Podcast
Questions and Answers
Which of the following behaviors are commonly seen as indicators of pain in horses?
Which of the following behaviors are commonly seen as indicators of pain in horses?
What is a primary reason for treating pain in patients?
What is a primary reason for treating pain in patients?
In pharmacological pain management, constant rate infusion (CRI) requires calculating which of the following?
In pharmacological pain management, constant rate infusion (CRI) requires calculating which of the following?
Non-pharmacological therapies for pain management might include which of the following?
Non-pharmacological therapies for pain management might include which of the following?
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When calculating the duration for a fluid bag in CRI, which formula should be used?
When calculating the duration for a fluid bag in CRI, which formula should be used?
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What is the first step in a checklist for assessing pain in a patient?
What is the first step in a checklist for assessing pain in a patient?
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Which of the following is a psychological effect of untreated pain?
Which of the following is a psychological effect of untreated pain?
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Which pain assessment tool is specifically designed for assessing acute pain in canines?
Which pain assessment tool is specifically designed for assessing acute pain in canines?
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What is a common physiological response mediated by the sympathetic nervous system due to pain?
What is a common physiological response mediated by the sympathetic nervous system due to pain?
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Which of the following is NOT a component of the stress response associated with untreated pain?
Which of the following is NOT a component of the stress response associated with untreated pain?
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Which of these pharmacological options is most likely used to manage pain in critical care patients?
Which of these pharmacological options is most likely used to manage pain in critical care patients?
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Non-pharmacological therapies for pain management include all of the following EXCEPT:
Non-pharmacological therapies for pain management include all of the following EXCEPT:
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Which of the following symptoms are associated with acute pain response in patients?
Which of the following symptoms are associated with acute pain response in patients?
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What is the purpose of calculating the bag duration in hours?
What is the purpose of calculating the bag duration in hours?
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When assessing units for medication dosage calculations, what is crucial to check?
When assessing units for medication dosage calculations, what is crucial to check?
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How do you convert mcg to mg in dosage calculations?
How do you convert mcg to mg in dosage calculations?
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What is the correct method to find the volume of medication to add to a fluid bag?
What is the correct method to find the volume of medication to add to a fluid bag?
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In a continuous rate infusion (CRI) scenario, what is essential to calculate before administration?
In a continuous rate infusion (CRI) scenario, what is essential to calculate before administration?
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What is a primary non-pharmacological therapy option in pain management?
What is a primary non-pharmacological therapy option in pain management?
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Which of the following accurately describes the process of calculating drug volume needed for a patient?
Which of the following accurately describes the process of calculating drug volume needed for a patient?
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What ethical consideration is important when managing a patient's pain?
What ethical consideration is important when managing a patient's pain?
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Why is it important to set aside the calculated bag duration during the medication process?
Why is it important to set aside the calculated bag duration during the medication process?
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What is the formula used to convert the hours calculated from the fluid bag into minutes?
What is the formula used to convert the hours calculated from the fluid bag into minutes?
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What should be done after calculating the volume of medication to add to the bag?
What should be done after calculating the volume of medication to add to the bag?
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For a continuous rate infusion of Lidocaine at 50mcg/kg/min, what is the initialization factor for calculating total medication?
For a continuous rate infusion of Lidocaine at 50mcg/kg/min, what is the initialization factor for calculating total medication?
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What role does drug concentration play in medication calculations?
What role does drug concentration play in medication calculations?
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Study Notes
Pain Physiology, Assessment & Treatment
- Veterinary Nursing 2 (VETC 2011) course
- Instructor: Laura Couch RVT, MSc, One Health (GradCert) BSc
References
- Chapter 9, pages 110+ in Small Animal Emergency and Critical Care for Veterinary Technicians
- Authors: Andrea Battaglia, Andrea Steele
- Includes links for the Feline Grimace Scale and Colorado Pain Scores
Learning Objectives
- Define pain
- Introduce different pain management options
- Provide information on determining if a patient is in pain
- Discuss constant rate infusion calculation and administration
Animals Cannot Communicate Pain
- Animals cannot verbally communicate pain
- Veterinary nurses must assess pain-related changes in behavior, stress signs, body position, and physiological responses
Definition of Pain
- "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. The inability to communicate in no way negates the possibility that an individual is experiencing pain and is in need of appropriate pain relieving treatment"
- International Association for the Study of Pain
Nature of Pain
- Complex phenomenon
- An aversive sensory and emotional experience
- Elicits protective motor actions
- Results in learned avoidance
- May modify species-specific behavior traits
Physiology of Pain
- Nociceptors: pain receptors in the nervous system
- Pain has a physiological explanation
- Acute pain: severe, sudden onset, overwhelming endogenous analgesic mechanisms
- Chronic pain: prolonged and persistent, body habituates to nervous system responses
Physiology of Pain (Categories)
- Nociception
- Physiology
- Pathology
Physiological Pain
- Normal response to noxious stimulus
- Produces protective behaviors
- "Ouch" pain type
- Little or no tissue injury
- Also called adaptive pain
- Prevents pathological pain
Pathological Pain
- Pain caused by damage or disease to the body,
- Tissue injury, acute or chronic
- Classification based on mechanism, origin and severity
Types of Pain
-
Somatic: originates from damage to bone, joint, muscle, or skin; well localized
- Examples include aching, dull, sharp, throbbing, stiffness, bruising
-
Visceral: originates from internal organs; poorly localized
- Examples include pressure, squeezing, cramping, constant, throbbing, gassy/bloated
- Neuropathic: originates from injury to the peripheral or central nervous system
- Inflammatory: originates from tissue damage (e.g., surgery, trauma, ischemia, OA, laminitis, infection)
- Referred: originates from one part of the body but perceived as occurring in another
Other Pathological Pain (Examples)
- Allodynia: pain evoked by a stimulus that does not normally cause pain
- Hyperalgesia: increased or exaggerated response to a normally painful stimulus (heightened sense of pain)
- Windup: summation of painful stimulation in the spinal cord, leading to secondary hyperalgesia and allodynia.
Nociception
- Detection by nervous system of potential or actual tissue injury
- Neural process of noxious transmission
- Nociception can protect animals from painful or noxious stimuli
Nociception vs. Pain
- Nociception: when nerves are stimulated to send info about tissue damage to the brain—the pain-sensing nerve cells are activated.
- Pain: the subjective experience of tissue damage – awareness of the pain, not all nociception results in pain.
The Pain Pathway
- transduction of noxious stimulus
- transmission of impulse
- modulation (of impulse at spinal cord)
- perception in cortical brain regions
Drugs for Pain Management
- Specific drugs can target specific pain receptors and steps in the pain pathway to block the pain response mechanism.
Analgesia Goal
- Reduce pain by interrupting nociception at one or more levels (transduction, transmission, modulation, perception)
Multimodal Therapy
- Using more than one drug to control pain
- Targets multiple receptors and mechanisms of action
- Usually reduces the dose of individual drugs or anesthetic agents for better pain management.
Mechanisms to Inhibit Pain
- Inhibit perception (e.g., anesthetics, opioids, benzodiazepines, phenothiazines)
- Inhibit transmission (e.g., local anesthetics, opioids, a-agonists)
- Modulation of spinal pathways (e.g., local anesthetics, opioids, tricyclic antidepressants, cholinesterase inhibitors, NMDA antagonists, NSAIDs, anticonvulsants)
- Transduction (e.g., local anesthetics, opioids, NSAIDs, corticosteroids)
- Examples include acetaminophen and codeine (oral), fentanyl and meloxicam (cats), morphine, lidocaine, and ketamine (surgery)
Analgesia During Treatment
- Needed at every stage of hospitalization and treatment
- Preanesthetic period
- Surgical period
- Postoperative period
- Hospital stay
- At home
Pain Management Considerations
- Severity and type of pain
- Patient's general condition
- Route of delivery
Signs of Pain in Animals
- Pain elicits a stress response
- Results in "fight-or-flight," or "freeze" physiological response
- Vary depending on species, age (young patients less tolerant), breed (large dogs often stoic), temperament, nature, duration, severity of the pain, and presence of humans
Generalized Evidence of Pain
- Decreased appetite
- Decreased sleep time
- Changes in posture
- Gait and activity level changes
- Reluctance to lie down and frequent positional shifts
- Decreased grooming
- Poor body condition
- Vocalization (e.g., whimpering, growling, snarling, hissing, grunting, or purring)
- Emergence delirium
- Immediate post-operative vocalization
- Changes in facial expressions, appearance, and attitude
Pain Behaviors (Canine vs Feline)
- Canine: lameness, praying position, head tilt, guarding behaviors, aggression, withdrawal, antisocial behavior, and lethargy
- Feline: hiding, social withdrawal, decreased appetite, anorexia, decreased grooming, excessive licking, reluctance to jump, missing the litter box, squinting eyes, lowered ears, aggression, and crouching in back
Pain Behaviors (Equine vs Ruminant)
- Equine: lameness, standing at the back of the stall, decreased social interaction or interest in surroundings, pain face (low ears, angled eye with intense stare, dilated nostrils and tension of the muzzle), colic (sweating, rolling, flank watching or biting, pawing, kicking, getting up and down),
- Ruminant: bruxism, hypersalivation, abnormal facial expression, decreased appetite, and rumination, decreased milk production, isolation from herd, vocalization and grunting
Signs of Pain in Anethetized Animals
- Increased heart rate, respiratory rate, blood pressure, and temperature
- Vocalization
- Inability to rest or sleep
- Trembling
- Changes in normal posture and movement like chewing or licking at painful site
Pain in Sedated/Anethetized Animals
- Possible factors to consider: the time since the last analgesic, whether the analgesia was adequate, the patient's age, co-morbidities, and surgical duration,
Pain Assessment Tools
- Simple descriptive scales
- Visual analogue scales
- Numeric rating scales
- CSU Canine Acute Pain Scale and CSU Feline Acute Pain Scale
- Categorical numerical rating scales
- Validated scales
Pain Management in Animals (Post-operative)
- Numerical rating systems with descriptions
- Reassessing the analgesic
- Animals shouldn't be evaluated if they are sleeping for a sustained time
Pain Assessment Considerations
- Pain management is needed in every stage of hospitalization: pre-anesthetic, surgical, postoperative, hospital stay, at home
- The severity and type of pain, patient's general condition, delivery route.
Consequences of Untreated Pain
- Physiologic effects: sympathetic stimulation (vasoconstriction, increased cardiac work, increased heart rate, oxygen consumption), immune system suppression, inflammation, delayed wound healing, anesthetic risk, increased anesthetic doses, patient suffering
- Stress response affects cardiovascular, respiratory, GI, renal, and hematological systems; also psychological effects like anxiety, fear, fatigue, suffering.
Non-Pharmacologic Interventions
- Differentiate between physical pain and other stress types
- Provide comfort
- Assess emotional needs
- Distraction as needed
- Reassess comfort after attending to physical & emotional needs
Analgesic Non-Pharmacological Methods
- Good nursing care
- Cleanliness
- Padding
- Bandaging
- Acupuncture
- Laser therapy
- Physical therapy
- Massage
- Cold/ice compress
- Circulating ice water in some cases
Summary of AAHA Pain Management Standards
- Pain assessment for every patient
- Use of preemptive pain management
- Assessment recorded in the medical record
- Appropriate pain management for anticipated level and duration of pain.
- Pain management for all surgical procedures
- Reassessment for pain throughout procedures
- Medical and chronic pain also treated
- Written protocols
- Teaching clients to recognize pain in their pets
Remembering Pain Management
- Each patient is unique, consider the procedure, how long it is and treat accordingly
- Opioids are easily reversible, if the effect(s) are not as per prescription the effect may be reversed,
- Easier to step back if control is lacking in a comfortable patient, in a painful patient the results might be less effective.
Monitoring Drug Effects
- Careful monitoring of cardiovascular status and mentation, in every case, to avoid detrimental side effects
- Supportive care is integral to pain management
- Monitor complications and side effects of treatment
- Eliminate pain and stress whenever possible
Dysphoria Vs Anxiety
- Dysphoria: unpleasant, uncontrolled thoughts and feelings, sometimes brought from drugs
- Anxiety: feelings of worry, nervousness, or unease
Analgesics (Examples)
- Opioids (e.g., morphine, hydromorphone, oxymorphone, fentanyl, methadone, meperidine)
- NSAIDs (e.g., variety of meds)
- Local anesthetics
- Alpha-2 adrenergic agonists (e.g., xylazine, dexmedetomidine)
- NMDA antagonists (e.g., ketamine)
- Gabapentin
Calculating CRI's
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Description
Test your knowledge on recognizing pain indicators in horses and managing pain in veterinary patients. This quiz covers pharmacological and non-pharmacological therapies, pain assessment tools, and physiological responses to pain. Ideal for veterinary students and professionals.
