Term
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Definition
| -an unpleasant sensory and EMOTIONAL experience associated with actual or potential damage, or described in terms of such damage |
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Term
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Definition
| -perception of an ordinarily non-painful stimulus as painful |
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Term
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Definition
| -absence of pain perception |
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Term
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Definition
| -absence of all sensation |
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Term
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Definition
| -upleasant or abnormal sensation iwth or without a stimulus |
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Term
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Definition
| -diminisehd response to noxious stimulus |
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Term
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Definition
| -inc response to noxious stimulaiton |
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Term
| Defintiion: Hyperesthesia |
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Definition
| -inc response to mild stimulation |
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Term
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Definition
| -presence of hyperesthesia, allodynia, and hyperalgesia usually associated with overreaction and persistence of sensation after the stimulus |
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Term
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Definition
| -reduced cutaneous senstion |
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Term
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Definition
| -pain in the distribution or group of nn |
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Term
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Definition
| -abnormal sensation perceived without apparent stimulus |
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Term
| Definition: Radiculopathy |
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Definition
| -functional abnormality of one or more nerve roots |
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Term
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Definition
-from direct tissue trauma
-most intense during initial 24 hours
-resoves in days to weeks |
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Term
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Definition
>3m duration
-can be considered a disease state |
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Term
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Definition
| -pain that exists despite normal healing time or as persistent pain caused by conditions where healing has not occurred or whicch it re-occurs |
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Term
| What are the two types of acute pain? |
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Definition
-somatic: superficial or deep
-visceral |
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Term
| What is somatic superficial pain? |
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Definition
| -nociceptio arising from skin, SQ tissues,, and mucous membranes well localized, sharp, throbbing, or burinin gsensation |
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Term
| What is deep somatic pain? |
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Definition
| -muscles, tendons, joints, or bones, dull aching quality and is less well localized |
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Term
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Definition
| -due to a disease process or abnormal function involving an itnernal organ or its covering |
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Term
| What is nociceptive pain? Is it irreversible or reversible? |
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Definition
-physiologic pain
-generally reversibe |
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Term
| The intensity of inflammatory pain relates to what two factors? |
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Definition
| -severity and duration of tissue damage |
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Term
| What are the 3 components of pain physiology? Describe them. |
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Definition
1) Sensory: temporal, spatial, thermal/mechanical
2) Affective: subjective and emotional
3) Evaluative: stabbing, pounding, mild vs severe |
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Term
| What are the 5 types of nociceptors and what do they sense? |
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Definition
1) Heat
2) Mechanical: pinch and pinprick
3) Chemical
4) Silent: respond in the presence of inflammation
5) Polymodal": respond to excessive pressure and/or heat, most prevalent, noxious timulants |
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Term
| What are the 3 primary chemical mediators of nociception? |
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Definition
-Substance P
-Calcitonin gene-related peptide
-Glutamate |
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Term
| Definition: Primarily hyperalgesia |
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Definition
| -substances released from damaged tissue |
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Term
| Definition: Secondary hyperalgesia |
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Definition
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Term
| What are some of the excitatory modulators of pain? |
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Definition
-Substance P (NK-1)
-Calcitonon gene-related peptide
-Glutamate
-Aspartate
-ATP |
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Term
| What are some of the inhibitory modulators of pain? |
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Definition
-Somatostatin
-ACh
-Enkephalins
-Beta-endorphin
-NE
-Adenosine
-Serotonin
-GABA
-Glycine |
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Term
| What is peripheral sensitization and what does it result in? |
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Definition
-inflammation starts the process and a continuous barrage of afferent flood the spinal cord
-results in non-painful stimulus being painful and nerves that were not mechano-sensitive can become mechano-sensitive |
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Term
| What is central sensitization and what does it result in? |
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Definition
-prolonged firing of Ca fibers involving a range of excitatory and inhibitory neurons = release of glutamate = NMDA and AMPA
-results in pain hypersensitivity in the CNS |
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Term
| What are the two forms of central modulation of pain? |
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Definition
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Term
| What is peripheral neuropathic pain? |
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Definition
-spontaneous discharge due to central sensitization of receptors
-/+ neural inflammation |
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Term
| How does the CV system respond to pain? |
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Definition
-hypertension
-tachycardia
-enhanced myocardia irritability
-inc SVR
-CO inc in healthy patients |
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Term
| How does the respiratory system respond to pain? |
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Definition
-inc total O2 consumption and CO2 inc pdn
-pain from abdominal or thoracic area can cause a dec in FRC
-impaired coughing and clearing of secretions |
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Term
| How do the GI and urinary tracts respond to pain? |
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Definition
-inc sphincter tone and dec in intestinal and urinary motility
-ileus promotion and urinary retention
-nausea, vomiting, and constipation are common |
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Term
| How does the Endocrine system respond to pain? |
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Definition
-inc catabolic hormones
-dec anabolic hormones
-most patients go into negative nitrogen balance
-inc in cortisol, renin, angiotensin, aldosterone, and ADH |
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Term
| What are the hematological effects of pain? |
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Definition
-inc platelet adhesiveness
-reduced fibrinolysis
-hypercoagulability |
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Term
| What are the immune effects of pain? |
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Definition
| -leukocytosis and overall dec immune function |
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Term
| What are the objective measurements of pain? |
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Definition
-HR
-RR
-pupil diameter
-BP
-acute pain scores |
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Term
| What are the 4 major one-dimensional scoring systems of pain? |
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Definition
1) Simple descriptive scale
2) Numeric rating scale (NRS)
3) Visual analog scale (VAS)
4) Dynamic and interactive visual analog scale (DIVAS) |
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Term
| What are the 2 primary multidimensional scoring systems for pain? |
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Definition
-Glasgow Composite Pain Scale
-Equine Composite Pain Scale |
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Term
| What are some of the types of drugs that we use for pain management? |
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Definition
-Alpha 2 adrenergic receptor agonists
-local anesthetics
-NMDA Rc antagonists
-NSAIDs
-opioids
-Adjunctive analgesics: corticosteroids, Gabapentin and pre-gabalin, NK-1 Rc antagonists |
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Term
| What is the analgesic site of alpha-2 agonists? |
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Definition
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Term
| What are some examples of alpha-2 agonists used for pain? |
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Definition
-Xylazine
-Detomidine
-Romifidine
-Medetomidine
-Dexmedetomidine |
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Term
| What are the sites of analgesic action of alpha-2 agonists? |
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Definition
-peripherally
-spinally
-supraspinally |
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Term
| Alpha-2 agonsits induce action via which two methods? |
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Definition
-presynaptic terminals primary afferent neurons
-direct inhibition of spinal cord neurons |
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Term
| What are the 3 subtypes of alpha-2 agonists? Describe them. |
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Definition
-Alpha 2a: act of K+ chh, analgesic is voltage dep, high proportoin in the dorsal horn
-Alpha 2b
-Alpha 2c: act of K+ chh |
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Term
| What do local anesthetics do? |
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Definition
-prevents nociceptive transmission
-revesible neuronal conduction blockade
-can produce dose dependent anti-inflammatory effects
-inh pre-inflammatory mediator
-alter all stages of leukocyte migration
-may reduce free radical formation
-dec MAC in various species |
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Term
| What are the 4 ways in which peripheral nn may vary in regards to local anesthetics? |
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Definition
1) size: inc size = need less drug
2) myelination = faster
3) distance from stimuli
4) depolarization threshold |
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Term
| What is the primary NMDA Rc antagonist? |
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Definition
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Term
| Generally describe Ketamine and how it works. |
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Definition
-somatic rather than visceral adjuntive analgesic but questionable for acute pain
-dose is much lower than used for induction
-can cause adverse side effect
-Site of action: peripherally, dorsal horn, supraspinally |
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Term
| Other than Ketamine, what are the other two NMDA Rc antagonists? |
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Definition
-Amantadine: oral for chronic pain but takes up to 2 weeks to work
-Methadone |
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Term
| What are the general characteristics of NSAIDs? |
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Definition
-long-acting
-non-controlled
-oral and injectable
-standard med after elective procedures
-dec COX enzyme conversion |
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Term
| Is COX-1 or COX-2 inhibition associated with more adverse side effects? How do we avoid this? |
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Definition
-COX-1
-try to have selective COX-2 inhibitors but no NSAID comes without COX-1 effets |
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Term
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Definition
-peripherally
-spinally
-supraspinally
-pre- and post synaptic
-certain peripheral tissues can generate opioid receptors: articular, periarticular, corneal tissue |
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Term
| What are the 3 types of opioid receptors? |
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Definition
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Term
| Are opioids lipophobic or lipophilic? How are they metabolized? |
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Definition
-highly lipophilic (IV, IM, SQ, PO)
-Phase I and Phase II rxns |
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Term
| Can tolerance develop to opioids? |
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Definition
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Term
| How does level of pain relate to the visible side effects resulting from administration of opioids? |
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Definition
| -more painful = less side effects |
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Term
| What are the overall effects of opioid administration? |
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Definition
-analgesia
-sedation and excitement
-antitussive effects
-resp depression: pigs most
-CV effects: enhances vagal tone
-nausea, emetic, and antiemetic efects (IV slow better than IM)
-pupil diameter: mydiasis in animals
-GI dec productivity but inc tone
-urinary retention and inc tone of sphincters
-thermoregulation is crazy
-reduction in MAC |
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Term
| Which receptors does Morphine effect? Describe its effects and characteristics. |
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Definition
-full Mu agonist
-for mild to severe pain while increasing dose will increase analgesia
-less lipophilic and can last for up to 24 hours |
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Term
| How does Oymorphone work? Describe it and its characteristics. |
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Definition
-full mu agonist
-more potent than morphine and causes less nausea nd vomiting
-give parenterally but very expensive |
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Term
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Definition
-more potent than morphine
-duration and effect is similar
-minimal histamine release in dogs
-SQ administration in cats cna result in slow absorption and lag time |
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Term
| Which opioid receptors does Fentanyl affect? Describe its effects. |
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Definition
-full mu agonist
-more potent than morphine
-less nausea nd vomiting
-can be given IV, IM, or SC
-short duration of action |
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Term
| Which opioid do we absolutely not use in cats? |
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Definition
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Term
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Definition
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Term
| Describe the effects of Methadone. |
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Definition
-similar potency and effects as Morphine with NMDA antagonist activity
-acts synergistically with other opioids |
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Term
| Which opioid do we always give IM? describe its effects. |
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Definition
-Meperidine
-mu agonsit with serotonergic, negative inotropic, and antimuscarinic effects
-more histamine release than morphine |
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Term
| What are some derivatives of fentanyl (an opioid)? |
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Definition
| -Sufentanil, alfentanil, and remifentanil |
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Term
| What opioids are highly potent for the restraint of wildlife animals but can be lethal to humas? |
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Definition
| -Etoprhine, carfentanil, thiafentanil |
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Term
| Give an example of a partial mu Rc agonist. Descibe its effects. |
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Definition
-Buprenorphine
-25x more potent than morphine but lower maximal efficacy
-difficult to reverse
-can provide up to 12 hrs of analgesia |
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Term
| Give an example of an opioid that is a Kappa agonist and a Mu antagonist. Describe its effects. |
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Definition
-Butorphanol
-for mild pain but good for sedation, very antitussive, antiemetic
-given for non-painful horses |
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Term
| What are the effects of Tramadol? How does it work? |
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Definition
-analgesic
-full mu opioid agonist, serotonin and NE uptake |
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Term
| What are 3 examples of opioid antagonists? |
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Definition
-Naloxone
-Naltrexone
-Methylnatrexone |
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Term
| What is used to reverse carfentanil? |
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Definition
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Term
| What do we always need to consider while administering opioid antagonists? |
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Definition
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Term
| What are some examples of non-pharmacologic pain modifiers? |
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Definition
-temp related
-tissue deformation
-modulation of metabolism and blood flow
-muscle spasms and myofascial trigger points
-immune modulation |
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