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pain and analgesia
WK 11
| Question | Answer |
|---|---|
| What is pain | Pain is an unpleasant experience that may or may not cause tissue damage The ability to feel pain is shared by ALL mammals BUT How we experience pain is subjective and individualised |
| Physiology Nociception is the stimulation of nociceptors by noxious stimuli Nociceptors can be found both externally and internally, for example; | Cutaneous Mucosal Corneal Joints Muscles Bladder Gut Digestive tract |
| the nociceptive pathway begins with stimulus of the receptor Nociceptors detect - | - Temperature extremes (thermal) - Pressure (mechanical) - Chemical alterations (chemical) - Nothing, unless something painful has happened to surrounding tissue (sleeping/silent) |
| The pain pathway consists of 4 events | - Transduction - transmission - Modulation - Perception |
| physiology: Transduction Nociceptors detect sensory input when tissues damaged - | pain threshold has been reached convert the chemical/mechanical/thermal energy at the site into electrical activity cells depolarise & spread the action potential this impuse movement termed transmission |
| physiology: Transmission nerve endings vary in sensitivity transmission to the spinal cord is rapid, but speed varies vetween the various .. | axon types based on their conduction velocity, there are three groupings of primary afferent neurons; Aβ, Aδ and C fibres |
| Aβ = | a beta or AB |
| Aδ = | a delta or AD |
| Transmission – Nerve Fibre Types | Aβ fibres: Large diameter; very rapid (>10 m/s); spatial awareness & pleasant touch; no pain link Aδ fibres: Medium diameter; 2–10 m/s; sharp, pricking pain; acute C fibres: Small diameter; <1.5 m/s; burning, aching pain; chronic |
| physiology: Modulation | involves changing, inhibiting & amplifying transmission impulses within the spinal cord Nociceptors bring the info into the dorsal horn of the spinal cord (action potential) neurotransmitors allow for onward transmission of the impulse |
| types of pain | Somatic: aching, sharp; tender, positional; treat with repair, NSAIDs, opioids Visceral: crampy, deep; signs; treat with repair, blocks, opioids, TCAs, anticonvulsants Neuropathic: burning, allodynia; treat with anticonvulsants, antidepressants |
| Acute vs chronic pain the initial pain felt is knows as | Acute pain caused by surgery or trauma nociception is designed to stimulate healing and limit further damage continued stimulation of these pathways leads to chronic pain and central sensitisation |
| Pain that continues past 3 -6 months is termed chronic OR Pain that extends beyond the normal healing time for a given disease process Need to recognise and | treat acute pain to reduce the likelihood of chronic pain developing |
| Acute pain Assessment: Feline simple Descriptive scales = | Colarado State Uni Scale Feline Grimace Scale |
| Acute pain Assessment: Feline Multidimensional scores = | Glasgow - Validated for use with a variety of pain Botucatu - Validated for use post-op and when operated by anaesthesia technicians |
| Chronic Pain Assessment: Feline | Feline Musculoskeletal Pain Index (FMPI) Developed for chronic pain and OA Validated May find QOL scoring more useful instead. |
| Chronic Pain Assessment: Feline | Karnofsky Scoring is used in Oncology patients – this is NOT a pain score but allows you to assess the patient holistically OA scoring tools Zoetis |
| Acute Pain Assessment: canine | Simple Descriptive Scales - Colorado State University Multidimensional Scores - Glasgow Composite Measure Pain Scale – Short Form (CMPS-SF) |
| Chronic Pain Assessment: Canine | Canine Brief Pain Inventory (CBPI) Helsinki Chronic Pain index LOAD COAST 5 H 2 M’s Tool Villalobos QOL scoring tool |
Created by:
lucy.fox