquatic therapy, acupuncture, thermotherapy, shock wave therapy, laser therapy, and electrical stimulation
Student #7, HHS
McCurnin 10th edition, pg:914
Which NSAIDS are FDA approved for the use in dogs?
Rimadyl (Carprofen), Metacam (meloxicam), Deramaxx (deracoxib), and Onisor (robenicoxib)
Student #15, HP
McCurnin 9th ed. pg. 990
Which drug should never be used in circumferential limb blocks?
Epinephrine
Student #15 ,HP
McCurnin 9th ed. pg 991
What is the onset and duration of action for Marcaine (bupivacaine)?
Marcaine has an onset time of 15 minutes and a duration of action for 6-8 hours
Student #15, HP
McCurnin 9th ed. pg. 991
Fentanyl, morphine, and hydromorphone are examples of _____
Pure opioid agonists
Student #15, HP
McCurnin 9th ed. pg 993
What are two examples of Alpha 2 agonists?
Dexmedetomidine (Dexdormitor) and Xylazine
Student #15, HP
McCurnin 9th ed. pg 994
Is fentanyl a partial or pure opioid agonist?
Pure
#9 KJ
McCurnins 10th ed. pg. 912
Nocita duration of pain relief postop?
72 hours
#9 KJ
McCurnins 10th ed. pg. 910
Is there an NSAID approved for chronic use in cats?
No. But Carprofen is a commonly used off-label NSAID for chronic inflammatory pain in cats.
#9 KJ
McCurnins 10th ed. pg. 910
Does Morphine or hydromorphone cause less adverse effects when compared to each other?
Hydromorphone causes less adverse effects than Morphine.
#9 KJ
McCurnins 10th ed. pg. 912
Why is it thought that an animal is experiencing more severe pain if they are showing obvious signs such as vocalizing?
5 SF
Animals have the natural instinct to hide pain to avoid seeming vulnerable to predators. So, if an animal is showing obvious signs of pain, it is likely that they are no longer able to hide it because the pain is more severe.
McCurnin’s 9th ed. pg 982-982
What are some reasons why it is important to treat/prevent pain?
5 SF
-Pain causes increased cortisol, which can interfere with wound healing and suppress the immune system
-Increased sympathetic tone caused by pain can cause increased catabolism and metabolic rate, anorexia, ileus, and atelectasis
-Pain can cause tachycardia, hypertension, arrhythmias, and coagulopathies
McCurnin’s 9th ed. pg 984-985
Classic signs of inflammation?
5 SF
redness, heat, and swelling
McCurnin’s 9th ed. pg 986
What is gabapentin used to treat, and what are some common indications for its use?
5 SF
Gabapentin is used to treat neuropathic pain
Some common indications include
-chronic degenerative conditions (ex: osteoarthritis, cancer)
-dermatologic conditions (lick granuloma, chronic skin or ear infections)
-persistent biting, licking, scratching, chewing of body areas
-resistance to being touched at unaffected body areas
-obvious signs of pain not associated with current inflammation
McCurnin’s 9th ed. pg 996
Why should an animal be placed in a quiet, dimly lit place after administering alpha 2 agonists?
5 SF
Loud noises and bright lights may cause agitation and decrease the effect of the drug.
McCurnin’s 9th ed. pg 994
