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Veterinary Nursing Anaesthesia and Analgesia > Pain Management > Flashcards

Pain Management Flashcards

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1
Q

What is pain?

A
  • Sensory experience associated with tissue damage

- Emotional component in humans and animals

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2
Q

Forms of pain management? (3)

A
  • Analgesia
  • Multi-modal analgesia
  • Pain scoring methods (pain behaviour)
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3
Q

Why should pain be avoided? (Mention 4 things)

A
  • Stress to patient
  • Prolonged recovery
  • Poor or delayed wound healing
  • Self-trauma
  • Impairs respiratory and cardiovascular function
  • Reduced food intake
  • Reduced mobility
  • Our ethical responsibility!
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4
Q

Name 3 responses to pain

A
  • Intra-operative pain
  • Increased HR
  • Increased RR
  • Dilation of bronchi
  • Adrenaline release
  • Cardiac arrhythmias due to adrenaline release
  • Dilation of blood vessels in skeletal muscle
  • Constriction of blood vessels in gastrointestinal tract
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5
Q

What is acute pain associated with?

A

Injury / trauma

- may be post surgical

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6
Q

When does acute pain usually abate

A
  • as healing occurs
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7
Q

What is acute pain?

A

Pain that does not usually outlast the initial painful stimulus

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8
Q

What is chronic pain?

A

Pain that does outlast the initial painful stimulus
OR
British pain society: ‘pain lasting longer than 12 weeks’
OR
pain lasting longer than anticipated

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9
Q

What can chronic pain cause changes in

A
  • Can cause changes in pain pathways of the central and peripheral nervous system
  • Continued pain can lead to changes in the way the animal responds to painful stimulus
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10
Q

What is pre-emptive analgesia

A

Administration of analgesics prior to pain stimulation preventing neuron sensitisation

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11
Q

What are the three kinds of pain?

A
  • Physiological
  • Inflammatory
  • Neuropathic
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12
Q

What is physiological pain?

A

Response that is proportionate to stimulus and pain goes when stimulus is removed
- ‘Protective pain’

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13
Q

What is inflammatory pain?

A

Clinical pain
- caused by surgery?
inflammation

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14
Q

What is neuropathic pain?

A

Caused by direct damage to the nervous system

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15
Q

What is the physiology of pain

A
  • Noxious (painful) stimulus associated with tissue damage and release of inflammatory mediators leading to the activation of pain receptors in nociceptors
  • Nociceptors transmit pain signals to CNS
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16
Q

What can repeated stimulus of pain pathways cause?

A

Heightened sensitivity

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17
Q

What are nerve endings that detect painful stimuli called?

A

Nociceptors

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18
Q

What are the main inflammatory mediators?

A

Prostaglandins

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19
Q

What is transduction

A

Pain being detected by nociceptors that then convert the painful stimulus into a nervous signal

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20
Q

What are the pain fibres?

A

Að and C

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21
Q

What is the aim of analgesia?

A

To interrupt or modify some or all parts of the CNS pathway

22
Q

What can ongoing pain cause?

A

Chronic hypersensitivity to pain that can outlast the actual pain event

23
Q

What is Allodynia?

A

Sensitivity to stimuli that would not normally cause pain e.g. touch

24
Q

What is hyperalgesia

A

Greater intensity and duration of pain that would be expected

25
Q

What 5 kinds of drugs are most commonly used

A 
Opioids 
NSAIDs
Alpha-2-adrenoreceptor agonists 
Local anaesthetics 
Ketamine 
Gabapentin
26
Q

Name 2 opioids used for analgesia and pain management

A

Methadone
Buprenorphine
Fentanyl

27
Q

Where do opioids act?

A

Centrally and peripherally

28
Q

How do NSAIDs work?

A

Inhibit the production of inflammatory mediators via the inhibition of COX enzymes

29
Q

What kind of NSAIDS are safer for the gut?

A

Cox-2 selective

30
Q

Name 3 NSAIDs commonly used

A 
meloxicam 
Carprofen 
Robencoxib 
Asprin 
Phenybutazone 
Ketoprofen 
Paracetamol
31
Q

What are NSAIDs used for

A

Management of chronic pain

Peri-operative pain relief

32
Q

When should you avoid NSAID usage? (name 2)

A

In patients that are:

  • Dehydrated
  • Hypotension (Shocked)
  • Have pre-existing renal disease
  • Liver disease
  • Animals already on corticosteroids or other NSAIDs
33
Q

Name 2 Alpha-2-adrenoreceptor agonists

A

medetomidine
dexmedetomidine
Xylazine

34
Q

What is used to reverse Alpha 2’s

A

Atipamezole

35
Q

Name a local anaesthetic used for pain management

A

Lignocaine
Bupivicaine
Mepivicaine

36
Q

What kind of analgesia do local anaesthetics provide?

A

Total analgesia

37
Q

What type of analgesia does ketamine provide

A

somatic analgesia

38
Q

Why is ketamine used for pain management

A
  • thought to prevent ‘wind up’

- acts centrally and can block central sensitisation

39
Q

When is Gabapentin used for pain management?

A

To block neuropathic pain in adult animals

40
Q

What is neuropathic pain

A

Pain caused by disease of sensory nerves

41
Q

What is a disadvantage of gabapentin

A

Cost

Exact mechanism of action is unknown

42
Q

Why is acupuncture used?

A
  • For chronic pain

- To compliment pharmaceutical measures in pain patients

43
Q

What are NSAID’s often combined with to create multi-modal analgesia? (name 1)

A
  • Opioids
  • Alpha-2-agonists
  • Local anaesthetics
44
Q

What kind of ‘infusion’ is often avoided in cats and why

A

‘Milk’ infusions due to sensitivity to lidocaine

45
Q

What is a ‘milk’ infusion’

A

combo of:

  • NaCl 0.9 or Hartmanns
  • Morphine
  • Lidocaine
  • Ketamine
46
Q

What variables can cause a variation in pain behaviour?

A 
Species 
Breed 
Age
Sex
Temperament
47
Q

Name 2 scales used to determine pain?

A
  • Simple descriptive scale
  • Numerical rating scale
  • Visual analogue scale
  • Glasgow composite pain scale
  • Colorado pain scale for cats
48
Q

Why are pain scales made?

A

To standardise and improve pain management

49
Q

How do you determine if it pain or a stormy recovery?

A

Palpation of would: Should elicit painful or heightened response
- Painful animals may be temporarily distracted unlike those who are dysphoric

50
Q

Name 4 additional roles of the VN to enhance a smooth recovery, and pain management

A
  • Monitor
  • Record and report signs of pain
  • Give good nursing care
  • Give clean warm bedding
  • Tend to wounds e.g. bandaging
  • Comfortable environment
  • Allow toileting and eating as close to normal
  • Provide psychological support

Veterinary Nursing Anaesthesia and Analgesia (25 decks)

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