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Y3 MOD Anaesthesia > Pain physiology and analgesia > Flashcards

Pain physiology and analgesia Flashcards

1
Q

Define pain

A

‘Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’

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2
Q

Define nociception

A

Relay of noxious stimulus from the periphery to the central nervous system

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3
Q

What are the 3 types of acute pain?

A

Somatic
Visceral
Neuropathic

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4
Q

Describe somatic acute pain

A
  • Chemical, thermal or mechanical stimuli to skin, muscles, bones etc
  • Usually localised to injury site
  • ‘Sharp, stabbing’ sensation – fast pain transmission
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5
Q

Define visceral acute pain

A
  • Inflammation, ischaemia or distension of viscera
  • Poorly localised, diffuse
  • ‘Burning, dull’ sensation – slower transmitted C fibres
  • Possible autonomic components e.g. vomiting, sweating, tachycardia
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6
Q

Define neuropathic acute pain?

A
  • Primary lesion or dysfunction within nervous system
  • May be localised or diffuse (depending on degree of nerve injury)
  • ‘Burning, tingling’ sensation, may be intermittent
  • Can become a component of chronic pain
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7
Q

What is hyperalgesia?

A

Exaggerated pain sensation in response to noxious stimulus

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8
Q

What is allodynia?

A

Perception of pain sensation in response to a normally non-noxious stimulus

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9
Q

What is spontaneous/idiopathic/functional pain?

A

Pain that arises in absence of detectable tissue or nerve injury

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10
Q

Which type of sensitisation may result in chronic pain?

A

Central

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11
Q

What is peripheral sensitisation?

A
  • Increased responsiveness of nociceptors (result off a decreased activation threshold)
  • Occurs with tissue damage and inflammation
  • Causes primary hyperalgesia and allodynia at injury site
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12
Q

What is central sensitisation?

A
  • Changes in membrane excitability and upregulation of post-synaptic receptors (especially NMDA receptors)
  • Results from intense, prolonged and/or repeated nociceptive input
  • Causes secondary hyperalgesia outside/adjacent
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13
Q

Why does acute pain rapidly alter an animals behaviour?

A
  • to minimise damage
  • optimise conditions for tissue healing
  • stops when healing is complete
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14
Q

What type of pain is relatively easy to treat?

A

Acute pain

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15
Q

What type of pain is associated with tissue damage (or threat of this) due to surgery, injury or disease?

A

Acute pain

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16
Q

What is meant by chronic pain being maladaptive?

A

No useful function

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17
Q

Over what length of time does chronic pain persist?

A

Beyond the expected time of tissue healing

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18
Q

What are some consequences of poor acute pain management?

A
  • unstable general anaesthesia
  • poor animal welfare
  • delayed recovery
  • development of central sensitisation and chronic pain
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19
Q

What are the 4 stages of nociception?

A
  • Transduction
  • Transmission
  • Modulation
  • Perception
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20
Q

What is pre-emptive analgesia?

A

Administration of analgesics prior to noxious stimulus to maximise their effect, reduce sensitisation and enhance post operative analgesia

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21
Q

What is multimodal (balanced) analgesia?

A

Formulation of an analgesic plan that targets as many stages in the nociceptive pathway as possible

22
Q

Where in the body does transduction, modulation and perception occur?

A 
Transduction = nerve terminal 
Modulation = Dorsal horn of the spinal cord
Perception = brainstem and cerebrum
23
Q

What are the pharmacological options for management of acute pain?

A 
N = NSAIDs
O = opioids
P = paracetamol (not in cats)
L = local anaesthetics
A = alpha-2 agonists
N = NMDA antagonists
24
Q

Which drug group are COX inhibitors?

A

NSAIDS

25
Q

Which stages of transmission do NSAIDS effect?

A

Transduction, modulation and perception

26
Q

Give some examples of opioids?

A 
Butorphanol 
Buprenorphine
Morphine
Methadone
Fentanyl
27
Q

Which opioid has the longest duration of effect?

A

Buprenorphine

28
Q

Can opioids be used in food producing animals?

A

No - but butorphanol can be applied via the cascade

29
Q

What are the considerations of using pathidine?

A

Causes histamine release when administered IV, but it is the only licensed full Mu agonist in horses

30
Q

Why is morphine more often used in horses over methadone even though it is not licenced?

A

In horses methadone causes a ‘twitchy’ response so morphine is often used instead

31
Q

Which stage/s of the transmission pathway are affected by paracetamol?

A

Modulation

32
Q

In which species can paracetamol not be used?

A

Cats - toxic at low doses

33
Q

How do local anaesthetics work as analgesics?

A

Sodium channel blockers, inhibit transmission of all nerve types

34
Q

What are some examples of local anaesthetics?

A

Lidocaine

Bupivacaine

35
Q

Which local anaesthetic cannot be administered IV and why?

A

Bupivacaine

- cardiotoxic

36
Q

What are the effects of alpha-2-agonists?

A

Analgesia, sedation and muscle relaxation

37
Q

Which stage of transmission is affected by alpha-2-agonists?

A

Modulation

38
Q

Why would you not want to use alpha-2 agonists in patients with some heart conditions?

A

Cause bradycardia

39
Q

What are the sedative and analgesic effects of alpha 2 agonists?

A

Analgesia peaks later than sedation and the duration is shorter

40
Q

What are some examples of drugs with NMDA antagonistic properties ?

A

Ketamine
Pethidine
Methadone
Nitrous oxide

41
Q

Which stages of transmission are affected by NMDA antagonists?

A

Modulation and perception

42
Q

What are some possible side effects of ketamine?

A

Muscle rigidity

Excitation

43
Q

What are some non-pharmacological methods for acute pain management?

A
  • Wound dressing and external coaptation

- Good nursing care e.g. warmth, stimulation, clean, empty bladder

44
Q

Why is recognition of acute pain more challenging in veterinary species over humans?

A
  • non-verbal
  • behaviour indicators can be difficult to assess
  • species/individual differences
45
Q

What is the multidimensional composite pain scale commonly used in dogs?

A

Glasgow Composite Measure Canine Pain Scale (Short Form)

46
Q

What is the Glasgow feline pain scale validated for assessing?

A

Acute pain in cats

47
Q

How would the face of a pain free cat differ from a marked pain cat?

A
  • Ear position will be upright and alert in pain free and tucked down in painful
  • You can also see that cats tend to squint (orbital tightening) when painful and the muzzle becomes flattened and tense
48
Q

What are some behavioural indicators in horses that show pain?

A
  • decreased weight bearing
  • pawing, flank watching, rolling
  • restlessness, reduced appetite, reduced socialisation
49
Q

How would a painful cow appear on assessment?

A
  • low head position
  • low ear position
  • tense expression
  • arched back
  • lame
50
Q

How would a painful sheep appear on assessment?

A
  • Orbital tightening
  • Lowered head and ear position
  • Flehming

Y3 MOD Anaesthesia (9 decks)

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