Pain Assessment (AH)

Question 1

What procedures/conditions have an anticipated minor pain level?

Answer 1

Urinary Catheterisation, Abscess lancing, Suturing, Debridement

Question 2

What procedures/conditions have an anticipated moderate pain level?

Answer 2

OHE, castration, Feline onychetomy, Dental extraction, Cystotomy

Question 3

Anticipated severe pain procedures/conditions?

Answer 3

Limb amputation, Fracture repair, Ear canal ablation, Thoracotomy, Laminectomy, Peritonitis, Pancreatitis.

Question 4

Objective, categorical methods of measuring pain?

Answer 4

1. Physiologic parameters: HR, BP, RR, pupil size, cortisol, B-endorphins. 2. Mechanical pressure or thermal threshold measuring devices.

Question 5

Subjective methods of measuring pain?

Answer 5

1. Uni-dimensional scales (descriptive, numeric, visual analogue scales). 2. Multi-dimensional scales (University of Melbourne pain scale- dogs, Glasgow pain scale – dogs.

Question 6

Effectiveness of Physiological Pain Parameters as a measurement of pain?

Answer 6

unreliable, and poor correlation with pain behavior. Unpractical. Affected by drug admin., affected by other stressors such as handling, unfamiliar environment, surgery…

Question 7

Mechanical or thermal threshold as a method of measuring pain?

Answer 7

objective measure. Useful to compare analgesics. Restricted to experimental setting. Temper of animals may interfere with measurement.

Question 8

Simple Descriptive Scale (SDS)

Answer 8

Semi-objective scoring system. Simple to use. Not sensitive for small changes. (1-no pain. 2-moderate pain. 3-mild pain. 4- severe pain.)

Question 9

Numerical Rating Scale (NRS)

Answer 9

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. )

Question 10

Visual analogue scale (VAS)

Answer 10

continuum along a scale of 100mm. ( 0mm= no pain, 100mm= worst pain. )

Question 11

Dynamic and interactive VAS (DIVAS)

Answer 11

VAS + interaction with observer and palpation of wound.

Question 12

When are multidimensional systems particularly important?

Answer 12

when self-reporting is not possible.

Question 13

Besides accounting for intensity of pain, what else does a multidimensional system address?

Answer 13

Sensory and affective (emotional) qualities

Question 14

What must a multidimensional system incorporate to be effective?

Answer 14

components that are proven to be sensitive and specific to pain.

Question 15

What are the MOST reliable methods of assessing pain in animals?

Answer 15

Quantitative measurements of behavior

Question 16

What is key in measuring behavior related to pain? Why?

Answer 16

knowing what normal behavior is. Deviations from normal behavior indicate pain, anxiety, or some combo of stressors.

Question 17

Quantitative measurements of behavior are more _____ with less _____?

Answer 17

More objective with less observer bias

Question 18

The University of Melbourne Pain Scale (UMPS) uses a scale with what ranges? What does it take into consideration when ranking pain?

Answer 18

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)

Question 19

To date, what is the most vigorously validated scale for assessing acute postoperative pain in dogs?

Answer 19

Glasgow composite measure pain scale (GCPS)

Question 20

Categories taken into account in the GCPS?

Answer 20

1 physiological and 7 behavioral categories measured. 279 words or expressions reduced to 47 well defined words/expressions that describe pain in dogs.

Question 21

GCPS short form behavioral categories?

Answer 21

Posture, comfort, vocalization, attention to the wound, demeanor and response to humans, mobility, response to touch.

Question 22

Dog spp.specific pain behavior?

Answer 22

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.

Question 23

Cat spp.specific pain behavior?

Answer 23

hunched posture with lowered back, aggression, eyelids half-closed, not grooming?, hiding at the back of cage, reluctance to move, loss of appetite.

Question 24

How often do you want to assess a patient for pain level post-op?

Answer 24

at least every 4-6 hours

Question 25

When in doubt, what should you do?

Answer 25

admin a test dose of analgesic, but use security steps to avoid overdose (administer morphine only if HR>60)