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Acute pain assessment and treatment (Proceedings)

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Aug 01, 2011

Benefits of pain management in the acute situation

      1. It is the type of care we would want for ourselves. Why wouldn't we want to give it to our own patients?
      2. Avoidance of wind-up pain and central sensitization
           a. Hyperalgesia
           b. Allodynia
      3. Earlier return to function
      4. Affects morbidity and mortality
      5. Low cost/high return

Strategies

      1. It is better to anticipate pain than to chase after it.
      2. Frequent evaluations so that over-treatment is avoided

Assessment of acute pain

      1. Don't confuse acute pain with chronic pain. Must be assessed in different ways
      2. When using a pain scale, be aware of the limitations of that scale
     3. Most scales are developed with acute surgical pain in mind. To use them for non-surgical diseases probably is not appropriate
     4. You need to know your patient
          a. Especially important when there are shift changes in evaluators. Hiding cat with back to cage door could be pain, or maybe it was doing that when it came in

Use of pain scale

      1. Intervals of use should be determined by anticipated pain, i.e. OHE v. Lumpectomy v. Fracture repair, the health and age of the animal and the expected duration and onset of the analgesic drug
           a. Hourly is appropriate for the first 4 hours post-surgery
           b. Start immediately upon recovery from anesthesia
           c. Don't wake up sleeping animals to assess pain
           d. Continuous distant observations with periodic interactive observations are best
      2. Characteristics of the "perfect" pain scale
           a. Objectivity
           b. Repeatability
           c. Validity
           d. Dogs scale for dogs, cat scale for cats
           e. Allowances given for differences in demeanor