Pain Assessment (AH) Flashcards
What procedures/conditions have an anticipated minor pain level?
Urinary Catheterisation, Abscess lancing, Suturing, Debridement
What procedures/conditions have an anticipated moderate pain level?
OHE, castration, Feline onychetomy, Dental extraction, Cystotomy
Anticipated severe pain procedures/conditions?
Limb amputation, Fracture repair, Ear canal ablation, Thoracotomy, Laminectomy, Peritonitis, Pancreatitis.
Objective, categorical methods of measuring pain?
- Physiologic parameters: HR, BP, RR, pupil size, cortisol, B-endorphins. 2. Mechanical pressure or thermal threshold measuring devices.
Subjective methods of measuring pain?
- Uni-dimensional scales (descriptive, numeric, visual analogue scales). 2. Multi-dimensional scales (University of Melbourne pain scale- dogs, Glasgow pain scale – dogs.
Effectiveness of Physiological Pain Parameters as a measurement of pain?
unreliable, and poor correlation with pain behavior. Unpractical. Affected by drug admin., affected by other stressors such as handling, unfamiliar environment, surgery…
Mechanical or thermal threshold as a method of measuring pain?
objective measure. Useful to compare analgesics. Restricted to experimental setting. Temper of animals may interfere with measurement.
Simple Descriptive Scale (SDS)
Semi-objective scoring system. Simple to use. Not sensitive for small changes. (1-no pain. 2-moderate pain. 3-mild pain. 4- severe pain.)
Numerical Rating Scale (NRS)
Semi-objective. Essentially the same as SDS. Use of numbers allows tabulation and analysis. Scale of 0-10. ( 0= none. 1-3= mild. 4-6= moderate. 7-10= severe. )
Visual analogue scale (VAS)
continuum along a scale of 100mm. ( 0mm= no pain, 100mm= worst pain. )
Dynamic and interactive VAS (DIVAS)
VAS + interaction with observer and palpation of wound.
When are multidimensional systems particularly important?
when self-reporting is not possible.
Besides accounting for intensity of pain, what else does a multidimensional system address?
Sensory and affective (emotional) qualities
What must a multidimensional system incorporate to be effective?
components that are proven to be sensitive and specific to pain.
What are the MOST reliable methods of assessing pain in animals?
Quantitative measurements of behavior
What is key in measuring behavior related to pain? Why?
knowing what normal behavior is. Deviations from normal behavior indicate pain, anxiety, or some combo of stressors.
Quantitative measurements of behavior are more _____ with less _____?
More objective with less observer bias
The University of Melbourne Pain Scale (UMPS) uses a scale with what ranges? What does it take into consideration when ranking pain?
Assigns factors numbers on a scale of 0-27. Takes into consideration objective physiological data (HR, RR, pupil size, rectal temp) as well as behavioral responses (activity, response to palpation, posture, mental status, and vocalization)
To date, what is the most vigorously validated scale for assessing acute postoperative pain in dogs?
Glasgow composite measure pain scale (GCPS)
Categories taken into account in the GCPS?
1 physiological and 7 behavioral categories measured. 279 words or expressions reduced to 47 well defined words/expressions that describe pain in dogs.
GCPS short form behavioral categories?
Posture, comfort, vocalization, attention to the wound, demeanor and response to humans, mobility, response to touch.
Dog spp.specific pain behavior?
Abnormal posture (praying), Limping or stiff gait, abnormal movement, vocalization, low carriage or tail, looking and licking or chewing at painful area, reluctance to move.
Cat spp.specific pain behavior?
hunched posture with lowered back, aggression, eyelids half-closed, not grooming?, hiding at the back of cage, reluctance to move, loss of appetite.
How often do you want to assess a patient for pain level post-op?
at least every 4-6 hours
When in doubt, what should you do?
admin a test dose of analgesic, but use security steps to avoid overdose (administer morphine only if HR>60)
