Trends Extra Quiz: What do you know about pain?
What do you know about animal pain?
One of the most important things veterinary staff can do is to help animals in pain.
Technicians and assistants can help the veterinarian assess and alleviate pain in an animal that is suffering. They can also teach pet owners how to recognize when their pet has pain, so owners can manage the pain at home.
Recognizing and managing pain enhances the patient’s quality of life, improves the human–animal bond, and benefits the practice and its team.
Are you up to date in your understanding of pain management? Take the following quiz to find out!
1. Pain after surgery or injury is an evolutionary device that is beneficial to animals because it limits their movement and prevents more injury and pain.
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It is not helpful to keep an animal in pain, just so it will stay quiet and still!
Veterinary science used to think that pain was useful because it limited an animal’s movement, which prevented additional injury. Modern research, however, has established that animals feel pain along neural pathways that are similar to the way people feel pain, and pain can actually delay healing.
Today, there is a better understanding about how pain develops, how animals feel pain and what should be done to alleviate pain in animals.
Therefore, preventing and alleviating a patient’s pain is considered a fundamental tenant for providing quality and compassionate care for animals.
2. What is considered the fourth vital sign?
Pain should be thought of as the fourth vital sign, and it should be assessed by the veterinary team whenever veterinarians and veterinary technicians or assistants evaluate and check on a patient.
Veterinary staff should not only recognize, assess and treat pain, but should also recognize the potential for a procedure or disease to cause pain and take steps to prevent that pain from occurring or lessen its impact, whenever possible.
Answers B, C and D are the three traditional vital signs.
3. What is the most common sign of pain in an animal?
Changes in behavior are the most common sign that an animal is experiencing pain.
However, it can be difficult to tell if an animal is in pain. Animals are quite adept at hiding it because, in the wild, giving in to pain is a sign of weakness that can turn an animal into prey.
Moreover, animals often show pain in subtle ways. That said, almost all of the observable signals have to do with changes in the animal’s normal behavior—animals in pain might sleep more, eat less, be less social with people and other pets, or groom less. A cat in pain might purr a little more.
A is incorrect because animals in pain rarely become friendlier.
Although animals experiencing dermatological pain might lick themselves more, C is not as precise an answer as B.
4. Who benefits when a practice incorporates pain management into the veterinary practice?
4. B and C
It’s easy to see how pain management helps the patient. Animals that are not in pain tend to recover faster and experience an improved quality of life.
The client benefits, too. The human–animal bond is enhanced when the client knows that the pet is not suffering.
And proper pain management benefits the veterinary staff. On a practical level, it is safer to handle an animal that is not in pain. But that’s not all.
A is incomplete and misleading. While pharmaceutical companies do make a profit when they sell a medication, the biggest winners in pain management are patients, clients and staff.
5. What is the difference between adaptive and maladaptive pain?
A. Adaptive pain is acute pain, and maladaptive pain is chronic.
B. Adaptive pain is a normal response to tissue damage or noxious stimulus, and maladaptive pain is unhelpful pain that tends to be out of proportion to the actual tissue damage.
C. Adaptive pain occurs after a surgical intervention, and maladaptive pain occurs after an accident.
D. All of the above.
Adaptive pain is a normal response to tissue damage; maladaptive pain is unhelpful pain that tends to be out of proportion to the actual tissue damage.
Modern characterizations of pain use the terms adaptive and maladaptive.
Acute and chronic denote the how long the animal is in pain; these terms do not provide useful information about how much pain the animal is experiencing.
6. What is wind-up pain?
A. Heightened sensitivity that results in altered pain thresholds, both peripherally and centrally
B. Painful stimulation that results from the administration of a procedure, such as a blood draw
C. Pain initiated or caused by a primary lesion in the peripheral nervous system
D. Pain caused by a stimulus that does not normally cause pain
Wind-up pain is a heightened sensitivity to pain, which results in altered pain thresholds, both peripherally and centrally. In other words, the pain gets worse and is no longer proportional to the injury.
Wind-up pain occurs because nerves transmitting painful signals to the brain increase the intensity of painful signals above what is needed to get the animal’s attention.
The nerves become "trained" to deliver painful signals, instead of delivering signals that tell the brain the pain has stopped or lessened.
The brain’s threshold to pain is lowered, so the animal’s pain feels worse and out of proportion to the injury or illness, even if the injury or illness is not worse.
B is an example of adaptive pain, C is the definition of neuropathic pain and D is the definition of allodynia.
7. The use of pharmacological interventions for pain should:
A. Always include ketamine
B. Always include low doses to prevent side effects
C. Be based on a physical examination, history, co-existing conditions, presenting complaint and laboratory results
D. Be based on pulse, respiration and temperature
A is incorrect because ketamine could be included for pain, but it is not needed for every condition and is not appropriate for every animal.
8. Name a nonpharmacological intervention for pain relief:
A. Ketamine, amantadine, alpha-2 agonists, opiods, local anesthetics
B. Basic lifestyle changes, complementary and alternative medicine, nutrition, nutraceuticals, rehabilitation therapy
C. Providing lifelong dental care
D. There are no nonpharmacological interventions that help relieve pain
Many nonpharmacological interventions can be used to reduce pain’s hold on a patient.
A is not the answer because it lists pharmaceutical interventions for pain relief.
Although providing lifelong dental care can prevent painful conditions and diseases of the mouth, C is not as inclusive an answer as B.
9. What body system mediates the body’s stress responses to pain?
The endocrine system mediates the pain-induced stress responses to pain.
The endocrine system releases chemicals like cortisol, catecholamines and inflammatory mediators that cause tachycardia or vasoconstriction, and decrease the motility of the gastrointestinal tract.
These stress responses are one of the negative aspects of pain.
Neither A nor B is the correct answer because the cardiovascular and respiratory systems do not mediate the body’s stress responses—they are affected by the body’s stress responses.
The integumentary system, which includes the skin, can feel pain, but this system does not mediate the body’s stress responses.
10. What is dysphoria?
A. A state of anxiety or restlessness, often accompanied by vocalization
B. Acute anxiety or pain felt by an animal
C. Pain caused by a stimulus that does not normally result in pain
D. All of the above
Dysphoria is a state of anxiety or restlessness, often accompanied by vocalization.
Pain and dysphoria can occur simultaneously, which makes it a challenge to differentiate dysphoria from pain.
Animals experiencing pain usually are helped by opiods, and can be distracted or calmed by interaction or handling.
Dysphoric animals are not typically helped by opiods, nor are they distracted or calmed by interaction or handling.
B is the definition of distress. C is the definition of allodynia.