Pain Flashcards
What is pain?
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage
What are the 3 dimensions of pain?
Sensory - discriminative (location, intensity, quality, duration)
Motivational - affective (how the pain makes you feel)
Cognitive - evaluative (influences behaviour)
What are the risks of uncontrolled post-op pain?
Discomfort
Suffering
Delayed healing
Increased morbidity
Risk of developing chronic persistent pain
What are the adverse effects of unrelieved pain?
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
Give examples of pain assessment tools
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
What are the disadvantages of SDS, NRS and VAS pain scoring?
Only consider intensity of pain - not sensory or affective qualities of pain
What are the challenges of pain scoring?
Difficult, subjective, other drugs can affect the evaluation
Environment/owner/caregiver can affect the animal
Species variation
Interspecies variation
Domestication, hierarchy, feeding, aggression
What is the most commonly used acute pain scale?
Glasgow Composite Measure Pain Scale (CMPS-SF)
Describe the process of the Glasgow Composite Measure Pain Scale (CMPS-SF)
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
Describe the use of the Glasgow Feline Composite Measure Pain Scale (CMPS-Feline)
clinical decision making tool for use in cats in acute pain
the recommended analgesic intervention level is 5/20.
What are features of grimace/pain faces?
- Ear Changes : fold, curl and angle forwards or outwards, pointed shape
- Orbital Tightening: narrowing of the orbital area,partial or complete eye closure orsqueezing
- Nose/Cheek Flattening: with eventual absence of thecrease between the cheek and whisker pads
- Whisker Change:move forward away from face
- Head position
What factors can be used to assess cattle pain evaluation?
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
What signs of pain can be seen in pigs
Wrinkling of snout
Ears held backwards
How can ear position be used to assess pain?
How can orbital tightening be used to assess pain?
How can muzzle tension be used to assess pain?
How can whisker change be used to assessed pain?
How can head position be used to assess pain?
Describe facial features of equine pain
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
Give examples of ways to treat acute pain
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
How does the inflammatory pathway work?
After a cell is damaged, an enzyme called cyclooxygenase (COX) is activated. COX then stimulates the cell to produce substances called prostaglandins, which contribute to signs of inflammation such as pain, redness, warmth, swelling, and fever.
What are the most commonly used small animal NSAIDs?
Meloxicam, Carprofen, Robenacoxib, Firocoxib
When are NSAIDs contraindicated?
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
What are the most common equine NSAIDs?
Phenylbutazone (suxibuzone), Flunixin meglumine, Meloxicam
