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Jorge FCP > Pain > Flashcards

Pain Flashcards

1
Q

What is pain?

A

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

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2
Q

What are the 3 dimensions of pain?

A

Sensory - discriminative (location, intensity, quality, duration)
Motivational - affective (how the pain makes you feel)
Cognitive - evaluative (influences behaviour)

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3
Q

What are the adverse effects of unrelieved pain?

A

Neuroendocrine e.g., hypoglycaemia, weight loss, slower wound healing
Cardiovascular - fatigue
Respiratory - decreased lung volume
GIT + urinary - decreased bowel motility => constipation, urinary retention
MSK - decreased muscle function
Psychological - poor sleep, PTSD

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4
Q

Give examples of pain assessment tools

A

Physiological measurements/exam
SDS (simple descriptive scale)
NRS (numeric rating scale)
VAS (visual analogue score)
DIVAS (Dynamic, interactive visual analogue scale)
Composite scales
Pain faces
Acute vs chronic pain scales
Quality of life (QoL) scales
Analgesiometry & accelerometers
Gait analysis
Pressure sensitive walkways, platforms

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5
Q

What are the challenges of pain scoring?

A

Difficult, subjective, other drugs can affect the evaluation
Environment/owner/caregiver can affect the animal
Species variation
Interspecies variation
Domestication, hierarchy, feeding, aggression

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6
Q

What is the most commonly used acute pain scale?

A

Glasgow Composite Measure Pain Scale (CMPS-SF)

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7
Q

Describe the process of the Glasgow Composite Measure Pain Scale (CMPS-SF)

A

Evaluate the dog once it has recovered sufficiently from anaesthesia (as scores can be affected by the hangover effect of sedative and anaesthetic drugs)
If pain scores are greater than 5/20 or 6/24, consider giving analgesia
Allow the analgesic to take effect and reassess after an hour; if the score has decreased to below the intervention level, reassess in 2 hours. If not consider additional analgesia
Then assess every 3-4 hours or earlier as appropriate (depending on the severity of the surgical procedure and the class/route of administration/expected duration of analgesic administered) and after each analgesic administration
The scale is intended to be an adjunct to clinical judgment, and no animal should be denied analgesia on the basis of the scores alone

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8
Q

What are features of grimace/pain faces?

A
  1. Ear Changes : fold, curl and angle forwards or outwards, pointed shape
  2. Orbital Tightening: narrowing of the orbital area,partial or complete eye closure orsqueezing
  3. Nose/Cheek Flattening: with eventual absence of thecrease between the cheek and whisker pads
  4. Whisker Change:move forward away from face
  5. Head position
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9
Q

What factors can be used to assess cattle pain evaluation?

A

Tense stare/withdrawn
Tension of muscles above eyes
‘lines’ above nostrils
Strained nostrils
Increased tone of lips
Tension of facial muscles
Tense ears pointed backwards

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10
Q

What signs of pain can be seen in pigs

A

Wrinkling of snout
Ears held backwards

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11
Q

How can ear position be used to assess pain?

A
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12
Q

How can orbital tightening be used to assess pain?

A
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13
Q

How can muzzle tension be used to assess pain?

A
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14
Q

How can whisker change be used to assessed pain?

A
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15
Q

How can head position be used to assess pain?

A
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16
Q

Describe facial features of equine pain

A

Distance between ears becomes larger
Muscles around eyes are stretched - sclera becomes more evident in medial canthus
Withdrawn stare
Dilated nostrils (side-to-side)
Tense facial muscles
Increased tonus of lips and tension of chin

17
Q

Give examples of ways to treat acute pain

A

Opioids, NSAIDs, local anaesthetics
Ketamine and alpha 2 agonists
Cold therapy
Good tissue handling
Nursing care (bandages, massage, IV lines, monitoring, ROM, ensuring sleep)
Other therapies (limited evidence) e.g. Laser, TRPV1 agonists, pulsed EMF

18
Q

When are NSAIDs contraindicated?

A

In patients with:
Renal or hepatic insufficiency
Hypovolaemia
Congestive heart failure & pulmonary disease
Coagulopathies, active haemorrhage
Spinal injuries
Gastric ulceration
Concurrent use of steroids
Shock, trauma
Pregnancy

19
Q

What are the most common equine NSAIDs?

A

Phenylbutazone (suxibuzone), Flunixin meglumine, Meloxicam

20
Q

What are the most common cattle NSAIDs

A

Meloxicam, Ketoprofen

21
Q

Describe the mode of action of grapiprant

A

Galliprant is an NSAID that does not block COX. It works lower down the inflammatory pathway by blocking some activity of a specific prostaglandin (EP4 receptor)

22
Q

What is the benefit of grapiprant over other NSAIDs?

A

targets canine pain and inflammation while reducing the impact on GI, kidney and liver homeostasis

23
Q

What opioid receptor gives an analgesic response

A

Mu receptor

24
Q

What are the effects of activation of mu opioid receptors?

A
25
Q

What is the effect of activation of K opioid receptors

A
26
Q

What is the effect of activation of beta opioid receptors?

A
27
Q

Why should you always draw back when giving local anaesthetics?

A

To ensure you are not injecting into the blood supply

28
Q

What is the risk of local anaesthetics?

A

Narrow therapeutic index (easy to overdose)

29
Q

What are the effects of alpha 2 agonists (a and b receptors)?

A

Sedation (a)
Decrease MAC
Analgesia (somatic & visceral) (a & b)
Hyper (b) then hypotension (a)
Decreased CO & HR, increased SVR
Respiratory depression
Increased urine production
Decreased GI motility
Decreased surgical stress response
Hyperglycaemia, GH enhanced,
Thermoregulation affected
Sweating

30
Q

What receptors do alpha 2 agonists act on?

A

a adrenergic receptors (presynaptic)
b adrenergic receptors (post-synaptic)

31
Q

What can be used as adjunctive to analgesia in chronic pain management?

A

Hydrotherapy & physiotherapy
Chondroprotectives
Exercise management
Weight control & diet
Joint replacement/salvage
Anti NGF Ab (Librela, Solensia)
Irap (Interleukin-1 Receptor Antagonist Protein)
Accupuncture
Other drugs: garlic & fenugreek, sodium hyaluronate (Hyonate), prednoleucotropin (PLT), steroids, paracetamol (not cats)
Stem cell therapies (MCS)

32
Q

What is mode of action of mesenchymal STEM cells in chronic pain management?

A

exerted primarily through their secreted factors, including extracellular vesicles and bioactive molecules such as chemokines, cytokines and growth factors

33
Q

What is the effect of cannabinoids?

A

act on peripheral, spinal & supra-spinal sites to exert antinociceptive and antihyperalgesic effects (not licensed in UK)

Jorge FCP (60 decks)

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