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Questions and Answers
Which opioid is classified as a partial mu agonist, providing analgesia for mild to moderate pain?
What are the potential gastrointestinal side effects of opioid use in animals?
Which of the following is a common route of administration for buprenorphine?
Which opioid is least likely to cause vomiting in cats and dogs?
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What important characteristic differentiates butorphanol from typical opioids?
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Which opioid is associated with causing excitement or dysphoria, particularly in cats and horses?
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Buprenorphine has a delayed onset of action but a longer duration of analgesia compared to which other opioid?
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Which opioid is typically utilized as a reversal agent for opioid agonists?
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The primary mechanism of action of nonsteroidal anti-inflammatory drugs (NSAIDs) involves inhibiting which enzymes?
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Which opioid is used to alleviate visceral pain and is considered a Schedule II drug in the United States?
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What type of pain occurs as a result of tissue injury and can be classified as acute or chronic?
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Which classification of pain is characterized by hypersensitivity in the area away from the site of injury?
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Which component of the pain pathway involves the transformation of stimuli into sensory electrical signals?
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What is the main goal of multimodal analgesia in pain management?
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What may occur as a consequence of untreated pain?
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Which of the following is characteristic of physiologic pain?
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Which type of pain scale involves descriptors to evaluate pain levels?
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What is the primary purpose of administering preemptive analgesia?
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Which of the following pain assessment tools allows for subjective interpretation of pain intensity using a visual scale?
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What is one common behavioral response to pain in dogs?
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Which type of pain is characterized as resulting from actual tissue injury and can be either acute or chronic?
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What is the main benefit of administering preemptive analgesia?
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Which step in the pain pathway is responsible for transmitting sensory impulses to the spinal cord?
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Which consequence of untreated pain involves the body's physiological responses such as hypertension and tachycardia?
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Which classification of pain arises from nerve damage or dysfunction?
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Which assessment tool utilizes facial expressions to evaluate pain in cats?
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What type of pain is primarily associated with internal organs and is often difficult to localize?
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Which term describes the phenomenon where non-noxious stimuli become painful due to tissue damage?
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Which behavioral response to pain would typically be seen in cats?
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What is the mechanism called whereby the central nervous system becomes hypersensitive due to ongoing stimulation?
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What is the primary advantage of multimodal therapy in analgesic administration?
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Which route of drug delivery is commonly utilized to mitigate postoperative pain with minimal adverse effects?
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In chronic pain management, effective analgesia is likely to cause which of the following changes?
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Which characteristic is typical of nonsteroidal anti-inflammatory drugs (NSAIDs)?
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What is a major concern when using opioid analgesics postoperatively?
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Hydromorphone is known for its greater potency than which other opioid, while maintaining similar effects?
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What is a notable side effect of using NSAIDs in treatment protocols?
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What characteristic is unique to Buprenorphine among opioid analgesics?
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Which of the following is a benefit of local anesthetics in analgesic protocols?
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What defines the mechanism of action of gabapentin as an analgesic?
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Study Notes
Pain
- Pain is a complex phenomenon, an aversive sensory and emotional experience
- It elicits protective motor actions, resulting in learned avoidance
- It may modify species-specific behavioral traits
Physiology of Pain
- Nociception is the detection by the nervous system of the potential for, or actual tissue injury
- It protects the animal from painful or noxious stimuli
- Physiologic pain (adaptive) is "ouch" pain with little or no tissue injury
- Pathologic pain follows tissue injury and can be acute or chronic
Pathologic Pain
- Classified based on mechanism: inflammatory, neuropathic, cancer, idiopathic
- Classified based on origin: visceral or somatic (superficial or deep)
- Classified based on severity of pain: none, mild, moderate, severe
Nociception: The Pain Pathway
- Step 1: Transduction: transformation of stimuli into sensory electrical signals (action potentials)
- Step 2: Transmission: sensory impulses conducted to the spinal cord
- Step 3: Modulation: impulses are either amplified or suppressed
- Step 4: Perception: impulses are transmitted to the brain where they are processed and recognized
- Each step has different receptors
- Drugs can be selected that will target specific receptors and block a specific step
- Multimodal therapy: targeting two or more receptors
Consequences of Untreated Pain
- Catabolism and wasting
- Immune system suppression
- Inflammation and delayed wound healing
- Anesthetic risk and increased anesthesia doses
- Patient suffering
Primary Hyperalgesia
- Peripheral hypersensitivity
- Results from tissue damage and constant stimulation of nerves
- Area close to the site of tissue injury becomes painful when stimulated with non-noxious stimuli
Secondary Hyperalgesia
- Chronic pain
- Central nervous system hypersensitivity or “windup”
- Area of hypersensitivity is further away from the site of tissue injury
- Results from constant stimulation of spinal cord neurons
- Neurons become hyperexcitable and sensitive
Physiologic Changes Caused by Pain
- Hypertension
- Tachycardia, tacharrhythmia
- Peripheral vasoconstriction (pale mucosae)
- Tachypnea
- Shallow breathing
- Exaggerated abdominal component
- Panting (dogs)
- Open-mouthed breathing (cats)
- Mydriasis
Signs of Pain in Animals
- Pain elicits a stress response
- Stress-related pain results in “fight-or-flight” physiological response
Preemptive Analgesia
- Administration of pain medication before the pain occurs
- Commonly involves adding analgesic to premedication before anesthesia
- Reduces overall requirement for analgesia and duration of administration
- Prevents windup
Behavioral Responses to Pain
- Vary depending on species, age, breed, and temperament
- Young patients less tolerant
- Cattle very stoic
- Large dog breeds more stoic than small toy breeds
- Cats hide; dogs seek owner comfort; herd animals separate themselves
- Vary depending on nature, duration, and severity of pain and presence of humans
Physical Evidence of Pain
- Changes in gait and level of activity
- Evidence of arthritic pain
- Reluctance to lie down or constantly shifting position
- Evidence of thoracic or abdominal pain
- Vocalization
- Changes in facial expressions, appearance, and attitude
Pain Assessment Tools
- Simple descriptive scales
- Visual analogue scales
- Numeric rating scales
- CSU Canine Acute Pain Scale and CSU Feline Acute Pain Scale
- Categorical numeric rating scale
- Validated
- Feline Grimace Scale
- Chronic Pain Assessment
Assessing Response to Therapy
- Acute surgical pain vs chronic pain
Nature of Pain
- Pain is a complex phenomenon
- A protective mechanism
- Can modify species-specific behavior traits
Physiology of Pain
- Nociception - detection of potential or actual tissue injury
- Physiologic pain is adaptive and occurs with little or no tissue injury
- Pathologic pain is linked to tissue injury and can be acute or chronic
Pathologic Pain Classification
- Inflammatory, neuropathic, cancer, idiopathic based on mechanism
- Visceral or somatic based on origin
- None, mild, moderate, severe based on severity
Nociception: The Pain Pathway
- Transduction: Stimuli transformed into sensory electrical signals
- Transmission: Sensory impulses conducted to the spinal cord
- Modulation: Impulses are amplified or suppressed
- Perception: Impulses are transmitted to the brain for processing and recognition
- Each step involves different receptors, allowing for targeted drug therapy
Multimodal Therapy
- Targeting two or more receptors in the pain pathway to manage pain
Consequences of Untreated Pain
- Catabolism and wasting
- Immune system suppression
- Inflammation and delayed wound healing
- Increased anesthetic risk and dosage
- Suffering
Primary Hyperalgesia
- Peripheral hypersensitivity due to tissue damage and nerve stimulation
- Area adjacent to the injury becomes sensitive to non-noxious stimuli
Secondary Hyperalgesia
- Central nervous system hypersensitivity or "windup"
- Area of hypersensitivity is distant from the site of injury
- Spinal cord neurons become hyperexcitable and sensitive
Pain-Induced Physiologic Changes
- Hypertension
- Tachycardia and tacharrhythmia
- Peripheral vasoconstriction
- Tachypnea
- Shallow breathing
- Exaggerated abdominal breathing
- Panting (dogs)
- Open-mouthed breathing (cats)
- Mydriasis
Behavioral Responses to Pain
- Vary based on species, age, breed, temperament, pain nature, duration, severity, human presence
- Stressed response leading to "fight-or-flight"
Physical Evidence of Pain
- Changes in gait and activity level, especially indicating arthritic pain
- Reluctance to lie down or constant shifting - thoracic or abdominal pain
- Vocalization
- Altered facial expressions, appearance, and attitude
Preemptive Analgesia
- Administering pain medication before pain occurs
- Often used as part of premedication before anesthesia
- Reduces overall analgesic needs and duration, prevents windup
Pain Assessment Tools
- Simple descriptive scales
- Visual analogue scales
- Numeric rating scales
- CSU Canine Acute Pain Scale and CSU Feline Acute Pain Scale
- Categorical numeric rating scale
- Validated Feline Grimace Scale
- Chronic Pain Assessment
Assessing Response to Therapy
- Hourly for acute surgical pain, monthly for chronic pain
- Pain-associated behaviors should recede with effective analgesia
- Pain assessment scores should decrease
Analgesic Administration Routes
- Intravenous
- Intramuscular
- Subcutaneous
- Oral
- Transdermal
- Epidural
- Intraarticular
Opioid Analgesics
- Vary in potency, duration, and adverse effects
- Injectable premedication often combined with tranquilizers
- Induce sedation at higher doses
- Postoperative analgesia
- Sedative/antianxiety effects
- Gastrointestinal effects: initial increased activity, followed by slowdown
- Metabolized in the liver
Opioid Agents: Morphine
- Used for moderate to severe visceral or somatic pain
- Can cause excitement or dysphoria in cats and horses
- Administered intravenously, intramuscularly, subcutaneously, intraarticularly, epidurally, spinally
- Adverse effects: Gastrointestinal stimulation, ileus, colic, excitement, miosis, mydriasis, hypothermia, hyperthermia, bradycardia, panting, increased intraocular pressure, urinary retention
Opioid Agents: Hydromorphone
- Greater potency than morphine with similar duration of effect
- Administered intravenously, intramuscularly, subcutaneously
Opioid Agents: Methadone
- Synthetic opioid with similar characteristics to oxymorphone and hydromorphone
- Less likely to cause vomiting in cats and dogs
Opioid Agents: Fentanyl
- One of the most potent analgesics
- Rapid onset, short duration when administered intravenously
- Continuous intravenous drip, transdermal patch, intramuscular, subcutaneous, or epidural injection
Opioid Agents: Buprenorphine
- Partial mu agonist with delayed onset and longer duration
- Can be used to reverse effects of morphine and fentanyl
- Expensive Schedule III drug
Opioid Agents: Butorphanol
- Synthetic opioid with agonist and antagonist properties
- Used as preanesthetic, sedative, and postoperative visceral analgesic
- Administered intravenously, intramuscularly, subcutaneously, and orally
- Schedule IV drug
Opioid Agents: Nalbuphine
- Kappa agonist and mu antagonist
- Weak analgesic and sedative
- Used as a reversal agent for opioid agonists
Opioids: Postoperative Analgesics
- Administered intramuscularly or subcutaneously before consciousness returns
- Short duration of action
- Potential adverse reactions: Respiratory depression, bradycardia, excitement, apprehension, hypersalivation, mydriasis, excessive sedation, panting, increased sensitivity to sound, urinary retention, gastrointestinal effects
Opioids: Intravenous Infusion
- Provides continuous analgesia for constant pain
Opioids: Intraarticular Injection
- Used after elbow or stifle surgery
- Provides 8 to 10 hours of postoperative analgesia
Opioids: Epidural Injection
- Instilled into epidural space at the lumbosacral junction
- Provides analgesia to hind limbs, abdomen, caudal thorax, pelvis, tail
- Morphine is most commonly used
Opioids: Transdermal Use
- Fentanyl transdermal patch provides convenient, long-term opioid administration
Nonsteroidal Antiinflammatory Drugs (NSAIDs)
- Inhibit prostaglandin synthesis by inactivating COX isoenzymes
- Metabolized in the liver, eliminated by kidneys and gastrointestinal tract
- Onset of action: 30 to 60 minutes
- Duration of effect varies with species
- Toxicity varies with species
Adverse Effects of NSAIDs
- Inhibit production of beneficial prostaglandins
- COX-2 selective NSAIDs cause fewer adverse effects
- Stomach ulcers, vomiting, gastrointestinal bleeding, lack of appetite
- Gastrointestinal ulceration
- Renal toxicity
- Impaired platelet aggregation
- Liver damage
- Antagonist to drugs for cardiac disease and hypertension
Local Anesthetics as Analgesics
- Advantages: Complete anesthesia of affected area, low toxicity, rapid onset of action
- Disadvantages: Short duration of action, central nervous system and cardiac toxicity with repeated use
Alpha2-Adrenoceptor Agonists
- Limited use in small animals due to adverse effects
- Used in horses to provide sedation, muscle relaxation, and analgesia
- Adverse effects: Cardiovascular, respiratory, GI
Ketamine
- Adjunct to other potent analgesics
- Blocks NMDA at the level of the spinal cord to prevent windup
Gabapentin
- Anticonvulsant that treats neuropathic pain and hypersensitivity
- Useful in dogs and cats for chronic pain
- Few adverse effects, except drowsiness
Amantadine
- NMDA receptor antagonist
- Useful for neuropathic pain and central hypersensitivity
Corticosteroids
- Strong antiinflammatory properties
- Adverse effects: Ulcerogenic, immunosuppression, hyperadrenocorticism
Tramadol
- Nonopiate drug with activity at the mu receptor
- Oral administration after patient has resumed eating
- Don't use concurrently with other norepinephrine or serotonin reuptake inhibitors
Tranquilizers
- Not analgesics but can potentiate opioid effects
Other Analgesic Adjuncts
- Antidepressants
- Antianxiety
- Bisphosphonates
Multimodal Therapy
- Combination of analgesic drugs targeting different pain pathway mechanisms
Examples of Multimodal Therapy
- Acetaminophen and codeine
- Fentanyl and meloxicam
- Morphine and injectable NSAID
- MLK
Home Analgesia
- Fentanyl patches for chronic pain
- NSAIDs for long-term therapy of chronic painful conditions
- Oral morphine
- Tylenol with codeine
- Tramadol
Nursing Care for Relieving Discomfort
- Keeping the patient and environment clean and dry
- Comfortable bedding and quiet surroundings
- Opportunity to urinate and defecate
- Comfortable position
- Reducing anxiety with familiar items
- Ophthalmic ointment for unconscious patients
- Touch and reassurance
Nonpharmacologic Therapies
- Used in conjunction with or as adjunct to pharmacological therapy
- Acupuncture
- Transcutaneous electric nerve stimulation
- Massage therapy
- Heat or cold application
- Physiotherapy
- Laser or magnetic therapy
- Homeopathic or herbal remedies
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Description
Explore the intricacies of pain as a sensory and emotional experience. This quiz covers nociception, adaptive and pathologic pain, along with classifications based on mechanisms and severity. Test your knowledge on the pain pathway and its implications for behavior and health.
