Pain Management

Question 1

Pain

Answer 1

Pain is the perception of nociception (occurs in brain)
* considered to be the 4th vital sign
* pain vs dysphoria
* inhalation agents = only block perception pathway
* local anesthetics = completely block pain

Question 2

Dysphoria

Answer 2

Mental / emotional state where patient has intense feelings and becomes indifferent / unresponsive to surroundings
* related to stress, not pain
* clear sign is patient not responding to being calmed down

Question 3

Pain Pathway

Answer 3

• Transduction
• Transmission
• Modulation
• Perception

Question 4

Adaptive Pain

Answer 4

Acute Pain
* sudden onset, usually with a known cause
* “good pain” = able to be treated / controlled

Question 5

Maladaptive Pain

Answer 5

Chronic Pain
* persists beyond normal healing time
* unknown cause
* “bad pain” = pain nerve endings become necrotic over time with repeated stimuli

Question 6

Neuropathic Pain

Answer 6

Maladaptive Pain State
* pain response associated with peripheral nerve damage

Question 7

Pain Wind-Up

Answer 7

Perceived increase to pain intensity over time
* painful stimulus given repeatedly

Question 8

Pain Management with Surgery

Answer 8

Goal is to decrease pain with analgesics and maintain safe plane of anesthesia
* aggressive analgesics = decreased persistent pain after

Question 9

Analgesia and Pain
Three Principles

Answer 9

1. Preemptive Analgesia - give drugs before anticipated pain to get ahead of controlling it
2. Multimodal Analgesia - combination of drugs to provide longer effects and cover more areas
3. Analgesia Drug Duration - continue as long as pain is present

Question 10

Palliative Care

Answer 10

Any form of care / treatment that focuses on reducing severity of symptoms
* does not look to stop or delay the progression

Question 11

COX-1 vs COX-2

Answer 11

Create prostaglandins (cause pain) and get inhibited by NSAIDs
* COX-1: help maintain normal organ function
* COX-2: contribute to inflammation

Question 12

Robenacoxib

Answer 12

• NSAID
• Also called Onsior
• Post-op pain and inflammation in cats
• Take only for 3 days

Question 13

Sileo

Answer 13

• Alpha 2 Agonist
• Oral dexmedetomidine for dogs
• Put on MM - not to be swallowed

Question 14

NMDA Antagonist

Answer 14

Ketamine
* provides some analgesia
* does not affect BP

Question 15

SSNRIs

Answer 15

Selective Serotonin / Norepinephrine Reuptake Inhibitors
* antidepressants

Question 16

Trazodone

Answer 16

• SSNRI (mild one)
• Also treats anxiety disorders

Question 17

Massage Techniques

Answer 17

• Effleurage
• Petrissage
• Friction
• Tapotement

Question 18

Effleurage Technique

Answer 18

Puts pressure into the tissue
* long / short / deep strokes

Question 19

Petrissage Technique

Answer 19

Lifting / Pulling / Broadening
* increase circulation
* reduce stiffness

Question 20

Tapotement

Answer 20

Tapping on the tissue
* used to coupage the lungs (break up mucus)