Pain Treatment Flashcards
Define pain
An unpleasant sensory and emotional experience (perception) associated with actual or potential tissue damage or is described in terms of such damage.
Define chronic pain
A maladaptive, extends beyond the time for healing, and is a welfare issue and massive social burden.
What is nociception?
The reception, conduction and CNS processing of nerve signals from nociceptors (pain receptors) – a physiological process that results in the perception of pain
What are the two important ascending pathways?
Spinocervicothalamic tract
Spinoreticular tract
Spino(cervico)thalamic tract:
A) What is it for?
B) How do you test?
A) Touch and superficiai pain
B) Light pinch of the skin
Spinoreticular tract:
A) What is it for?
B) Where do primary afferents enter?
C) How is it activated?
A) Deep pain and visceral sensations
B) Enter cord and diverge cranially and caudally – spreads over several segments – allows intersegmental reflexes such as withdrawal
C) Emotional response
What is the gate theory of pain?
1965 Melzack and Wall suggested that the CNS can control nociception; activity in large fibres (non nociceptive) can modify perception of activity in small nociceptive fibres and descending activity can also inhibit it
What happens with time to cause chronic pain?
•With time the noxious stimuli that result in the perception of pain appear to reconfigure the set up of the peripheral and central nervous systems
How can we assess chronic pain?
- Chronic pain is multifactorial (mood, posture & movement domains) and subjective
- Chronic pain scales will be made up of questions from these domains
- Helsinki Chronic Pain Index
- GuvQuest
- Canine Brief Pain Inventory (CBPI) (OA & bone cancer pain)
- Liverpool osteoarthritis in Dogs (LOAD e)
- Feline Musculoskeletal Pain Index (FMPI)
What are the analgesia options for chronic pain?
- Opioids
- NSAIDs
- Alpha-2 agonists
- NMDA receptor antagonists
- Nitrous oxide
- Local anaesthetics
- ‘Others’
- (paracetamol, steroids, amantadine, tramadol, gabapentin, tapentadol, pregabalin, TCAs SSRIs, methocarbamol)
How can we have analgesia options without medication for chronic pain?
- TLC, nursing
- Grooming
- Exercise (incl PROM), hydrotherapy
- Diet
- Modifications
- Bedding, ramps, litter trays
- Novel objects, toys
- Massage
- Trigger points
- Acupressure
- U/S, laser
Name 2 examples of novel delivery systems of pain relief? (3)
–Polymer gels & buprenorphine SR
–Liposome encapsulated opioids
–Pro-drugs
What is the holistic aproach to the treatment of chronic pain?
- Identify and address underlying problem
- Restore normal joint biology
- Provide relief from pain and inflammation
- Restore normal joint function
- Plan long term management / prevention of problem
Name some un-licensed pharmacotherapy drugs for pain relief?
- Amantadine
- Tramadol
- Gabapentin
- Methocarbamol
- Trazadone
Name “other treatments” for pain
- Stem cells
- Physical therapies
- Complementary therapies
- Nerve growth factor therapies
- EP4 Rc antagonists
- Autoimmune therapies
- Euthanasia
- Therapies targeting the descending controls
