PAIN MEDICATIONS
What is pain? The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (IASP, 2023). Classification of pain A. Anatomic origin (Stellfox et al., n.d.) ● Physiologic pain: The type of pain that animals experience on a regular basis. This type of pain requires noxious (high-threshold) input, is discrete (well-localized) and transient, and serves a protective function. This type of pain is a protective mechanism used by the body to "teach" itself to withdraw from a specific noxious stimulus (painful event) causing the tissue damage. ● Peripheral pain can be visceral (thoracic or abdominal) or somatic (localized and felt in the skin, muscles, joints, or periosteum). ● Neuropathic pain results when the peripheral nerves or spinal cord are damaged or sensitized. ● Idiopathic pain is more commonly associated with emotional tension and behavioral issues. It is not specifically associated with a specific origin and is not a response to a painful event. B. Temporal ● Acute ● Chronic C. Mechanistically ● Inflammatory: associated with tissue trauma and inflammation ● Neuropathic: associated with nerve injury Not only is it an ethical obligation to alleviate suffering, but it also promotes patient recovery and cultivates a more positive relationship between veterinarians and owners. Keys to providing excellent pain management in small animal practice: ● Recognize and understand the clinical indicators of pain, and bear in mind that pain has negative impacts on the body, which involve behavioral, physiological, and clinical responses (IASP, 2023). ● Make pain assessment a routine part of evaluating each patient's vital signs. The patient's pain level should be checked on a regular basis and documented in the medical record. ● Learn about the anatomy and physiology of the pain pathway, including how pain signals are generated and transmitted throughout the body. Be able to apply this knowledge to find effective strategies to relieve pain. ● Preventive and multimodal pain control should be practiced. Learn about the pharmacology of the most popular drugs, which drugs work well together, and contraindications of drug classes. Also, understand Principles of pain management: a multi-modal approach Multimodal pain management refers to the utilization of various medications with distinct mechanisms of action, sometimes from multiple classes, along with different administration techniques to achieve pain relief across many body systems. In an ideally designed protocol, each medication targets distinct pain receptors along the pathway or within the brain, employing substantially different mechanisms to ensure maximal pain reduction at each stage.
the different stages in the pain pathway and how medications interact with the body's systems to suppress or eliminate pain signals and perception, which occur only in the brain, at each stage (Stellfox et al., n.d.). Table 2: Signs of Pain in Small Animals Posture Behavior Laboratory Results* • Cowering • Shaking • Trembling • Vocalization • Lameness • Aggression • Excessive salivation • Restlessness • Lethargy • Hiding • Licking, biting, • Elevated cortisol levels that may result in leukocytosis • Neutrophilia • Polycythemia • Hyperglycemia • Elevated catecholamine levels
chewing of an injured part of the body
*These results are not automatically unique to an animal in pain and can also be observed in animals under stress.
• Tachycardia • Increased body temperature • Increased or shallow respiration • Lack of appetite • Changes in blood pressure • Heat or warmth at the affected site
Negative physiologic, metabolic, and immunologic effects of pain: ● Ventilation-perfusion abnormalities
● Increased metabolic demand ● Increased tissue catabolism ● Impaired immune function ● Increased risk of sepsis ● Poor or delayed wound healing ● Cardiovascular stress ● Decreased gastrointestinal motility
● Imbalance in body fluids ● Prolonged hospitalization ● Increased mortality
The prompt recognition and treatment of acute pain can influence many physiological factors: acute neurohormonal changes, production of inflammatory cytokines, reduction of systemic stress, improving hemodynamic stability, prevention of postoperative complications, and prevention of chronic pain syndromes (Stellfox et al., n.d.). Benefits: ● Enhance patient comfort and also prevent the negative effects of untreated pain. ● Preoperative and intraoperative analgesics reduce the severity of postoperative pain, resulting in a lower requirement for postoperative pain medication.
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