Pain Asessment and Treatment Flashcards
What are some painful dog behaviors?
Lamenss, “praying position”, head tilt, guarding, behavior change
What is the praying position indicative of in dogs?
Abdominal pain
What are some painful cat behaviors?
Hiding, decreased appetite, decreased grooming, excessive grooming of effected area, reluctance to use box, squinting eyes, lowered ears, aggression, crouching
What are some painful horse behaviors?
Lameness, standing at back of stall, decreased socializing, decreased appetite, low ears, angled eye, staring, dilated nostrils, tension of face, colic
What are some painful ruminant behaviors?
Buxism, hypersalivation, abnormal expression, decreased appetite/rumination, decreased milk production, isolation, vocalization, grunting
What are some biological markers for pain?
Cortisol, glucose, catecholamines, endorphins, enkephalins, lactic acid, FFAs
What are some signs of pain in an anesthetized animal?
Movement, trembling, increased HR/RR/BP
T/F: Peripheral and central sensitization are prevented by general anesthesia.
False, they are not prevented
Is pain scoring subjective or objective?
Subjective- physiologic markers are inadequate and individual variation is high
What are the pain scales used in small animal vet med?
Simple descriptive
Visual analog scale
Glasgow composite pan scale
Colorado state pain scales
What is the simple descriptive pain scale?
Uses simple descriptors to classify pain (mild, moderate severe etc)
Very subjective
What is the visual analog scale?
Commonly used in researched
Subjective sliding scale from no pain to sever pain- not graduated
What is the glasgow composite pain scale used for?
Assessing post-op pain in dogs based on behavioral changes
What are the max scores in the glasgow scale if the patient is abulatory vs non-ambulatory?
Ambulatory- 24
Non-Ambulatory- 20
When are analgesics recommended in the glasgow scale?
6/24 or 5/20
What are the three criteria used in the colorado state pain scale?
- Physiological and behavioral
- Response to palpation
- Body tension
Should an animal be evaluated while sleeping?
No
What do the scores range from in the colorado state pain scale?
0-4
Reassessment of analgesic plan anywhere from score of 2-4
Is the colorado state pain scale appropriate for both dogs and cats?
Yes
Are there different scales for equine abdominal and orthropedic pain?
Yes
What is the equine abdominal pain scale based on?
Behaviors and palpation
What is the equine orthopedic scale based on?
- Physiologic characteristics
- Response to treatment
- Behavior
What is the treatment plan for painful animals?
- Analgesic drugs
- Bedding
- Bandaging/stabilization
- Cooling
- Acupuncture/laser
What is the advantage of pre-emptive analgesic strategies?
- Allows lower doses of systemic anesthetics and analgesics during procedures
- Prevention of central sensitization
What is multimodal analgesia and what is the advantage?
- Usage of multiple analgesics with different MOAs synergistically
- Lowers dosing of each individual drug to minimize side effects
What are the common analgesics used in vet med?
Local anesthetics NSAIDs Opioids NMDA antagonists Alpha-2 agonists
What part of the pain pathway to local anesthetics work on?
Transduction or transmission depending on route of administration
Transduction= topicals Transmission= epidurals or IVRA
What is a disadvantage of using LAs as analgesics?
Short acting
What part of the pain pathway do opioids work on?
Transduction, modulation, or perception depending on type
What is a disadvantage to opioid use in animals?
Limited oral options (take home tricky)
What is the only oral opioid in vet med?
Tramadol
T/F: Bioavaliability is limited in oral dosing of tramadol in animals.
True- Use highest safe dose and do not use alone
What patients are NSAIDs contraindicated in?
GI, renal or liver patients
How do NMDA antagonists effect the pain pathway?
Block NMDA receptors so that glutamate cannot bind and facilitate transmission of pain (Modulation); also decreases central sensitization
What are the two common NMDA antagonists used in vet med?
Ketamine and amantadine
Which of the NMDA antagonists is used in conjunction with NSAIDs for chronic pain?
Amnantidine- oral administration
Typically used for OA or cancer patients
Alpha-2 agonists provide the most potent analgesia in which species?
Horses
Can alpha-2 agonists be used in equine epidurals?
Yes, commonly used
What is gabapentin typically used for?
Analgesic adjunct in neuropathic and chronic pain (modulation)
Do we know gabapentins MOA?
Not really
