Pain Management & Inflammation
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Unpleasant sensory or emotional experience associated w/ a protective motor action & learned avoidance
What are important factors that the technician must learn in relation to pain?
- Recognizing procedures which will stimulate pain
- Use of techniques which minimize pain
- Monitor behavior & physiological parameters that indicate pain
- Bringing animal's pain to the attention of the doctor
Pain can increase ______, ______ and _____
Stress; HR; BP
An increase in stress is known to cause what effects on the body?
- Increased cortisol levels which can decrease wound healing & supress the immune system
- Increase metabolic rates
Special nerve cells which detect noxious stimuli are called?
What are examples of noxious stimuli that nociceptors detect?
- Mechanical injury
- Chemicals released by inflammation or tissue damage, such as leukotrienes, histamines, and prostaglandins
What are the steps of pain? Briefly describe them.
- Transduction: stimulus transformed to electric signals in nerves
- Transmission: signal moves alon peripheral nerves to spinal cord
- Modulation: nerve impulse is amplified or suppressed
- Perception: impulses go to brain to recognize pain
What is it called when pain is intercepted at multiple pathways?
What are the 2 types of sensory neurons?
A delta fibers & C fibers
The sensory neuron that is also referred to as "first pain" and localizes pain to an exact site.
A delta fibers
What type of pain signals are transmitted by A delta fibers?
Sharp, descrete pain
What type of pain signals are transmitted by C fibers?
Dull, aching or throbbing sensations
A delta fibers have long __________ neurons, while C fibers have short _________ neurons.
What are the 2 types of pain?
- Somatic pain
- Visceral pain
Somatic pain is transmitted by what sensory neuron(s)? Visceral pain? What type of pain is associated with each?
- A delta & C fibers; stabbing, throbbing, or aching
- C fibers; cramping, burning
What is the wind-up phenomenon?
A secondary reaction to chronic or intense pain where nerve response to painful stimulation is increased, resulting in non-responsive or chronic pain
When nerve fibers require less stimulation to initiate pain, this is called?
When nerve fibers that do not typically carry pain sensation are recruited, it is called?
Why is pre-emptive pain control so important?
Prevention of wind-up
What are the 4 levels of pain? Name examples of procedures or complications in each level.
- Mild: lacerations, dental w/ no extractions, insect sting
- Moderate: OHE, castration, dental w/ extractions, laparotomy, cystotomy, gastrotomy, mass removal
- Severe: fracture repair, joint sx, mammary gland sx, enucleation, ear sx
- Excruciating: neuropathic pain, multiple fractures, bone cancer
Oseosarcoma is common in the long bones of what dogs?
Lg & giant breeds
When a mass is removed from an animal, it is usually sent in for a histopathology to detect what?
Chronic cases of otitis externa may require what procedure?
Total ear canal ablation
What is acute pain?
Sudden onset of pain that can commonly be treated with analgesics
What is chronic pain?
Long standing pain that may be unresponsive to drug therapy
What is referred pain?
Pain that is felt in a part of the body other than the effected area, such as in IVDD
An increase in sensitivity to stimuli like sound or touch is called?
This classification of pain is poorly responsive to pain meds and is due to the damage of a peripheral nerve or the spinal cord.
What is the position commonly seen in animals with abd pain?
Amounts of analgesia needed to make a patient comfortable varies between what?
- Level of consciousness
Patients should closely be monitored for signs of pain for how long post-op?
1st 24 hrs
What can make it difficult to assess a patients level of pain?
- Unknowing of normal behavior
- Subtle changes in behavior
- Sedation modifies behavior
What are common signs of pain?
- Gaurding or self mutilization
- Attitude changes
- Appetite decrease
- Crying, hiding, aggression w/ palpation
- Physiologic signs
True or False: poor and positive responses to pain should be reported to the veterinarian.
How often should patients be monitored for pain?
Anywhere from every 30 min to every 6 hrs depending on the procedure
What is dysphoria?
Abnormal vocalization or behavior typically due to opioids or anesthesia
What is emergence delirium?
Abnormal behaviors during anesthetic recovery
How can a VT help alleviate discomfort?
- Decrease fear and anxiety
- Keep patient clean & dry
- Provide many opportunities to urinate and defecate
- Comfortable bedding and quiet surroundings
- Turn animals unable to move itself every 2 - 4 hours
- Cool bath to soothe skin conditions
- Soothing salves for burns upon vet orders
What are routes of administration for opioids?
What are Fentanyl patches used for in the cat and dog?
- Post-op pain control
- Chronic, severe pain due to cancer
Alternate analgesia should be used during use of Fentanyl patches for how long in the cat and dog?
- 6 - 12 hours in cats
- 12 - 24 hours in dogs
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