Making our pets comfortable. A modern approach to pain and analgesia.

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1 Making our pets comfortable. A modern approach to pain and analgesia.

2 What is pain? Pain is an unpleasant sensory and emotional experience with awareness by an animal to damage or potential damage to its body resulting in a change in its physiology and behavior directed to reduce the damage and promote recovery.

3 A Nerve Cell

4 Nerve Endings

5 The Brain and Spinal Cord

6 How are animals different to humans? Likely to have the same experience Response to stimulus might be different

7 Types of pain Somatic - skin bone muscle etc. Visceral internal organs can be referred Neuropathic nervous tissue Acute - immediate Chronic 3-4 weeks

8 Other definitions Hyperalgesia prolonged and exaggerated response to a noxious stimulus Allodynia pain response to a normally innocuous stimulus. Peripheral and Central sensitisation

9 Pain in the dog How do we recognise the signs? Hunched or praying posture. Stiff locomotion Non weight-bearing Barking, growling or whining, Abnormal ear and eye positions. Attention to areas Guarding of areas Aggression Inappetence Weak tail wag Old age / Other illness? Treatment trial?

10 Pain in the cat How do we recognise the signs? Furrowed brow and ears held back Depression Not grooming Hunched immobile stance Hyperventilation Hiding away Dilated pupils Reslessness

11 Pain in the cat 90% of cats over 12 have osteoarthritis only 6% will have treatment possible 470,000 cats in pain. 4 key points for chronic pain Long claws Behaviour changes Dull Matted Coat Decreased activity

12 Pain in the rabbit Prey animals Signs of pain are very subtle The same as anxiety and other illness Become very still and stop blinking Loss of interest in surroundings Loss of appetite Tooth grinding Soiled bottom and poor grooming

13 What can we do? Holistic approach Multi-modal therapy Weight control Diet - j/d mobility control Exercise Physiotherapy/Hydrotherapy Soft bedding Drugs Nutraceuticals Acupuncture K-laser Surgery

14 Opioids Morphine, Pethidine, Methadone, Fentanyl, Buprenorphine, Butrophanol Work on cell receptors in brain and spinal cord Great for acute pain and where other analgesics can t be used esp. surgical use Can be abused Side effects

15 Anti-inflammatories Steroids (control severe inflammation) Non-steroids NSAID s (control inflammation and pain) Prostaglandins (inflammatory mediators) From damaged tissue under the control of cyclooxygenase enzymes

16 Anti-inflammatories COX1 housekeeping COX2 inflammation & pain Work through inhibition of COX Side effects COX2 selective are safer? Commonly used multiple applications

17 Local Anaesthetics Lignocaine, Bupivacaine, Act in the periphery Mostly given by injection or topical application Blocks signals traveling along the cell body (nerve) Different speed and duration of action Mostly used at around time of surgery

18 K-laser how it works In the blood capillaries, red blood cells pass through in single file. Laser therapy helps to increase blood flow. Red blood cells carry molecules of oxygen to the tissues (represented here by the tiny white spheres).

19 K-laser how it works Laser therapy also helps the red blood cells deliver the oxygen molecules directly to the affected tissues Finally, laser therapy stimulates an enzyme in the mitochondria of the cells. This processes the oxygen more quickly, and more energy (ATP) is produced in the cell.

20 K-laser faster healing increased circulation reduced swelling decreased pain

21 Osteoarthritis - Stiffness or something more?

22 Increasing awareness of dental pain Very Common Under perceived Animals in pain will eat!

23 Helping to beat Cancer Inflammatory and Neuropathic pain Surgery? Concurrent illness and meds

24 Minimising Surgical Pain Pre-empting pain to avoid sensitisation Assessing and adjusting doses and using multiple analgesics Minimal invasive techniques and good surgical technique Soft bedding Keeping warm Fluids Nursing and communication

25 In Summary Be aware of pain behaviours Species differences Treat if in doubt Treat to prevent wind-up Multi-modal therapies

26 Any questions?

27

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