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Principles of Science BVetMed 3 > Pain and analgesia > Flashcards

Pain and analgesia Flashcards

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1
Q

Define pain

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

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2
Q

What is adaptive pain (protective)?

A
  • protective pain
  • nociceptive pain
  • inflammatory pain
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3
Q

What is maladaptive (pathological) pain?

A
  • serve no protective function

- neuropathic pain (abnormal)

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4
Q

Define acute pain

A

often has an obvious cause and is relatively short duration (hours to days)

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5
Q

Define chronic pain

A

pain lasting longer than 1 month, associated with a wide range of often subtle behavioural disturbances

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6
Q

Outline the 3 processes of pain

A
  1. NOCICEPTION: sensory process by which a noxious stimulus is transmitted to the brain (transduction, transmission, modulation)
  2. PERCEPTION of an unpleasant sensation in CNS
  3. BEHAVIOURAL response to pain -varies according to species
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7
Q

Define allodynia

A

painful response to a normally innocuous stimulus

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8
Q

Define hyperalgesia

A

increased response to painful stimulus

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9
Q

What does hypersensitisation mean?

A
  • level of pain perceived is more severe
  • analgesic drugs may be less effective if given once pain is present
  • one type of analgesic may not be effective on its own
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10
Q

What causes variations in behaviour to pain?

A
  • species (prey vs. predator)
  • breed (labrador vs greyhound)
  • demeanour
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11
Q

How can pain be assessed?

A
  • scales: visual analogue or numerical rating
  • simple descriptive: no pain to worst pain imaginable
  • composite scoring system (based on different behaviours)
  • multidimensional scoring system
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12
Q

What pain scoring systems are validated in horses? 4

A
  • composite orthopaedic pain
  • equine acute abdominal pain scale (EAAPS)
  • complex numerical rating scale - postop colic
  • post abdominal surgery pain assessment scale (PASPAS)
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13
Q

Ideal features of pain assessment in practice

A
  • simple
  • repeatable and reproducible
  • minimal time
  • allows effective pain management
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14
Q

Multimodal analgesic options

A
  • opioids
  • NSAIDs
  • ketamine
  • alpha-2-agonists
  • local anaesthetics
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15
Q

What receptor does ketamine antagonise?

A

NMDA-R

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16
Q

Describe multi-modal analgesia

A
  • attack pain pathway at multiple sites
  • each method helps in overall control of individual pain
  • more effective than using single method of analgesia
  • allows lower doses of each drug to be used, reducing the risk of side effects
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17
Q

Use - gabapentin

A

usually for chronic pain

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18
Q

List systemic analgesia options

A
  • opioids
  • NSAIDs
  • ketamine
  • lidocaine
  • alpha 2 agonists
  • (tramdol)
  • (gabapentin/ pregabalin)
  • (chronic pain)
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19
Q

List local analgesia options

A
  • local anaesthetics
  • opioids
  • alpha 2 agonists
20
Q

Define opium

A

mixture of alkaloids from poppy plant

21
Q

Define opioid

A

any naturally occurring, semi-synthetic or synthetic compound that binds to opioid receptors and shares the proerties of the natural occuring endogenous opioids

22
Q

Define opiate

A

any naturally occuring opioid, derived from opium (e.g. morphine, codeine)

23
Q

Define narcotic

A

from the Greek meaning ‘to numb’. It was used to denote an opioid but also to describe non-opioid drugs of addiction

24
Q

Name 2 naturally occurring opioids

A
  • morphine

- codeine

25
Q

Name 4 semi-synthetic opioids

A
  • diamorphine (heroid)
  • dihydromorphone
  • buprenorphine
  • hydromorphone
26
Q

Name 7 synthetic opioid compounds

A
  • pethidine
  • methadone
  • fentanyl, alfentanil, remifentanil
  • butorphanol, tramadol
27
Q

What are the 4 receptors opioids mediate their effects through?

A
  • delta
  • kappa
  • miu
  • (nociceptin)
  • kappa and miu are the most important, miu provides most analgesic effects but also some side effects
28
Q

List some full miu agonist (opioids)

A
  • morphine
  • methadone
  • pethidine (licensed)
  • fentanyl / remifentanil
  • etorphine (Immobilon)
  • Papaveretum (Omnopon)
29
Q

Example of a partil miu agonist

A

Buprenorphone (licensed)

30
Q

Example - mixed opioid agonist-antagonist

A

Butorphanol (licensed)

31
Q

Name 2 opioid antangonists

A
  • naloxone

- diprenorphine (Revivon)

32
Q

What is a partial agonist?

A
  • same overall actions as agonists
  • doesn’t produce maximal effects
  • Buprenorphine
  • partial miu agonist
  • analgesia but not as profound as full agonists
  • use for mild to moderate pain
33
Q

What is a mixed agonist-antagonist?

A
  • agonist at some Rs, antagonist at others
  • Butorphanol
  • antagonist at miu receptors: relatively poor analgesic
  • agonist at kappa receptors: some analgesia, sedation, dysphoria
34
Q

Define dysphoria

A

state of unease or dissatisfaction with life (can be a side effect of opioid analagesics in cats, horses, ruminants). You see pupil dilation. Tx with a partial agonist (buprenorphine)

35
Q

ROA - opioid analgesics

A
  • IV (NOT pethidine)
  • IM
  • SC (variable absorption)
  • Oral (high 1st pass metabolism)
  • Oral transmucosal (OTM) - i.e. cats that don’t like injections, best way to give buprenorphine but you don’t want the cat to swallow
  • Spinal/ epidural
  • intra-articular
  • transdermal
36
Q

Side effects - opioid analgesics in dogs, monkeys, people

A

CNS depression translated into sedative effect

37
Q

Side effects - opioid analgesics in cats, horses and ruminants

A

CNS stimulation (excitement, locomotor activity) –> euphoria and dysphoria

38
Q

Why are the side effects of opioids on arousal different in dogs, monkeys, people vs. cats, horses and ruminants?

A
  • interspecies differences in type and distribution of receptors in various regions of brain
  • presence or absence of pain
  • dose and ROA
  • specific opioid administered.
39
Q

Side effects - opioid analgesics

A
  • nausea and vomiting
  • variation in pupillary diameter (cats develop mydriasis d/t catecholamines and are very light sensitive, dogs develop miasis)
40
Q

Why do opioid analgesics cause nausea and vomiting?

A
  • direct CTZ stimulation
  • antiemtic effects on vomiting centre
  • dogs +++, cats +
  • morphine +++, methadone + (difference in lipid solubility)
  • rarely occur if pain present
41
Q

How do opioids affect thermoregulation?

A
  • dogs: decrease in thermoregulatory set point and panting

- CATS, horses, swine, ruminants: hyperthermia d/t increase mm activity

42
Q

How do opioids affect respiratory system?

A
  • -> respiratory depression
  • miu mediated effect in respiratory centre
  • d/t decreased responsiveness to CO2
  • especially if co-administration of a sedative
43
Q

How do opioid analgesics affect the heart?

A
  • -> bradycardia
  • vagal stimulation
  • response to anticholinergics
  • pethidine an exception
44
Q

What is the Controlled Drugs Legislation?

A
  • 1971 Misues of Drugs Act
  • SCHEDULE 2: Pure agonists (controlled drugs):
  • must be kept in locked cupboard
  • records kept of purchase and use
  • special prescription requirements
  • must be disposed of according to legislation
  • SCHEDULE 3: partial agonist (buprenorphone)
  • should be kept in locked cupboard with schedule 2 drugs, but no record of use necessary
  • BUTORPHANOL - currently free from restrictions
45
Q

Outline ketamine as an analgesic

A
  • an adjuvant to pain management
  • sub-anaesthetic doses –> blocks NMDA-R
  • INDICATIONS: skin sx, grafts, burns, neurogenic pain (amputation).
  • USE: infusion during sx but car d/t dysphoria
46
Q

What is tramadol?

A
  • mix of 2 stereoisomers (each has 5 different metabolites)
  • cheap, currently not controlled
  • no studies into efficacy
  • can’t be reversed
  • most of action mediated by inhibition of uptake (e.g. serotonin)
47
Q

Summarise NSAID effects

A
  • anti-inflammatory (not paracetamol)
  • analgesic
  • anti-pyretic
  • acute and chronic use

Principles of Science BVetMed 3 (110 decks)

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