Pain management

Question 1

pain

Answer 1

unpleasant sensory and emotional experience associated with actual or potential tissue damage

Question 2

role of vet techs in pain management

Answer 2

patient advocate, communication, recognition of pain, pain charts and scales

Question 3

nociception

Answer 3

process of communicating pain throughout the body

Question 4

what are the four steps of nociception?

Answer 4

1. transduction
2. transmission
3. modulation
4. perception

Question 5

transduction

Answer 5

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

Question 6

transmission

Answer 6

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

Question 7

fast pain

Answer 7

A-delta fibers
causes withdraw from stimulus

Question 8

slow pain

Answer 8

C fibers
dull throbbing aspects of pain

Question 9

modulation

Answer 9

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

Question 10

perception

Answer 10

occurs in the conscious brain
recognizing pain
nociception still happens under anesthesia but animal doesn’t percieve the pain

Question 11

types of pain

Answer 11

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

Question 12

neuropathic pain

Answer 12

pain derived directly from nerves involved in pain transmission
persistent stabbing, aching, burning, itching, or tingling sensations

Question 13

neuropathic and windup phenomenon

Answer 13

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

Question 14

hyperalgesia

Answer 14

increased sensitivity to pain and causes an extreme response to pain

Question 15

allodynia

Answer 15

pain due to a stimulus that doesn’t normally provoke pain

Question 16

dysphoria

Answer 16

emotional state characterized by anxiety, depression, or unease

Question 17

when can dysphoria happen?

Answer 17

post operative (“emergence delirium”)
can happen when patient is on opioids

Question 18

what are the signs that a patient is dysphoric?

Answer 18

vocalizing, thrashing, rolling, self-mutilation, tachypnea, can’t make a connection with you
dysphoric episodes should only last a few minutes

Question 19

effects of pain

Answer 19

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)

Question 20

principles of pain management

Answer 20

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

Question 21

monitoring patients on opioids

Answer 21

opioids usually used for severe pain (surgery, trauma, etc)
what to expect: sedation, low BP, respiratory depression, vomiting
monitor: mentation, BP, respiratory rate, behavior

Question 22

monitoring patients on local anesthetics

Answer 22

what to expect: not much unless given CRI (Lidocaine IV), nausea, vomiting, neurologic signs: seizures
monitor: observe q1-2 hours, muscle tremors, GI upset

Question 23

monitoring patients on NSAIDs

Answer 23

what to expect: GI disturbances, GI bleeds, renal disturbances
monitor: femoral pulses, heart rate/ rhythm, BP

Question 24

monitoring patients on alpha-2 agonists

Answer 24

what to expect: bradycardia, cardiac arrhythmias, hypertension, peripheral vasoconstriction
monitor: femoral pulses, heart rate/rhythm, BP

Question 25

signs of acute pain in cats

Answer 25

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)

Question 26

signs of chronic pain in cats

Answer 26

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

Question 27

signs of acute pain in dogs

Answer 27

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

Question 28

signs of chronic pain in dogs

Answer 28

increasingly diminished function and mobility, diminished exercise tolerance and general activity, decreased grooming, decreased socialization, decreased curiosity, more clingy to owner, increased sleeping, etc

Question 29

pain scales

Answer 29

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

Question 30

pain scale limitations

Answer 30

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

Question 31

when should an animal receive pain medicine? (when does red flag go up for an animal being too painful?)

Answer 31

if they score anything above a 1 on the pain scale

Question 32

what does BEAP stand for?

Answer 32

B- breathing
E- eyes
A- ambulation, activity level, appetite, attitude
P- palpation