SAOP2- Pain Mgmt

  1. Describe the basic aspects of the pain pathway.
    • Transduction- conversion of noxious stimuli into electrical signal via nociceptors (thermal, mechanical, chemical)
    • Transmission- A-delta fibers (fast, localized pain), A-beta fibers (poorly reactive, light touch), C fibers (poorly localized, dull, delayed pain)
    • Modulation- signal travels up spinal cord dorsal horn, incoming signals are summated and altered
    • Projection- signal travels to brainstem
    • Perception- integration, processing of pain, behavioral or motor responses
  2. What pain management tools alter perception? (7)
    • opioids
    • tramadol
    • alpha-2 agonists
    • ketamine
    • tricyclic antidepressants
    • NSAIDs
    • benzos
  3. What pain management tools alter modulation of pain? (5)
    • opioids
    • alpha-2 agonists
    • local anesthetics
    • ketamine
    • NSAIDs
  4. What pain management tools prevent transmission of pain signals? (1)
    local anesthetics
  5. What pain management tools prevent transduction from local nociceptors? (3)
    • NSAIDs
    • local anesthetics
    • opioids
  6. Describe A-delta, A-beta, and C fibers.
    • A-delta: low threshold (pressure, vibration), mechanoreceptors, fast, myelinated
    • A-beta: high and low threshold (pressure, pain), mechanoreceptors and nociceptors, fast, myelinated
    • C: high threshold mechanoreceptors, thermoreceptors, nociceptors, slow, unmyelinated
  7. Describe peripheral nerve terminal sensitization.
    inflammatory soup converts high threshold receptors to low threshold receptors (more sensitive), activated silent ("sleeping") receptors--> more input to nociceptors
  8. What is central sensitization?
    • persistent nociceptive input after peripheral sensitization causes signal recruitment and amplification locally and at the level of the spinal cord
    • repetitive firing of excitatory neurons
    • minor, non-painful stimuli result in excessive pain sensation
  9. Describe pre-emptive analgesia.
    goal is to prevent amplification (sensitization) from occurring, resulting in decrease post-op pain and decreased anesthetic requirements (reduced MAC)
  10. Describe multi-modal analgesia.
    aim to impact the amplification response in as many places as possible to decrease pain
  11. __(2)__ are more sensitive physiologic indicators of pain than __(2)__.
    • resp rate and character; HR or BP 
    • [still, better to use behavioral indicators than physiologic]
  12. Describe emergence delirium and how it is differentiated from pain?
    • emergence delirium- dissociative behavior on emergence from anesthesia; looked similar to pain in vocalization, thrashing, altered mentation
    • Begin with analgesia (err on the side of pain); if it doesn't resolve with analgesia, titrate opioid antagonist; if still bad, consider sedation
Card Set
SAOP2- Pain Mgmt
vetmed SAOP2