Pain Flashcards
What are some common clinical signs of pain in dogs and cats?
4 JG
Tachycardia, increased respiratory rate, restlessness, increased temperature, increased BP, abnormal posturing, inappetence, aggression, frequent movement, facial expression, trembling, depression, and insomnia
Bassert, J. M., Beel, A. D., & Samples, O. M. (2021, March 25). McCurnin’s clinical textbook for Veterinary Technicians and nurses. McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses - 10th Edition. (p. 903)
What are more subtle clinical signs of pain that can be seen in cats and dogs?
4 JG
Anxiety, nausea, pupil enlargement, licking, staring, and chewing at the surgical site or wound, poor mucous membrane color, salivation, and head pressing
Bassert, J. M., Beel, A. D., & Samples, O. M. (2021, March 25). McCurnin’s clinical textbook for Veterinary Technicians and nurses. McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses - 10th Edition. (p. 903)
What are the pain management standards according to AAHA?
4 JG
Pain assessment for every patient, regardless of presenting complaint
Assessment should be recorded in the medical record
Use of preemptive pain management
Appropriate pain management for anticipated level and duration
Pain management for all surgical procedures
Reassessment for pain throughout the procedure
Medical and chronic pain also treated
Teaching clients to recognize pain in their pets
Bassert, J. M., Beel, A. D., & Samples, O. M. (2021, March 25). McCurnin’s clinical textbook for Veterinary Technicians and nurses. McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses - 10th Edition. (p. 906)
What are the principles of administering analgesia?
4 JG
The best way to treat pain is to prevent it
Using drug combinations, which often produces better pain relief compared with single agents
Matching analgesics (based on dosage and duration of action) to the degree of expected surgical pain
Maintain an analgesic plane once pain control is established
Adopting the approach of “don’t quit till the pain quits”
Bassert, J. M., Beel, A. D., & Samples, O. M. (2021, March 25). McCurnin’s clinical textbook for Veterinary Technicians and nurses. McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses - 10th Edition. (p. 908)
What are the general signs of pain in horses and farm animals? What about GI pain?
4 JG
General signs
Decreased interest in food or anorexia
Lethargy
Excitement, restlessness
Pawing
Vocalizing (mainly cattle)
Bruxism
Reluctance to move
Lying down more frequently or for longer periods than usual
Any abnormal behavior
GI signs
Kicking or looking at the abdomen
Violently trying to roll
Stretching out in an abnormal posture (especially horses)
Standing with the abdomen tucked (especially cattle)
“Dog sitting” (especially foals)
Bassert, J. M., Beel, A. D., & Samples, O. M. (2021, March 25). McCurnin’s clinical textbook for Veterinary Technicians and nurses. McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses - 10th Edition. (p. 917)
What is the difference between acute and chronic pain?
Acute pain is described as a sharp stabbing sensation.
Chronic pain is described as a dull, persistent throbbing.
Student #10, AM
McCurnin 10th edition, page: 906
What is multimodal analgesia?
Multimodal analgesia is the process of using drug combinations, which often produces better pain relief compared with single agents.
Student #10, AM
McCurnin 10th edition, page: 908
After temperature, pulse, respiration, and blood pressure, what is known as the “fifth vital sign?”
Pain is considered to play such an important role in overall health and well-being that it is now regarded as the fifth vital sign.
Student #10, AM
McCurnin 10th edition, page: 904
What is an effective technique for managing a variety of pain states?
IV administration of lidocaine via CRI
Student #10, AM
McCurnin 10th edition, page: 911
What anticonvulsant drug plays an important role in the reduction of neuropathic pain and central sensitization?
Gabapentin
Student #10, AM
McCurnin 10th edition, page: 914
What are some posture signs of pain in dogs?
Tail between legs
Arched/hunched back
Twisted body to protect pain site
Drooped head
Prolonged sitting position
Tucked abdomen
Lying in flat, extended position
Student #11, JM
McCurnin 10th edition, page: 903
What are some posture signs of pain in cats?
Tucked limbs
Arched or hunched head and neck or back
Tucked abdomen
Lying flat
Slumped body
Drooped head
Student #11, JM
McCurnin 10th edition, page: 903
What are the two classifications of opioids?
Agonists: stimulate the opioid receptors
Antagonists: block particular opioid receptors
Student #11, JM
McCurnin 10th edition, page: 911
Why do horses generally receive better analgesic treatment than other large animals?
- They are more likely to be treated as “companion animals.”
- They generally are performance animals, and pain can affect their performance.
- They may become violent and dangerous when in acute pain (especially GI pain).
- Most horses do not have an absolute economic value such as cattle or pigs, so owners are more likely to spend money on their care.
Student #11, JM
McCurnin 10th edition, page: 921
What block is achieved with an SQ injection of either bupivacaine or a bupivacaine/lidocaine combination and is very effective in a feline declaw procedure?
Circumferential Ring Block
Student #11, JM
McCurnin 10th edition, page: 910
What are some temperament signs in dogs that may indicate pain?
13 TN McCurnin 10th Ed
Aggression, clawing, attacking and/or biting, attempting to escape.
pg 903
What are some temperament signs in cats that may indicate pain?
13 TN McCurnin 10th Ed
Aggression, biting, scratching, chewing, attacking, trying to escape and/or hiding
pg 903
What are the two phases of wind-up?
13 TN McCurnin 10th Ed
Hyperalgesia: less and less stimulation is required to initiate pain.
Allodynia: Interpretation of normally harmless sensations as pain
pg 906-907
What are some monitoring signs for patients taking NSAIDs?
13 TN McCurnin 10th Ed
Hydration status, stool quality, urine production, general observations
pg 909
What are some monitoring signs for patients taking opioids?
13 TN McCurnin 10th Ed
Mentation, blood pressure, respiratory, and sedation nature.
pg 909
Define hyperalgesia
Less stimulation is required to elicit pain
DM,12, McCurnin 10th Ed. Pg. 906
General signs of pain in large animals
1) decreased interest in food, anorexia
2) lethargy
3) excitement, restlessness
4) pawing
5) vocalizing (especially cattle)
6) bruxism (especially goats/sheep)
7) reluctance to move
8) lying down more frequently or for longer periods than usual, getting up and down frequently in succession
9) any abnormal behavior (per animal)
DM,12, McCurnin 10th Ed. Pg. 917
Additional signs of GI pain in large animal
1) kicking or looking at abdomen
2) violently trying to roll
3) stretching out in abnormal posture (especially horses)
4) standing with abdomen “tucked” (especially cattle)
5) “dog sitting” (especially foals with GI pain)
DM,12, McCurnin 10th Ed. Pg. 917
Define dysphoria
Dysphoria is an emotional state characterized by anxiety, depression or unease, and does not specify a cause.
Student #6, MH
Mccurnin’s 10th edition, page 904
What negative effects can pain have on a mammals pulmonary system?
Tachypnea
Hypoxemia
Pulmonary edema
Pulmonary hypertension
Respiratory acid-base imbalance
Student #6, MH
Mccurnin’s 10th edition, page 906
What are the three phases of nociception?
Transduction
Transmission
Modulation
Student #6, MH
Mccurnin’s 10th edition, page 906
What is the main advantage of using morphine as a CRI for pain management?
Using it as a CRI prevents the peaks and valleys typically seen with opioid bolus dosing. It can also reduce unwanted side effects.
Student #6, MH
Mccurnin’s 10th edition, page 913
What things are technicians responsible for in pain management?
Assessing patients
Identifying or predicting pain
Providing nonpharmacologic comfort and care
Differentiating pain from other stress
Requesting appropriate analgesia and or sedation
Helping to develop appropriate protocols for pain management
Administering medications, performing analgesia techniques
Monitoring and treating drug effects
Assessing patient postoperatively
Communicating with the clients
Logging controlled substances
Student #6, MH
Mccurnin’s 10th edition, page 923
Define allodynia
Second phase of wind-up, after hyperalgesia. Allodynia is when normally pleasant stimuli become painful.
DM,12, McCurnin 10th Ed. Pg. 906
Is Phenylbutazone allowed in dairy cattle?
It’s use is completely prohibited in dairy cattle 20 months of age or older
DM,12, McCurnin 10th Ed. Pg. 922
Best source for updated information on withdrawal times
Food Animal Residue Avoidance Databank at www.farad.org
DM,12, McCurnin 10th Ed. Pg. 922
What is the definition of allodynia?
Nerve fibers that normally carry pleasure or neutral information are recruited and become part of the pain transmission process.
Student: #2, AF
Source: McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses – 10th Edition (Chapter 29, Page 906)
What is multimodal analgesia?
Synergistic effects obtained by combining two or more classes of analgesic drugs to alter more than one phase of nociception (transduction, transmission, modulation, and perception).
Student: #2, AF
Source: McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses – 10th Edition (Chapter 29, Page 908)
What are examples of topical analgesia?
- Lidocaine
- Bupivacaine
- Tetracaine
- Epinephrine
Student: #2, AF
Source: McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses – 10th Edition (Chapter 29, Page 910)
What is the mechanism of action for Alpha-2 Agonists?
Inhibits the release of the excitatory neurotransmitter norepinephrine to produce analgesia and sedation.
Student: #2, AF
Source: McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses – 10th Edition (Chapter 29, Page 912)
What are general signs of pain in horses and farm animals?
- Decreased interest in food or anorexia
- Lethargy
- Excitement, restlessness
- Pawing
- Vocalization (especially cattle)
- Bruxism
- Reluctance to move
- Lying down more frequently or for longer periods that usual
- Any abnormal behavior
Student: #2, AF
Source: McCurnin’s Clinical Textbook for Veterinary Technicians and Nurses – 10th Edition (Chapter 29, Page 917)
What are some indications for gabapentin therapy?
8 JM
-Chronic degenerative conditions like cancer, osteoarthritis.
-Dermatological conditions that cause excessive licking or scratching (ear infections, etc)
-pain or limping not associated with current inflammation
McCurnin’s 10th ed pg 914
This newer type of NSAID is proposed to be safer on the GI tract than others in the past?
grapiprant or Galliprant
#8 JM
McCurnin’s 10th ed pg 909
What types of environmental care can be taken to help a painful patient feel more comfortable?
Clean cage, padding, bedding, keeping stress and noise to a minimum, careful positioning to reduce pressure on painful areas.
#8 JM
McCurnin’s 10th ed pg 907
Nocita can provide pain relief for up to ____ hours
72 hours
#8 JM
McCurnin’s 10th ed 910
This NMDA receptor agonist can be given as a CRI for wind up pain
Ketamine
#8 JM
McCurnin’s 10th ed pg 917
Pain triggers a series of physiologic changes that increase, what?
Stress.
TM, #7, McCurnin’s (electronic version) 10th ed. Location 45708 of 67848 (1 out of 5 cards)
What is the negative effect of pain in mammals with regards to the cardiovascular system?
Arrhythmias.
TM, #7, McCurnin’s (electronic version) 10th ed. Location 45721 of 67848 (2 out of 5 cards)
What are the negative effects of pain in mammals with regards to the gastrointestinal system?
Nausea and vomiting
TM, #7, McCurnin’s (electronic version) 10th ed. Location 45721 of 67848 (3 out of 5 cards)
What are the negative effects of pain in mammals in regards to the metabolic system?
Cachexia, increased oxygen demand, and negative nitrogen balance.
TM, #7, McCurnin’s (electronic version) 10th ed. Location 45732 of 67848 (4 out of 5 cards)
What is the negative effects of pain in mammals in regards to immune function?
Hemorrhage.
TM, #7, McCurnin’s (electronic version) 10th ed. Location 45732 of 67848 (5 out of 5 cards)
Where does the pain pathway start?
The pain pathway begins at the site of tissue damage (evidenced by localized redness, heat, and swelling - classic signs of inflammation)
Student #3, AF
McCurnin 10th edition page 906
Card 1
What do nociceptors convert when there is pain?
These specialized nerve endings convert mechanical, chemical, and thermal energy into electrical impulses once their threshold is exceeded.
Student #3, AF
McCurnin 10th edition page 906
Card 2
What are NSAIDs used for, and how do they reduce pain?
Chronic and acute pain.
Reduces the inflammatory response.
#5 ZZ
Bassert, J. M., Beal, A. D., Samples, O. M., & McCurnin, D. M. (2022). McCurnin’s clinical textbook for Veterinary Technicians and nurses. Elsevier. (pg 909).
True or false: Pigs require different medications for pain than other large animals?
False. Even though pigs are not commonly treated for pain, when they are any medications for large animals are safe and effective.
#5 ZZ
Bassert, J. M., Beal, A. D., Samples, O. M., & McCurnin, D. M. (2022). McCurnin’s clinical textbook for Veterinary Technicians and nurses. Elsevier. (pg 923)
What are some Nonpharmacologic options to treat pain?
Thermotherapy, massage, therapeutic exercise, aquatic therapy, acupuncture, electrical stimulation, therapeutic ultrasonography, extracorporeal shock-wave therapy, and low-level laser among others.
Student #3, AF
McCurnin 10th Edition page 914
Card 4
Should gabapentin be stopped abruptly?
No. Even if being used for pain, patients who are on gabapentin should be weaned off.
#5 ZZ
Bassert, J. M., Beal, A. D., Samples, O. M., & McCurnin, D. M. (2022). McCurnin’s clinical textbook for Veterinary Technicians and nurses. Elsevier. (pg 914)
When giving an equine patient potent opioids what is a side effect that can be considered adverse?
Excitement. A sedative should be given along side it.
#5 ZZ
Bassert, J. M., Beal, A. D., Samples, O. M., & McCurnin, D. M. (2022). McCurnin’s clinical textbook for Veterinary Technicians and nurses. Elsevier. (pg 922)
When is wind-up most evident?
Wind-up will be most evident in the postoperative period once the patient has regained consciousness.
Student #3, AF
McCurnin 10th Edition page 914
Card 5
What does the suffix “-caine” mean in regards to medication?
It means the drug blocks a nerve.
#5 ZZ
Bassert, J. M., Beal, A. D., Samples, O. M., & McCurnin, D. M. (2022). McCurnin’s clinical textbook for Veterinary Technicians and nurses. Elsevier. (pg 910)
What location can a block of lidocaine be given to in animals undergoing dental procedures to help ease pain of extractions?
Infraorbital Foramen
#1 CE
McCurnin 10th Editon pg 911
What is a common side effect of opioids (particularly hydromorphone and morphine)?
Emesis is a common side effect of hydromorphone and morphine.
#1 CE
McCurnin 10th Edition pg 911
What are some examples of drugs commonly used in a CRI?
Fentanyl, lidocaine, and morphine are all examples of common CRI drugs.
#1 CE
McCurnin 10th Edition pg 913
What is the most common, and potent analgesic medications that can be used in hospitalized patients?
Opioids tend to be the most commonly used analgesic medications used
#1 CE
McCurnin 10th Edition pg 910
What is known as a “rescue” drug for patients experiencing a rough recovery after anesthesia and can provide both sedation and analgesia?
Dexmedetomidine (Dexdomitor)
#1 CE
McCurnin 10th Edition pg 913
What analgesia is an excellent choice for all ruminants but can easily be overdosed with sheeps and goats?
9 RP, McCurnin 10th Ed, pg 923
local anesthetic agents
T/F
All drugs used in ruminants can be used in camelids.
9 RP, McCurnin 10th Ed, pg 923
True
what are adverse effects of Alpha 2 Agonists and what should we be monitoring for?
9 RP, McCurnin 10th Ed, pg 909
adverse effects: bradycardia, cardiac arrhythmias, hypertension, peripheral vasoconstriction
monitoring: femoral pulse rate and quality, HR and rhythm, BP
what are adverse effects of local anesthetics and what should we be monitoring for?
9 RP, McCurnin 10th Ed, pg 909
adverse effects: none unless given CRI then nausea, vomiting, neurologic signs and seizures
monitoring: observe regularly for muscle tremors and GI upset
what are adverse effects of opioids and what should we be monitoring for?
9 RP, McCurnin 10th Ed, pg 909
adverse effects: sedation, low BP, respiratory depression
monitoring: mentation, BP, resp rate and nature
