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Define pain.
an unpleasant sensory and emotional experience associated with actual or potential tissue damage
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What are the two different results of pain?
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What are some benefits for an animal experiencing pain?
- limit exposure to situations that damage tissue
- learn to avoid the situation in the future
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What is pathologic pain? Is pathologic pain detrimental or beneficial?
- pain that is produced by tissue injury, inflammation, or direct damage to the nervous system
- detrimental
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Is unrelieved pain a stressor? What does it do to the body?
- yes
- triggers sympathetic nervous system, including the release of cortisol
- slows recovery and healing
- produces a catabolic state (tissue breakdown)
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What does detrimental pain trigger?
exaggerated inflammatory response
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Does detrimental pain increase blood pressure?
yes
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Do anesthetized animals experience conscious pain?
no
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Even though anesthetized animals do not experience conscious pain, what still happens?
their nociceptors (pain receptors) are stimulated by surgery
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What will happen if a patient does not receive pain medication before surgery?
they will be in more pain when they recover
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Do nociceptors fatigue with continued stimulation like owther sensory receptors do?
no
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What happens to a nociceptor that is continuously stimulated? What does this result in?
- it transmit a nerve impulse every time
- develops increased sensitivity by lowering the pain detection threshold
- this results in heightened pain sensation (hyperalgesia) and can lead to long term pain and debilitation
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What is acute pain? How long does it last?
- relatively short pain
- lats minutes, hours, days, sometimes weeks but goes away as tissue heals
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Does acute pain happen suddenly?
yes and is localized to the affected site
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Does acute pain usually have an identifiable cause?
yes
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What can acute pain be associated with?
soft tissue trauma or inflammation assoicated with surgery, injury, or disease
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Is acute pain a warning sign?
yes
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What is chronic pain?
pain that persists beyond the time required for healing after tissue trauma or is associated with chronic or degenerative disease
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Is chronic pain have a sudden onset or a more gradual onset?
gradual onset
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Can chronic pain be continuous or sporadic?
both
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What are some common causes of chronic pain?
- cancer
- osteoarthritis
- otitis
- degenerative disk disease
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Is chronic pain debilitating?
yes, provides no survival advantages
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What is "wind up"?
when spinal neurons are subjected to repeated or high-intensity nociceptive impulses they become more and more excitable and take less to "set them off"
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What is "central sensitization"?
these neurons remain excitable even after the painful stimuli stop
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Because of wind up, untreated acute pain can lead to _____.
chronic pain
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Which is harder to treat, chronic pain or acute pain?
chronic pain
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Is pain easy to assess in an animal patient?
- no, they can not talk and tell us how bad it hurts
- the owner will usually be the best judge of the level of pain the animal is in
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How do we do an assessment of pain on a patient?
- do a good PE
- be familiar with the behavior of the species, breed, and individual
- know the degree of pain to expect with particular surgical procedures and illnesses
- recognize the behavior and physiological signs of pain
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Do some animals hide pain? Why or why not?
yes, survival mechanism or may not act painful around to people because they want to please them
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What are some examples of procedures/conditions that we can anticipate being severe pain?
- cervical disc herniation
- extensive inflammation
- fracture repair
- limb amputation
- declawing
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What are some examples of procedures/conditions that we can anticipate being moderately to mildly painful?
- cruciate repair
- laparotomy (including spays)
- mass removal
- castration
- dental procedures
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Do we need "proof of pain" before we start treating pain?
no anticipate the level of pain the procedure may cause and treat the animal before it becomes painful
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What are some patient behaviors that indicate pain?
absence of normal behavior
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What is the most dependable gauge of an animals pain?
the animal's response to analgesic therapy
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What are some ways dogs and cats express pain?
- vocalization
- facial expression
- self- awareness
- activity
- attitude
- appetite
- housetraining
- grooming
- response to palpation
- withdrawing, scratching, escaping
- posture
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What are some ways a dog vocalizes when they are in pain?
- growling
- whining
- whimpering
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What are some facial expression a dog gives that expresses pain?
- fixed stare
- glazed appearance
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What does a dog do that is considered "self-awareness" when they are experiencing pain?
- protecting wound or limb
- licking, chewing or rubbing wounds, surgical site or painful area
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What is the dogs activity like when they are painful?
- restlessness
- restricted movement
- trembling
- shivering
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What is the dogs attitude like when they are painful?
- increased aggression
- fearful
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What is a dogs appetite like when they are painful?
reduced
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What happens to a dog's housetraining when they are painful?
- increased urination
- decreased frequency of urination
- failed housetraining
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What is a dog's posture like when they are painful?
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What are some ways a cat vocalizes when they are in pain?
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What are some facial expression a cat gives when they are in pain?
- furrowed brow
- squinting eyes
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What does a cat do that is considered "self-awareness" when they are experiencing pain?
- protecting wound or limb
- licking, chewing, or rubbing wounds, surgical site, or painful area
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What is the activity level like for a cat who is in pain?
- restricted movement
- repeated meaningless movements
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What is the attitude of a cat like when they are in pain?
- comfort-seeking
- hiding
- aggression
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What is the appetite like for a cat who is in pain?
reduced
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What happens to housetraining for a cat who is in pain?
failure to use the litterbox or go outside
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What is grooming like for a cat who is in pain?
- failure to groom
- unkempt appearance
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What is the posture like for a cat who is in pain?
- hunched
- lying on chest or abdomen
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What are the physiologic signs of pain?
- sympathetic stimulation
- clinical signs
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What is sympathetic stimulation?
pain, especially acute pain, activates the symathetic nervous system - fight or flight physiologic responses
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What are some clinical signs of pain?
- increased heart rate and blood pressure
- peripheral vasoconstriction (blanched mucous membranes)
- increased respiratory rates
- muscle splinting
- stress leukogram
- dilated pupils, anxiety, fear
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What should be our pain management plan?
- start pain meds as soon as possible
- use more than one class of analgesics
- provide adequate analgesia
- evaluate patient's response to analgesic treatment
- provide analgesia for the expected duration of pain
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When is acute pain (due to surgery, trauma, and disease) the most intense?
during the first 24 - 72 hours following tissue injury
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