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Define pain.
Unpleasant sensory or emotional experience associated w/ a protective motor action & learned avoidance
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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
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Pain can increase ______, ______ and _____
Stress; HR; BP
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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
- Anorexia
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Special nerve cells which detect noxious stimuli are called?
Nociceptors
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What are examples of noxious stimuli that nociceptors detect?
- Distension/stretching
- Mechanical injury
- Chemicals released by inflammation or tissue damage, such as leukotrienes, histamines, and prostaglandins
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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
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What is it called when pain is intercepted at multiple pathways?
Multimodal therapy
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What are the 2 types of sensory neurons?
A delta fibers & C fibers
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The sensory neuron that is also referred to as "first pain" and localizes pain to an exact site.
A delta fibers
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What type of pain signals are transmitted by A delta fibers?
Sharp, descrete pain
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What type of pain signals are transmitted by C fibers?
Dull, aching or throbbing sensations
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A delta fibers have long __________ neurons, while C fibers have short _________ neurons.
Myelinated; unmyelinated
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What are the 2 types of pain?
- Somatic pain
- Visceral pain
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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
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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
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When nerve fibers require less stimulation to initiate pain, this is called?
Hyperalgesia
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When nerve fibers that do not typically carry pain sensation are recruited, it is called?
Allodynia
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Why is pre-emptive pain control so important?
Prevention of wind-up
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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
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Oseosarcoma is common in the long bones of what dogs?
Lg & giant breeds
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When a mass is removed from an animal, it is usually sent in for a histopathology to detect what?
Clean margins
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Chronic cases of otitis externa may require what procedure?
Total ear canal ablation
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What is acute pain?
Sudden onset of pain that can commonly be treated with analgesics
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What is chronic pain?
Long standing pain that may be unresponsive to drug therapy
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What is referred pain?
Pain that is felt in a part of the body other than the effected area, such as in IVDD
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An increase in sensitivity to stimuli like sound or touch is called?
Hyperesthesia
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This classification of pain is poorly responsive to pain meds and is due to the damage of a peripheral nerve or the spinal cord.
Neuropathic pain
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What is the position commonly seen in animals with abd pain?
Prayer position
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Amounts of analgesia needed to make a patient comfortable varies between what?
- Species
- Age
- Breed
- Level of consciousness
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Patients should closely be monitored for signs of pain for how long post-op?
1st 24 hrs
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What can make it difficult to assess a patients level of pain?
- Unknowing of normal behavior
- Subtle changes in behavior
- Sedation modifies behavior
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What are common signs of pain?
- Vocalization
- Gaurding or self mutilization
- Attitude changes
- Appetite decrease
- Crying, hiding, aggression w/ palpation
- Physiologic signs
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True or False: poor and positive responses to pain should be reported to the veterinarian.
True
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How often should patients be monitored for pain?
Anywhere from every 30 min to every 6 hrs depending on the procedure
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What is dysphoria?
Abnormal vocalization or behavior typically due to opioids or anesthesia
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What is emergence delirium?
Abnormal behaviors during anesthetic recovery
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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
- TLC
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What are routes of administration for opioids?
- IV/SQ/IM
- Intra-articular
- Epidural
- Transdermal
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What are Fentanyl patches used for in the cat and dog?
- Post-op pain control
- Chronic, severe pain due to cancer
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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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