Pain Flashcards
What are the two categories of signs of pain shown in veterinary medicine?
Physiologic (examples are increased heart rate, blood pressure, respiratory rate) or
behavioral (examples are restlessness, inappetite, aggression)
#11, McCurnin’s (electronic version) 10th ed. Pg 2840
What level of body tension would a pain score 1 cat or dog have?
Mild body tension.
#11, McCurnin’s (electronic version) 10th ed. Pg 2844
When behaviors are thought to be related to stress other than pain, they are often described or referred to as ‘dysphoria’. What is dysphoria?
An emotional state described as anxiety, depression, or unease. This is a general term that does not specify a cause.
#11, McCurnin’s (electronic version) 10th ed. Pg 2846
Nociception has three distinct phases. What are they?
Transduction, transmission, and modulation.
#11, McCurnin’s (electronic version) 10th ed. Pg 2848
What is allodynia?
When non-painful stimulus is now seen as pain.
#11, McCurnin’s (electronic version) 10th ed. Pg 2851
What are some behavioral signs of pain in a dog and cat?
1 IB
arched/hunched back, twisted body to protect pain site, tucked abdomen, lying flat
McCurrin’s 10th edition pg 903
AAHA required guidelines for pain assessment.
1 IB
require pain assessment in every patient, regardless of presenting complaint
making regular/repeated pain assessments throughout hospitalization and recording in medical record
McCurrin’s 10th edition pg 905
What are some drugs that can be used for an epidural?
1 IB
opioids - morphine, fentanyl
local anesthetics - lidocaine, bupivicaine
McCurrin’s 10th edition pg 911
Why is morphine used with a alpha 2 when given parenterally in equine?
1 IB
reduces the chance of an excitatory response
McCurrin’s 10th edition pg 921
What is the age limit for using phenylbutazone in dairy cattle?
1 IB
20 months
McCurrin’s 10th edition pg 922
Negative effects of pain on the renal system
Renal hypertension
#9 McCurnins 10th Edition pg. 906
What do nociceptors convert?
Mechanical, Chemical, and thermal energy into electrical impulses
#9 McCurnins 10th Edition pg. 906
What is wind-up phenomenon?
When spinal neurons are subjected to repeated or high intensity nociceptive impulses. And become excitable after stimulation.
#9 McCurnins 10th Edition pg.906
What is multimodal analgesia?
Combining two or more classes of analgesia to alter more than one phase of nociception.
#9 McCurnins 10th Edition pg.908
Instead of Meloxicam what other NSAID can be used in cats?
Robenacoxib (Onsior)
#9 McCurnins 10th Edition pg. 909
What is hyperalgesia?
When less and less stimulation is required to initiate pain.
McCurnins 10th Edition pg. 906
#5
What is the best way to treat pain?
By preventing pain
McCurnins 10th Edition pg. 908
#5
What are common adverse effects of NSAIDS in dogs?
GI upset including vomiting, diarrhea, GI bleeding, and GI perforation
McCurnins 10th Edition pg. 909
#5
How are the adverse reactions of NSAID different for cats and dogs?
NSAID side effects in cats’ are commonly related to the renal system whereas in dogs the most common side effects are GI-related.
McCurnins 10th Edition pg. 909
#5
What are common drugs used in CRI’s?
lidocaine
Opioids
NMDA antagonists
alpha 2 agonists
McCurnins 10th Edition pg. 913
#5
What are the three main drugs that can be used for a local blocks?
Lidocaine, Bupivacaine, and Mepivacaine
McCurnin’s 10th Edition pg. 917
JY #19
The FDA approved butorphanol for what common disease process in horses?
Colic pain
McCurnin’s 10th Edition pg. 918
JY #19
What is the biggest issue with delivering drugs orally to ruminants?
The rumen will deactivate many drugs, have slower absorption, and alter the drug’s mode of action
McCurnin’s 10th Edition pg. 922
JY #19
What large animal species are easily overdosed with local anesthetics?
Sheep and goats
McCurnin’s 10th Edition pg. 922
JY #19
When giving potent opioids to horses what is something that is important to keep in mind?
Horses can may exhibit an excitatory phase (especially when not in pain) so it’s important to give a sedative along with the opioid
McCurnin’s 10th Edition pg. 922
JY #19
What are the steps to calculating a CRI?
- Set-up equation based on dosage: ug/kg/ minute = ug to add to bag
- Replace hash marks with time signs: ug x kg x minutes= ug to add to bag
- Enter known information: dose and weight
- Solve for hours: Fluid bag size divided by hourly rate= # hours bag will last
- solve for minutes # hours x 60 mins/ hour
- Solve equation: ug x kg x minutes =ug to add to bag
- Convert ug to mg, divide answer by 1000
- Calculated drug volume and add to bag desires: mg divided by concentration in mg/ mL= mL
McCurnin’s 10th ed. pg. 913
#13
What are the negative effects of pain on the metabolic system?
Cachexia
Increased oxygen demand
Negative nitrogen balance
McCurnin’s 10th ed. pg. 906
#13
What are the negative effects of pain on the pulmonary system?
Tachypnea
Hypoxemia
Pulmonary edema
Pulmonary Hypertension
Respiratory acid- base imbalance
McCurnin’s 10th ed. pg. 906
#13
What anatomical structures are blocked with a dental nerve block for the entire muzzle?
Infraorbital and mandibular foramen
McCurnin’s 10th ed. pg. 910
#13
What are signs of GI pain in horses and farm animals?
Kicking at or looking at abdomen
Violently trying to roll
Stretching out in abnormal posture (especially horses)
Standing with abdomen “tucked” (especially cattle)
“Dog Sitting” (especially foals with GI pain)
McCurnin’s 10th ed. pg. 917
#13
What are some adverse effects that can be caused by opioids?
17 AG
Sedation, Low Blood Pressure, and Respiratory Depression
McCurnin 10th Ed. Pg. 909
What opioids are classified to treat severe pain?
17 AG
Morphine Sulfate
Hydromorphone
Fentanyl Citrate
McCurnin 10th Ed. Pg. 912
What forms of preemptive pain management should be given for a feline onychectomy?
17 AG
NSAID SQ 1-2 hours prior to Sx
Buprenorphine IM 30 to 45 minutes prior to Sx
Ring Block w/ Bupivacaine 15 minutes prior to Sx
McCurnin 10th Ed. Pg. 914
What drug is prohibited for use in Dairy Cattle over 20 months of age due to food regulations?
17 AG
Phenylbutazone
McCurnin 10th Ed. Pg. 922
17 AG
McCurnin 10th Ed. Pg.
Define the transduction phase of the pain pathway
Conversion of mechanical, chemical, or thermal energy into electrical impulses
SS 18
McCurnin’s 10th Edition
pg. 906
Define the transmission phase of the pain pathway
Once stimuli exceeds threshold, nerve impulses are generated and sent from the peripheral to the spinal cord
SS 18
McCurnin’s 10th Edition
pg. 906
Define the modulation phase of the pain pathway
Dampening of the pain sensation as nerve impulses enter the brain
SS 18
McCurnin’s 10th Edition
pg. 906
What is the 4th phase of the pain pathway?
Perception
SS 18
McCurnin’s 10th Edition
pg. 906
Pain vs. nociception
Pain–conscious awareness of physical discomfort
Nociception–discomfort during state of unconsciousness
SS 18
McCurnin’s 10th Edition
pg. 906
Environmental care for animals
Environmental factors seem to affect the perception of pain in pet animals. Environmental care can include keeping a clean and comfortable cage and keeping a quiet and stress free.
8 PL McCurnin 10th Edition pg. 907
Emotional care for animals
Emotional needs can reduce stress for animals. This can include giving them a blanket or toy from home to give them something familiar and giving them tender loving care.
8 PL McCurnin 10th Edition pg. 907
Analgesic Techniques for a painful patient.
Includes preemptive analgesia, multimodal analgesia (Different classes of drugs simultaneously), and follow up analgesia (post-op and take home).
8 PL McCurnin 10th Edition pg. 908
Intravenous analgesia
IV administration of lidocaine given in a CRI is an effective technique for managing a variety of pain states.
8 PL McCurnin 10th Edition pg. 911
What is Ketamine and usage.
Ketamine is a NMDA receptor antagonist that is given as a CRI to treat the pain of “Wind-up”. Can be used with multimodal analgesia protocols for patients with pain difficult to control.
8 PL McCurnin 10th Edition pg. 917
How many hours of pain relief can Nocita provide?
72 hours
#10 JM
McCurnin 10th ed pg 910
A newer type of NSAID that is proposed to be easier on the GI tract than its predecessors
10 JM
Grapiprant/Galliprant
McCurnin 10th ed pg 909
Describe some environmental care that can taken to help painful patients
Padding, bedding, quiet environment, positioning, clean cage
#10 JM
McCurnin 10th ed pg 907
Indications for Gabapentin therapy
Chronic, degenerative conditions, dermatological conditions that cause excessive licking or scratching, pain or limping not associated with current inflammation
#10 JM
McCurnin 10th ed pg 914
An NMDA receptor agonist that can be given as a CRI for wind up pain
Ketamine
#10 JM
McCurnin 10th ed pg 917
What is Topical Analgesia and when would you use it?
Topical analgesia is applied to the surface or mucosa to reduce pain associated with minor procedures, such as wound suturing, venipuncture, arterial puncture, nasal cannulation, and urinary catheterization.
McCurnin’s 10th ed pg 910, #12 OR
What is Local Infiltration?
Local Infiltration is an injection of lidocaine or bupivacaine into local tissue to reduce pain associated with various painful procedures. Ex: Small mass removals, digit amputation, arterial placements, thoracocentesis, abdominocentesis, etc.
McCurnin’s 10th ed pg 910, #12 OR
What is Intra-articular Anesthesia?
Injection of local anesthetics directly into the joint space. Ex: Cruciate ligament repair.
McCurnin’s 10th ed pg 910, #12 OR
What is a Circumferential Ring Block?
Injection of bupivacaine or a combination of bupivacaine and lidocaine above surgical site, the skin is tented horizontally and the needle is inserted under the skin. As the needle is being withdrawn, the drug is being injected slowly to leave behind a “line”. When this is done on both surfaces, the lines will connect, creating a bracelet or ring block. Ex: Digit amputation.
McCurnin’s 10th ed pg 910, #12 OR
What is an Epidural Nerve Block?
Injection of opioids and/or local anesthetics directly into the epidural space to provide analgesia to the caudal half of the body while minimizing sedative effects.
McCurnin’s 10th ed pg 911, #12 OR
What are negative effects of pain on the GI system?
Nausea and Vomiting
#6
McCurnin’s 10th ed pg 906
What are the four category of drugs that are used for pain management?
NSAID’s, local anesthetics, opiods, and alpha2s
#6
McCurnin’s 10th ed pg 908
What are some adverse effects of Alpha2 agonists
Bradycardia, cardiac arrythmias, hypertension, peripheral vasoconstriction
#6
McCurnin’s 10th ed pg 909
What are negative effects of pain on the pulmonary system?
Tachypnea, hypoxemia, pulmonary edema, pulmonary hypertension, respiratory acid-base imbalance
#6
McCurnin’s 10th ed pg 906
What drugs are used to treat moderate to severe pain?
Buprenorphine
#6
McCurnin’s 10th ed pg 912
What is the reversal agent for pure mu antagonist opioids?
16 RW
IV Naloxone at 2 ug/kg
McCurnin’s 10th ed pg 912
Give examples of non-pharmacologic pain management options
16 RW
thermotherapy, massage, therapeutic exercise, aquatic therapy, acupuncture, electrical stimulation, therapeutic ultrasonography, shock-wave, and low-level laser therapy.
McCurnin’s 10th ed pg 914
What is the common brand name for flunixin meglumine?
16 RW
Banamine
McCurnin’s 10th ed pg 916
What species is extremely sensitive to the sedative properties of butorphanol?
16 RW
Camelids
McCurnin’s 10th ed pg 920
Which species is sensitive to side-effects of local anesthetic agents and must be dosed carefully?
16 RW
Goats
McCurnin’s 10th ed pg 920
What is the drug of choice to treat emergence delirium?
7 MJ
Dexdomitor
McCurnins 10th ed pg 913
What is the most common opioid used in large animals?
7 MJ
Butorphanol
McCurnins 10th ed pg 917
T/F: Pain only has an effect on the nervous system
7 MJ
False, pain affects all major body systems (Immune, cardiovascular, pulmonary, GI, renal, metabolic, neuro)
McCurnins 10th ed pg 905
What drugs act on the transmission phase of the pain pathway?
7 MJ
- Local anesthetics
- Alpha 2 agonists
McCurnins 10th ed pg 907
What criteria is involved in pain assessment of a patient?
7 MJ
- Good examination skills
- Familiarity with species, breeds and individual behaviors
- Knowledge of the degree of pain associated with specific surgical procedures or illnesses
- Recognition of the signs of stress and pain
McCurnins 10th ed pg 903
What are signs of pain in patients?
Tachycardia, increased RR, restlessness, increased temp and BP, abnormal posture, inappetence, aggression, frequent movement, facial expression change, trembling, depression, insomnia,
Kb2 McCurnins 10th ed pg 903
Difference between acute and chronic pain
Acute pain is described as a sharp stabbing sensation
Chronic pain is described as a dull and persistent throbbing
Kb2 McCurnins 10th ed pg 906
Why is analgesia important for animals under anesthesia?
Without analgesia the nervous system is still activated to process pain signals which triggers negative physiologic effects
Kb2 McCurnins 10th ed pg 906
Why are NSAIDS an ideal choice for painful conditions?
They have anti-inflammatory and analgesic properties
Kb2 McCurnins 10th ed pg917
What are some examples of alpha 2 agonists?
Detomidine, xylazine, romifidine
Kb2 McCurnins 10th ed pg917
What is the primary goal of pain management in veterinary medicine?
To improve the animal’s quality of life by minimizing pain and discomfort.
#4, GG, McCurnin, Pg. 901
What is the most common analgesic techniques used in adult cattle?
Local analgesic agents used in ways such as local blocks, regional blocks, epidurals, and paravertebral blocks
3 LD
McCurnin’s 10th ed
pg 922-923
What is one of the biggest roles for a veterinary technician regarding pain/pain control in patients?
Patient advocacy - technicians are often the people monitoring and noticing changes in the patient that can indicate they are painful
3 LD
McCurnin’s 10th ed
pg 902
Describe the role of veterinary technicians in pain management.
Patient advocate, assisting in pain assessment, administration of analgesics, and providing emotional support.
#4, GG, McCurnin, Pg. 902
Bradycardia is considered a normal finding when what class of drugs are used? Why does this happen?
Alpha-2-agonists - this is because of the effect that they have on alpha-1 receptors causing vasoconstriction which in turn causes hypertension so the heart rate slows to compensate and bring blood pressure back to a normal level.
3 LD
McCurnin’s 10th ed
pg 913
Describe the physiological process of pain transmission.
Nociceptors detect painful stimuli, transmitting signals through the spinal cord to the brain.
#4, GG, McCurnin, Pg. 906
What factors should be considered when selecting an analgesic for pain management?
Patient’s pain severity, medical history, age, weight, and potential side effects.
#4, GG, McCurnin, Pg. 908
Describe the role of NSAIDs in pain management.
Anti-inflammatory, analgesic effects; commonly used for acute and chronic pain.
#4, GG, McCurnin, Pg. 907
What nerve is blocked when a cornual block is performed in cattle? What about for goats?
Cattle - cornual branch of the zygomaticotemporal nerve
Goats - cornual branch of zygomaticotemporal nerve AND the cornual branch of the infratrochlear nerve
3 LD
McCurnin’s 10th ed
Pg 921
How is neuropathic pain described as feeling?
Persistent stabbing, aching, burning, itching, or tingling sensation with or without an observable cause. It can coincide with inflammation or be completely separate to from it.
14 BR
McCurnin’s 10th ed. pg 906
Local anesthetics, such as lidocaine and bupivacaine, are considered safe if administered correctly. Toxicity may occur in cases of overdose or inadvertent IV administration. If toxicity occurred, what would be the signs?
Seizures, coma, neurotoxicity, cardiovascular collapse.
14 BR
McCurnin’s 10th ed. pg 906
Are the various forms of gabapentin, such as neurontin elixer solution, a good way to manage pain in dogs?
No. Neurontin elixer contains xylitol.
14 BR
McCurnin’s 10th ed. pg 914
What are some common joint supplements and chondroprotective agents used in horses?
Chondroitin sulfate
Hyaluronic acid
Glycosaminoglycans
14 BR
McCurnin’s 10th ed. pg 920
What are some condiserations for administering an NSAID preoperatively?
The patient must be normotensive, with normal renal and liver function with no bleeding abnormalities nor any concers for gastric ulceration. Blood pressure must be monitored intraoperatively and an IVC must be placed in case fluid administration is required.
14 BR
McCurnin’s 10th ed. pg 909
