Untreated Pain Effects Quiz

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Questions and Answers

What physiological effects can sympathetic stimulation from untreated pain lead to?

Enhanced immune system response

Increased digestive enzyme production

Decreased heart rate and blood pressure

Increased cardiac work and oxygen consumption (correct)

Which of the following is a consequence of untreated pain related to the immune system?

Increased leukocyte production

Immune system suppression (correct)

Immediate immune response activation

Immune system enhancement

Which stress response is primarily mediated by the sympathetic nervous system due to pain?

Decreased hormone release

Stable glucose levels

Reduced heart rate

Increased cortisol and epinephrine release (correct)

What is a common psychological consequence of untreated pain?

Anxiety and suffering Signup and view all the answers

What is NOT included in the patient pain assessment checklist?

Determining the patient's favorite activities Signup and view all the answers

Which pain assessment tool involves scoring based on psychological and behavioral criteria?

CSU Canine Acute Pain Scale Signup and view all the answers

What physiological complication can occur in the renal system due to untreated pain?

Urinary retention Signup and view all the answers

Which consequence can occur in the cardiovascular system as a result of untreated pain?

Tachycardia and hypertension Signup and view all the answers

What is the primary goal of analgesia?

To reduce pain by interrupting nociception Signup and view all the answers

Which of the following describes multimodal therapy?

Targeting multiple pain receptors and mechanisms Signup and view all the answers

At what pain score should the analgesic plan be reassessed for animals?

2-4 Signup and view all the answers

What is the importance of allowing an animal to sleep post-surgery?

Sleep is crucial for recovery and healing. Signup and view all the answers

What is an example of multimodal therapy for dogs?

Morphine combined with injectable NSAID Signup and view all the answers

During which period is analgesia needed in animals?

Throughout the entire hospital stay and at home Signup and view all the answers

Which of the following is NOT a component of the equine pain assessment scale for orthopedic issues?

Reaction to temperature changes Signup and view all the answers

Why should animals not be evaluated for pain while they are sleeping?

Animals do not feel pain when sleeping. Signup and view all the answers

Which factors influence the choice of analgesic drugs?

Severity and type of pain, patient condition, route of delivery Signup and view all the answers

What physiological response is commonly triggered by pain in animals?

Fight-or-flight-freeze response Signup and view all the answers

What behavior might indicate colic in horses according to the pain assessment scale?

Frequent lying down Signup and view all the answers

Which of the following is NOT a component of nociception?

Memory formation Signup and view all the answers

Which pain assessment scale is specifically tailored for post-abdominal surgery in horses?

Post Abdominal Surgery Pain Assessment Scale (PASPAS) Signup and view all the answers

Which combination of drugs can be used to control pain in cats until the fentanyl patch takes effect?

Fentanyl and meloxicam Signup and view all the answers

What aspect is NOT considered when using the post-abdominal surgery pain assessment scale (PASPAS)?

Grooming behaviors Signup and view all the answers

What is evaluated in the composite orthopaedic pain scale for equines?

Behavioral changes Signup and view all the answers

Which type of analgesics primarily act on opioid receptors in the body?

Opioids Signup and view all the answers

What is the main action of non-steroidal anti-inflammatory drugs (NSAIDs)?

Inhibit COX-1 and COX-2 enzymes Signup and view all the answers

Which of the following would be classified as a partial agonist at mu receptors?

Buprenorphine Signup and view all the answers

How do local anesthetics primarily achieve analgesia?

By blocking sodium-gated channels Signup and view all the answers

Which of the following is a characteristic of mu agonists?

They are the most potent analgesics Signup and view all the answers

What is a common caution for the use of NSAIDs?

They may worsen gastrointestinal conditions Signup and view all the answers

What is the role of alpha2-adrenergic agonists in analgesia?

To decrease the release of norepinephrine Signup and view all the answers

How long should topical analgesia maintain contact for effectiveness?

20 to 30 minutes Signup and view all the answers

What should be done when adding medication to a bag to maintain proportions?

Remove an equal amount from the bag. Signup and view all the answers

Which of the following is NOT considered a non-pharmacologic intervention for pain management?

Opioid administration Signup and view all the answers

Why is preemptive pain management important?

It anticipates pain before it occurs. Signup and view all the answers

Which statement about patient pain perception is true?

Each patient may require different levels of analgesia. Signup and view all the answers

What is one of the main responsibilities of effective pain management?

Monitoring cardiovascular status and mentation. Signup and view all the answers

What differentiates dysphoria from anxiety?

Dysphoria involves unpleasant thoughts induced by drugs. Signup and view all the answers

What is the consequence of not reassessing pain during a procedure?

It can lead to uncontrolled pain in the patient. Signup and view all the answers

What is the most effective approach when a patient displays signs of undue pain during treatment?

Monitor the patient's status and adjust pain management. Signup and view all the answers

How long will a 250mL bag last if it is administered at a rate of 15mL/hr?

16.67 hours Signup and view all the answers

What is the appropriate dose in mg to add to the bag for a 20kg dog receiving hydromorphone at 0.01mg/kg/hr over 16.67 hours?

3.33 mg Signup and view all the answers

How much of a 10mg/mL hydromorphone solution should be added to the bag to achieve the required 3.33mg dosage?

0.33 mL Signup and view all the answers

If a 500mL bag is administered at a rate of 62mL/hr, what is its duration in hours?

8.06 hours Signup and view all the answers

What is the total microgram (mcg) dosage required to be added to a bag for a 33kg dog receiving fentanyl at a rate of 2mcg/kg/hr over 8.06 hours?

531.96 mcg Signup and view all the answers

How much of a 50mcg/mL fentanyl solution is needed to provide the required 531.96 mcg dosage in the bag?

10.64 mL Signup and view all the answers

Determine the total volume in mL required to administer 50mcg/kg/min of lidocaine to a 30kg dog for 15.38 hours.

69.21 mL Signup and view all the answers

How many minutes will a 1L bag last if it is administered at a rate of 65mL/hr?

922.80 minutes Signup and view all the answers

What is the bag duration in hours when there is a 1000mL bag administered at a rate of 65mL/hr?

15.38 hours Signup and view all the answers

When calculating drug dosage, which step is used to check that Rx units match concentration?

Set up equation and assess units Signup and view all the answers

What do you need to do before adding medication to the fluid bag?

Remove the same volume of fluid from the bag Signup and view all the answers

What is the effect of calculating dose in mcg/min while the fluid rate is in mL/hr on the overall calculations?

It necessitates conversions for accuracy before calculations. Signup and view all the answers

Why is it important to convert mcg to mg when required in the calculations?

To ensure all doses are in compatible units. Signup and view all the answers

If a drug dose is given in mcg/kg/min, which additional step must be taken when calculating the total dosage?

Convert to mcg/hr before calculating total dosage. Signup and view all the answers

Study Notes

Pain Physiology, Assessment & Treatment

Veterinary Nursing 2 course material
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The inability to communicate does not negate the possibility of experiencing pain.
Pain is a complex phenomenon and a subjective experience.
Pain elicits protective motor actions which leads to avoidance behaviours.

Nature of Pain

Pain is a complex phenomenon described as an aversive sensory and emotional experience.
Protective motor actions are triggered, resulting in avoidance behaviours.
Species-specific behaviours may be altered.

Physiology of Pain

Nociceptors are pain receptors in the nervous system.
Acute pain: Severe, sudden onset overwhelming endogenous analgesic mechanisms.
Chronic pain: prolonged and persistent pain, where the body becomes habituated to nervous system responses.

Nociception vs Pain

Nociception is the process by which the nervous system detects potential or actual tissue injury.
Pain is the subjective experience of tissue damage, accompanied by awareness of that damage. Nociception might be present without pain (e.g. during anesthesia), while pain will always have nociception component.

Nociception Pathway

Transduction
Transmission
Modulation
Perception

Pathologic Pain

Pathologic pain is caused by damage or disease to the body, specifically tissue injury
Pain can be acute or chronic in nature.

Classification of Pathologic Pain

Categories may be based on the mechanism of pain (inflammatory, neuropathic, cancer, or idiopathic)
Origin (visceral or somatic, superficial or deep)
Severity (none, mild, moderate, or severe).

Types of Pain

Somatic pain originates from damage to bone, joint, muscle, or skin; is usually localized.
Visceral pain originates from internal organs and is poorly localized, from stretching or twisting of viscera, mesenteries, and ligaments.
Neuropathic pain originates from injury to the peripheral or central nervous system.
Inflammatory pain originates from tissue damage (e.g. trauma, ischemia, OA, laminitis).

Other Pathologic Pain Types

Allodynia: Pain evoked by a stimulus that does not normally cause pain.
Hyperalgesia: An increased or exaggerated response to a stimulus normally causing pain.
Windup: Summation of painful stimulation in the spinal cord.

Pain Assessment Tools

Simple descriptive scales
Visual analogue scales
Numerical rating scales
CSU Canine Acute Pain Scale
CSU Feline Acute Pain Scale
Categorical numeric rating scales

Pain Assessment

Observe behaviours like anxious expression, facial expressions, restlessness, panting
Obtain heart rate, blood pressure, and respiration rate.
Palpate for painful areas.

Pain Management

Goals of analgesia are to reduce pain and prevent undesirable effects on patient physiology
Use multimodal therapy, employing multiple drugs.
Treat pain at one or multiple levels during an animal's hospitalization (transduction, transmission, modulation, and perception).

Consequence of Untreated Pain

Sympathetic nervous system stimulation contributes to vasoconstriction and increased cardiac work, heart rate and oxygen consumption.
Immune system suppression, delayed wound healing.
Risk of increased anesthesia doses and increased anesthetic risk.
Suffered increase patient pain.
Pain has significant negative effects on both physical and physiological parameters of the body.

Analgesia Goal

Reduce pain by interrupting nociception at one or multiple levels.

Multimodal Therapy

Use of more than one drug to control pain, covering multiple receptors and mechanisms.

Types of Analgesics Targeted at Specific Steps in Nociception Pathway

Inhibit perception: anesthetics, opioids, benzodiazepines, phenothiazines.
Inhibit transmission: local anesthetics, opioids, alpha-agonists.
Inhibit modulation: local anesthetics, opioids, tricyclin antidepressants, cholinesterase inhibitors, NMDA antagonists, NSAIDs, and anticonvulsants.
Inhibit transduction: local anesthetics, opioids, NSAIDs, corticosteroids.

Examples of Multimodal Anagesia

Acetaminophen & codeine for moderate-severe pain in dogs.
Fentanyl & meloxicam for pain relief in cats.
Morphine, Lidocaine, & Ketamine (MLK) for moderate-severe pain in dogs.

Analgesia Timing

Analgesia is important at every stage of hospitalisation (pre-anesthesia, surgical period, immediately postoperative, remainder of stay at home).

Criteria for Drug Choice

Severity and type of pain.
Patient's general condition.
Route of delivery.

Signs of Animal Pain

Vary depending on species, age, breed, and temperament.
Young patients less tolerant.
Large breeds of dogs more stoic than small or toy breeds.
Cats tend to hide, whereas dogs seek owner comfort, with the herd animals separating themselves.
Pain response can vary based on nature, duration, and severity of pain, and presence of humans.
Changes in behaviour, posture, facial expressions, and attitude are common.
Signs to look for: vocalization (whimpers, growls, etc.), reduced appetite, changes in posture (guarding behaviour, avoiding movement), changes in facial expression/attitude/appearance, difficulty sleeping, depression, changes in gait or motility, reluctance to move, constant shifting of position, decreased grooming.

Signs of Pain (in general)

Decreased appetite, decreased sleeping time, changes in posture, changes in gait (level of activity), and reluctance to lie down.
Decreased grooming, poor body condition, significant reductions in activity or motility.
Vocalization signs (whining, growling etc.) emergence delirium, immediate postoperative vocalization, changes in facial expressions, and attitude, (crouching, posture alteration, head tilt)
Specific examples in different animal types are also mentioned (canine, feline, equine) behaviours.

Pain in Animals Under Anesthesia

Anesthetized animals can process nociception but aren't consciously aware.
Signs of pain under general anesthesia include increased heart rate and respiration rate, increased blood pressure, difficulty maintaining plane of anesthesia, trembling, changes in normal behaviour (or lack thereof), changes in normal posture/movement.

Things to consider

When was the last analgesia?
Was it adequate?
Age of the animal and comorbidities.
Severity of pain
Surgery duration

Pain vs Anxiety

Pain can be difficult to distinguish from anxiety, as physiological changes similar to anxiety can occur during pain. Observing patient behaviours can assist to distinguish, with pain generally being more acutely reflected, whereas anxiety can be more chronic in nature.

Consequences of Untreated Pain

Sympathetic stimulation (vasoconstriction, increased cardiac work/heart rate, increased oxygen consumption/hypoxia)
Immune/inflammation system issues /delayed wound healing or impaired healing)
Increased anesthetic risk / increased anesthetic doses required; greater adverse effects of anesthesia/recovery etc.)
Patient suffering

Stress-response Consequences of Untreated Pain

Cardiovascular effects (tachycardia, hypertension, arrhythmias)
Respiratory effects (atelectasis, hyperventilation/hypoventilation, hypoxia)
Gastrointestinal effects (delayed gastric emptying, nausea, ileus)
Renal effects (oliguria and urinary retention)
Hematological effects (hypercoagulability, thrombosis risk)
Psychological effects (anxiety, fear, fatigue, suffering)

Recall: References - CRI

Reference materials: McCurnin's Clinical Textbook & small animal ECC textbook.
Specific chapters and pages are cited to indicate the location of references

Calculating Constant Rate Infusion

Detailed steps for calculating CRI dosages, covering different units (mg/kg/hr vs mcg/kg/min) with specific examples.

Pain Assessment, Different Species

Detailed descriptions of pain assessment techniques for equine, feline, canine, and ruminants.
Common behaviours to look out for in each animal type (eg lameness, changes to posture, vocalization, hiding, aggression, stress response)

Non-Pharmacological Interventions

Differentiating pain from other stress-related behaviours.
Assessing physical and emotional needs
Provide physical comfort or distraction methods to alleviate perceived stress/anxiety.
Reassessing patient comfort after addressing emotional and physical pain needs

Analgesic Options: Non-Pharmacological

General nursing care, including cleanliness and padding.
Acupuncture
Laser analgesics
Physical therapies (massage), ice/cold therapy

Summary of AAHA Pain Management Standards

Pain assessment is essential for every patient, especially preemptively.
Recording pain assessments in medical records.
Employing preemptive pain relief measures.
Appropriate pain management for surgical procedures and chronic pain.
Using written protocols and teaching client to recognize pain.

Remember Pain Management

Each patient is unique
Pain can be well-hidden, with many factors contributing to this including stress and anxiety
The procedure itself can profoundly influence perception of pain & therefore requirements for pain management.

Monitoring Drug Effects

Careful monitoring of cardiovascular & mental health in patients is critical when assessing effects of pain relief medicines.
Assess for detrimental side effects, or complications and/or further stress factors, and treat these adverse consequences as needed.

Dysphoria vs Anxiety

Dysphoria: A state of uncontrolled unpleasant thoughts and feelings (often induced by drugs).
Anxiety: Feeling of worry, nervousness, or unease.
Distinction is important because treatments differ

Overview of Analgesic Categories

Opioids, NSAIDs, locals, alpha-2 agonists, NMDA antagonists, and gabapentin are all presented.

Analgesic: Opioids

Mainstay for perioperative pain, highly effective, minimal side-effects, and generally inexpensive.
Act on opioid receptors (mu, kappa, delta) within various sections of the body (transduction, modulation, and perception).
Different forms of opioid action are provided (eg. mu agonists).

Analgesic: NSAIDS

Act by blocking COX-1 and COX-2 enzymes.
Anti-inflammatory and antipyretic.

Analgesic: Local Anesthetics

Block Na-gated channels, preventing action potential propagation in nerve fibers
Extremely effective but generally short-acting.

Analgesic: Topical Anesthesia

Applied to surface skin or mucosa to reduce pain.
Effective for minor procedures such as wound surgery, venipuncture, arterial punctures, and nasal cannulation.

Analgesic: Alpha-2 Agonists

Decrease NE release peripherally and centrally.
Provide potent analgesia in horses, less effective in other species.

Analgesic: NMDA Antagonists

Block glutamate receptors, helping reduce central sensitization
E.g., Ketamine (dissociative agent).

Analgesic: Gabapentin

Analgesic adjunct.
Used primarily for neuropathic and chronic pain.
Helps to prevent/decrease central sensitization (preemptively or before surgery).
May have mild sedative properties, especially in cats.

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Description

This quiz examines the various physiological and psychological effects of untreated pain. Participants will explore the consequences of pain on the immune, cardiovascular, and renal systems, as well as psychological impacts and assessment tools. Test your knowledge on this critical aspect of pain management.