Pain management Flashcards
pain
unpleasant sensory and emotional experience associated with actual or potential tissue damage
role of vet techs in pain management
patient advocate, communication, recognition of pain, pain charts and scales
nociception
process of communicating pain throughout the body
what are the four steps of nociception?
- transduction
- transmission
- modulation
- perception
transduction
starts at the site of the injury
nociceptors are stimulated
specialized nerve endings convert mechanical, chemical, and thermal energy into electrical impulses once their threshold is exceeded
transmission
if stimulus is large enough and exceeds threshold, a nerve impulse is generated and moves along the peripheral nerves to the spinal cord to the higher centers of the brain
fast pain
A-delta fibers
causes withdraw from stimulus
slow pain
C fibers
dull throbbing aspects of pain
modulation
spinal cord to thalamus (then to other parts of brain)
body alters pain signal (unique to each patient): amplifying/dampening the nerve impulse in the CNS
perception
occurs in the conscious brain
recognizing pain
nociception still happens under anesthesia but animal doesn’t percieve the pain
types of pain
acute pain: a symptom, sharp stabbing sensation, adaptive, healing and protective, easier to manage, short-term (< 3 months), nociceptive and inflammatory pain
chronic pain: disease, maladaptive, serves no biological function, can become a disease, neuropathic pain
neuropathic pain
pain derived directly from nerves involved in pain transmission
persistent stabbing, aching, burning, itching, or tingling sensations
neuropathic and windup phenomenon
extreme neuropathic pain occurs when CNS is bombarded with persistent pain impulses
when neurons are subjected to repeated or high intensity impulses they become more easily excitable (even when stimulus is removed)
hyperalgesia and allodynia
hyperalgesia
increased sensitivity to pain and causes an extreme response to pain
allodynia
pain due to a stimulus that doesn’t normally provoke pain
dysphoria
emotional state characterized by anxiety, depression, or unease
when can dysphoria happen?
post operative (“emergence delirium”)
can happen when patient is on opioids
what are the signs that a patient is dysphoric?
vocalizing, thrashing, rolling, self-mutilation, tachypnea, can’t make a connection with you
dysphoric episodes should only last a few minutes
effects of pain
altered mentation, decreased appetite, stress hormone release, decreased immune function, prolonged recumbency, self-mutilation of painful areas, unnecessary suffering, altered physiological parameters (cardiovascular, GI, pulmonary, renal, metabolic, immune function, sleep pattern)
principles of pain management
best way to treat pain is to prevent it
use a multimodal approach
match analgesics
maintain the plane (can do this by making sure pain medication doses are always given on time)
don’t quit until the pain quits
monitoring patients on opioids
opioids usually used for severe pain (surgery, trauma, etc)
what to expect: sedation, low BP, respiratory depression, vomiting
monitor: mentation, BP, respiratory rate, behavior
monitoring patients on local anesthetics
what to expect: not much unless given CRI (Lidocaine IV), nausea, vomiting, neurologic signs: seizures
monitor: observe q1-2 hours, muscle tremors, GI upset
monitoring patients on NSAIDs
what to expect: GI disturbances, GI bleeds, renal disturbances
monitor: femoral pulses, heart rate/ rhythm, BP
monitoring patients on alpha-2 agonists
what to expect: bradycardia, cardiac arrhythmias, hypertension, peripheral vasoconstriction
monitor: femoral pulses, heart rate/rhythm, BP
signs of acute pain in cats
reduced activity, loss of appetite, quietness, hiding, hissing/growling, excessive licking of a specific area, guarding behavior, cessation of grooming, tail flicking, aggression
severe: depressed, immobile, silent (appear tense and distant)
signs of chronic pain in cats
decreased grooming, reluctance to jump, inability/reluctance to climb/descend stairs, inability to jump as high, urinating/soiling outside litter box, decrease or increased sleep, avoiding human interaction, hiding, dislike of being pet/brushed
signs of acute pain in dogs
scared/submissive behavior, anorexia, inability to lay down, constant trembling, flinching, tense facial muscles, lips drawn back, grimace with unfocused/fearful look in eyes, etc
signs of chronic pain in dogs
increasingly diminished function and mobility, diminished exercise tolerance and general activity, decreased grooming, decreased socialization, decreased curiosity, more clingy to owner, increased sleeping, etc
pain scales
acute: grimace scale (cats), glasgow (human scale that is sometimes used in vet but not common), Colorado State University scale (most common and widely used in clinics)
chronic: BEAP pain scale
pain scale limitations
pain scales should be used in conjunction with through physical exam and history to assess every patient, recognize that all pain scales have limitations, individual patient behavior may dictate prompt pain relief regardless of pain score, caregivers should strive for low pain scores in a comfortable-appearing patient
when should an animal receive pain medicine? (when does red flag go up for an animal being too painful?)
if they score anything above a 1 on the pain scale
what does BEAP stand for?
B- breathing
E- eyes
A- ambulation, activity level, appetite, attitude
P- palpation
