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The Physiology of Pain Kristen Cooley BA, CVT, VTS (Anesthesia) Globe University Madison, WI
What is Pain? <ul><li>sensory  and  emotional </li></ul><ul><li>actual   or  potential   </li></ul>
What is Pain? <ul><li>Often over looked  </li></ul><ul><li>In 2000 JCAHO </li></ul><ul><ul><li>mandated pain be 5 th  vita...
Noxious stimulus <ul><li>Pain causing  </li></ul><ul><ul><li>Intensity </li></ul></ul><ul><ul><ul><li>Chemical </li></ul><...
Nociceptor <ul><li>Pain detecting  </li></ul><ul><ul><li>Found throughout the body </li></ul></ul>
Nociception <ul><li>The  activity  by a noxious stimulus </li></ul>
Definitions <ul><li>Allodynia </li></ul><ul><ul><li>Not typically painful </li></ul></ul><ul><li>Hyperalgesia </li></ul><u...
Types of pain <ul><li>Peripheral pain </li></ul><ul><ul><li>Visceral  </li></ul></ul><ul><ul><ul><li>Abdominal or thoracic...
Types of pain <ul><li>Neuropathic pain </li></ul><ul><ul><li>Damage to peripheral nerves or spinal cord </li></ul></ul><ul...
Factors affecting pain <ul><li>Stress </li></ul><ul><ul><li>Exacerbates pain </li></ul></ul><ul><ul><ul><li>Environmental ...
Factors affecting pain <ul><li>Wind-up </li></ul><ul><ul><li>Sensitize to subsequent stimuli </li></ul></ul><ul><ul><li>Gl...
Types of Pain <ul><li>Acute </li></ul><ul><li>Injury </li></ul><ul><li>Surgery </li></ul><ul><li>Inflammation  </li></ul><...
Types of Pain <ul><li>Adaptive </li></ul><ul><li>Normal response </li></ul><ul><ul><li>Tissue damage </li></ul></ul><ul><l...
The Pain Pathway <ul><li>Transduction </li></ul><ul><ul><li>Signal formation  </li></ul></ul><ul><ul><ul><li>Chemical sign...
The Pain Pathway <ul><li>Transmission </li></ul><ul><ul><li>How the signal is sent </li></ul></ul><ul><ul><ul><li>Transmit...
The Pain Pathway <ul><li>Modulation </li></ul><ul><ul><li>Signal processing  </li></ul></ul><ul><ul><ul><li>Spinal cord </...
The Pain Pathway <ul><li>Cross section of the spinal cord </li></ul><ul><ul><li>Dorsal horn  </li></ul></ul><ul><ul><ul><l...
The Pain Pathway <ul><li>Perception </li></ul><ul><ul><li>Receiving and interpretation  </li></ul></ul><ul><ul><ul><li>Suc...
The Pain Pathway & Drugs <ul><li>Transduction (formation) </li></ul><ul><ul><li>Drugs that work “on site” </li></ul></ul><...
Transduction & drugs <ul><li>NSAIDS </li></ul><ul><ul><li>Carprofen, meloxicam, ketoprofen </li></ul></ul><ul><ul><ul><li>...
Arachidonic Acid COX-1 COX-2 <ul><li>Prostaglandins for homeostatic  </li></ul><ul><li>functions </li></ul><ul><ul><li>Int...
Transduction & drugs <ul><li>Steroids </li></ul><ul><li>Intra-articular opioids </li></ul><ul><ul><li>Opioid receptors can...
The Pain Pathway & Drugs <ul><li>Transmission (sent) </li></ul><ul><ul><li>Drugs that stop nerve impulses </li></ul></ul><...
The Pain Pathway & Drugs <ul><li>Modulation (processing) </li></ul><ul><ul><li>Opioids </li></ul></ul><ul><ul><ul><li>Rais...
The Pain Pathway & Drugs <ul><li>Perception </li></ul><ul><ul><li>General anesthetics </li></ul></ul><ul><ul><ul><li>Injec...
Pre-emptive Analgesia <ul><li>Pain meds given in anticipation of pain </li></ul><ul><ul><li>intensity and duration  </li><...
Balanced Analgesia <ul><li>Simultaneous administration of two or more analgesic drug classes or techniques </li></ul><ul><...
Pre-emptive and  balanced analgesia <ul><li>Utilizes lower doses  </li></ul><ul><ul><li>Less unwanted side effects </li></...
Consequences of pain
Is pain beneficial? <ul><li>NO! </li></ul><ul><ul><li>Decrease quality of life </li></ul></ul><ul><ul><li>Prolongs healing...
Recognition of pain <ul><li>Subjective </li></ul><ul><ul><li>Know what is normal </li></ul></ul><ul><ul><ul><li>Species </...
Recognition of pain <ul><li>Can be difficult to asses </li></ul><ul><ul><li>Prey species </li></ul></ul><ul><ul><li>Stoici...
Pets in pain <ul><li>Assess: </li></ul><ul><ul><li>Body posture </li></ul></ul><ul><ul><li>Appearance  </li></ul></ul><ul>...
Physiologic signs of pain <ul><li>Increase in monitoring parameters </li></ul><ul><ul><li>blood pressure </li></ul></ul><u...
Common behavioral responses to pain <ul><li>Pain recognition </li></ul><ul><ul><li>Whine, whimper </li></ul></ul><ul><ul><...
Behavioral responses to pain <ul><ul><li>Restlessness </li></ul></ul><ul><ul><ul><li>Frequent position changes </li></ul><...
Behavioral responses to pain <ul><li>Pain recognition </li></ul><ul><ul><li>Over grooming </li></ul></ul><ul><ul><ul><li>G...
Common procedures & pain <ul><li>No/temporary pain </li></ul><ul><ul><li>PE </li></ul></ul><ul><ul><li>Nail trim </li></ul...
Common procedures & pain <ul><li>Moderate pain </li></ul><ul><ul><li>OHE/castration </li></ul></ul><ul><ul><li>Declaw </li...
Pain Scoring <ul><li>Assigns a numerical value to observed behaviors </li></ul><ul><li>Makes pain assessment more objectiv...
Pain Scoring <ul><li>Comfort </li></ul><ul><li>Movement </li></ul><ul><li>Appearance </li></ul><ul><li>Behavior </li></ul>...
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The Physiology Of Pain

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Understanding the pain pathway is the first step to effective pain management in veterinary patients.

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The Physiology Of Pain

  1. 1. The Physiology of Pain Kristen Cooley BA, CVT, VTS (Anesthesia) Globe University Madison, WI
  2. 2. What is Pain? <ul><li>sensory and emotional </li></ul><ul><li>actual or potential </li></ul>
  3. 3. What is Pain? <ul><li>Often over looked </li></ul><ul><li>In 2000 JCAHO </li></ul><ul><ul><li>mandated pain be 5 th vital sign </li></ul></ul><ul><li>2003 AAHA followed suit </li></ul>
  4. 4. Noxious stimulus <ul><li>Pain causing </li></ul><ul><ul><li>Intensity </li></ul></ul><ul><ul><ul><li>Chemical </li></ul></ul></ul><ul><ul><ul><li>Mechanical </li></ul></ul></ul><ul><ul><ul><li>Thermal </li></ul></ul></ul>
  5. 5. Nociceptor <ul><li>Pain detecting </li></ul><ul><ul><li>Found throughout the body </li></ul></ul>
  6. 6. Nociception <ul><li>The activity by a noxious stimulus </li></ul>
  7. 7. Definitions <ul><li>Allodynia </li></ul><ul><ul><li>Not typically painful </li></ul></ul><ul><li>Hyperalgesia </li></ul><ul><ul><li>Exaggerated response </li></ul></ul><ul><li>Hyperesthesia </li></ul><ul><ul><li>Increased sensitivity </li></ul></ul>
  8. 8. Types of pain <ul><li>Peripheral pain </li></ul><ul><ul><li>Visceral </li></ul></ul><ul><ul><ul><li>Abdominal or thoracic organs </li></ul></ul></ul><ul><ul><ul><ul><li>Poorly localized </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Referred </li></ul></ul></ul></ul><ul><ul><li>Somatic </li></ul></ul><ul><ul><ul><li>Superficial </li></ul></ul></ul><ul><ul><ul><ul><li>Skin </li></ul></ul></ul></ul><ul><ul><ul><li>Deep </li></ul></ul></ul><ul><ul><ul><ul><li>tendons, joints, muscle, periosteum </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Easily localized </li></ul></ul></ul></ul></ul>
  9. 9. Types of pain <ul><li>Neuropathic pain </li></ul><ul><ul><li>Damage to peripheral nerves or spinal cord </li></ul></ul><ul><ul><li>Often difficult to treat appropriately </li></ul></ul>
  10. 10. Factors affecting pain <ul><li>Stress </li></ul><ul><ul><li>Exacerbates pain </li></ul></ul><ul><ul><ul><li>Environmental changes </li></ul></ul></ul><ul><ul><ul><li>Physiologic changes </li></ul></ul></ul><ul><li>Anxiety </li></ul><ul><ul><li>Exacerbates pain </li></ul></ul><ul><ul><li>Pain recognition </li></ul></ul><ul><ul><ul><li>Anxiolytics </li></ul></ul></ul><ul><ul><ul><li>Too much sedation can mask signs of pain </li></ul></ul></ul><ul><ul><ul><ul><li>This is inhumane </li></ul></ul></ul></ul>
  11. 11. Factors affecting pain <ul><li>Wind-up </li></ul><ul><ul><li>Sensitize to subsequent stimuli </li></ul></ul><ul><ul><li>Glutamate </li></ul></ul><ul><ul><ul><li>Activates NMDA receptor </li></ul></ul></ul><ul><ul><li>Initiates an intracellular cascade </li></ul></ul><ul><ul><ul><li>Increases membrane sensitivity to stimuli </li></ul></ul></ul><ul><li>‘ Central sensitization’ </li></ul><ul><ul><li>Less tolerant </li></ul></ul><ul><ul><li>Maladaptive </li></ul></ul>
  12. 12. Types of Pain <ul><li>Acute </li></ul><ul><li>Injury </li></ul><ul><li>Surgery </li></ul><ul><li>Inflammation </li></ul><ul><li>Infection </li></ul><ul><li>Limits mobility </li></ul><ul><li>Temporary </li></ul><ul><li>Chronic </li></ul><ul><li>Age related disorders </li></ul><ul><li>Slow to develop </li></ul><ul><li>May learn to cope </li></ul>
  13. 13. Types of Pain <ul><li>Adaptive </li></ul><ul><li>Normal response </li></ul><ul><ul><li>Tissue damage </li></ul></ul><ul><li>Protects from further injury </li></ul><ul><li>Inflammation is a large component </li></ul><ul><li>Maladaptive </li></ul><ul><li>Abnormal response </li></ul><ul><ul><li>No real purpose </li></ul></ul><ul><li>Stimulus is gone but pain persists </li></ul><ul><ul><li>Inappropriately managed adaptive pain </li></ul></ul>
  14. 14. The Pain Pathway <ul><li>Transduction </li></ul><ul><ul><li>Signal formation </li></ul></ul><ul><ul><ul><li>Chemical signal </li></ul></ul></ul><ul><ul><ul><ul><li>Inflammatory mediators </li></ul></ul></ul></ul><ul><ul><ul><li>Electrical activity </li></ul></ul></ul><ul><ul><ul><ul><li>Recognizable by nervous system </li></ul></ul></ul></ul>Transduction
  15. 15. The Pain Pathway <ul><li>Transmission </li></ul><ul><ul><li>How the signal is sent </li></ul></ul><ul><ul><ul><li>Transmitted through PNS </li></ul></ul></ul><ul><ul><ul><ul><li>A-delta </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Fast, small, myelinated </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Acute pain </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>C-fibers </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Slow, large, unmyelinated </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Chronic pain </li></ul></ul></ul></ul></ul>Transmission
  16. 16. The Pain Pathway <ul><li>Modulation </li></ul><ul><ul><li>Signal processing </li></ul></ul><ul><ul><ul><li>Spinal cord </li></ul></ul></ul><ul><ul><ul><ul><li>Dorsal horn </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Endogenous systems </li></ul></ul></ul></ul>Modulation
  17. 17. The Pain Pathway <ul><li>Cross section of the spinal cord </li></ul><ul><ul><li>Dorsal horn </li></ul></ul><ul><ul><ul><li>Modulation </li></ul></ul></ul>Tissue trauma Signal enters dorsal horn Reflex activity exits ventral horn To higher levels of CNS
  18. 18. The Pain Pathway <ul><li>Perception </li></ul><ul><ul><li>Receiving and interpretation </li></ul></ul><ul><ul><ul><li>Successful transduction, transmission, & modulation of a painful stimulus </li></ul></ul></ul><ul><ul><ul><li>Conscious, subjective, and emotional </li></ul></ul></ul>Modulation Perception
  19. 19. The Pain Pathway & Drugs <ul><li>Transduction (formation) </li></ul><ul><ul><li>Drugs that work “on site” </li></ul></ul><ul><ul><ul><li>Local anesthetics </li></ul></ul></ul><ul><ul><ul><ul><li>Lidocaine, bupivacaine </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Block sodium channels </li></ul></ul></ul></ul></ul>
  20. 20. Transduction & drugs <ul><li>NSAIDS </li></ul><ul><ul><li>Carprofen, meloxicam, ketoprofen </li></ul></ul><ul><ul><ul><li>Inhibit the production of prostaglandins from inflamed tissue </li></ul></ul></ul>
  21. 21. Arachidonic Acid COX-1 COX-2 <ul><li>Prostaglandins for homeostatic </li></ul><ul><li>functions </li></ul><ul><ul><li>Integrity of GI mucosa </li></ul></ul><ul><ul><li>Modulate renal blood flow </li></ul></ul><ul><ul><li>Regulate platelet function </li></ul></ul><ul><li>Prostaglandins in </li></ul><ul><li>inflammation </li></ul><ul><li>Pain </li></ul><ul><li>Edema </li></ul><ul><li>Fever </li></ul>Inhibition undesirable Inhibition desirable 5-LOX <ul><li>Leukotrienes </li></ul><ul><li>GI Ulcers </li></ul><ul><li>DJD </li></ul>NSAIDS COX-3
  22. 22. Transduction & drugs <ul><li>Steroids </li></ul><ul><li>Intra-articular opioids </li></ul><ul><ul><li>Opioid receptors can be found in inflamed joints </li></ul></ul>
  23. 23. The Pain Pathway & Drugs <ul><li>Transmission (sent) </li></ul><ul><ul><li>Drugs that stop nerve impulses </li></ul></ul><ul><ul><li>Local anesthetics </li></ul></ul><ul><ul><ul><li>Locally and systemically (lidocaine only) </li></ul></ul></ul><ul><ul><ul><ul><li>Preferential tx </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Great for pancreatitis pain </li></ul></ul></ul></ul><ul><ul><ul><li>Do not give bupivicaine IV! </li></ul></ul></ul><ul><li>Alpha-2 agonists </li></ul>
  24. 24. The Pain Pathway & Drugs <ul><li>Modulation (processing) </li></ul><ul><ul><li>Opioids </li></ul></ul><ul><ul><ul><li>Raise threshold </li></ul></ul></ul><ul><ul><ul><ul><li>Methadone, morphine… </li></ul></ul></ul></ul><ul><ul><li>Alpha-2’s </li></ul></ul><ul><ul><ul><li>Decrease signal </li></ul></ul></ul><ul><ul><ul><ul><li>Dexmedetomidine </li></ul></ul></ul></ul><ul><ul><li>Local anesthetics </li></ul></ul><ul><ul><ul><li>Blocks sodium channels </li></ul></ul></ul><ul><ul><ul><ul><li>Lidocaine, bupivacaine </li></ul></ul></ul></ul><ul><ul><li>NSAIDS </li></ul></ul><ul><ul><ul><li>Carprofen, meloxicam </li></ul></ul></ul><ul><ul><li>Tricyclic antidepressants </li></ul></ul><ul><ul><ul><li>Amitriptaline </li></ul></ul></ul><ul><ul><li>NMDA antagonists </li></ul></ul><ul><ul><ul><li>Decreases wind-up </li></ul></ul></ul><ul><ul><ul><ul><li>Ketamine, methadone </li></ul></ul></ul></ul>
  25. 25. The Pain Pathway & Drugs <ul><li>Perception </li></ul><ul><ul><li>General anesthetics </li></ul></ul><ul><ul><ul><li>Injectables </li></ul></ul></ul><ul><ul><ul><li>Inhalants </li></ul></ul></ul><ul><ul><li>Opioids </li></ul></ul><ul><ul><li>Alpha-2’s </li></ul></ul>Z z z z z z z
  26. 26. Pre-emptive Analgesia <ul><li>Pain meds given in anticipation of pain </li></ul><ul><ul><li>intensity and duration </li></ul></ul><ul><ul><li>Chronic pain state </li></ul></ul><ul><ul><li>Does not eliminate post-op pain it just makes it easier to control! </li></ul></ul>
  27. 27. Balanced Analgesia <ul><li>Simultaneous administration of two or more analgesic drug classes or techniques </li></ul><ul><ul><li>Synergism </li></ul></ul><ul><ul><li>Additive </li></ul></ul><ul><ul><li>Pain pathway </li></ul></ul>
  28. 28. Pre-emptive and balanced analgesia <ul><li>Utilizes lower doses </li></ul><ul><ul><li>Less unwanted side effects </li></ul></ul><ul><li>More complete analgesia </li></ul><ul><li>Suppresses the stress response </li></ul><ul><ul><li>Decreases chronic pain state </li></ul></ul><ul><li>Shorten recovery </li></ul>
  29. 29. Consequences of pain
  30. 30. Is pain beneficial? <ul><li>NO! </li></ul><ul><ul><li>Decrease quality of life </li></ul></ul><ul><ul><li>Prolongs healing </li></ul></ul><ul><ul><ul><li>Injury, illness, surgery </li></ul></ul></ul><ul><li>All tissue injury causes pain </li></ul><ul><ul><li>Routine or quick procedures </li></ul></ul><ul><ul><li>Skill of individual </li></ul></ul>
  31. 31. Recognition of pain <ul><li>Subjective </li></ul><ul><ul><li>Know what is normal </li></ul></ul><ul><ul><ul><li>Species </li></ul></ul></ul><ul><ul><ul><li>Breed </li></ul></ul></ul><ul><ul><ul><li>Individual </li></ul></ul></ul><ul><ul><li>Use common sense </li></ul></ul><ul><ul><li>Big picture </li></ul></ul><ul><ul><li>Pre-emptive techniques </li></ul></ul><ul><ul><li>Remember that it is better to treat pain that isn’t there than to not treat pain that is </li></ul></ul>
  32. 32. Recognition of pain <ul><li>Can be difficult to asses </li></ul><ul><ul><li>Prey species </li></ul></ul><ul><ul><li>Stoicism is innate and evolutionary </li></ul></ul>
  33. 33. Pets in pain <ul><li>Assess: </li></ul><ul><ul><li>Body posture </li></ul></ul><ul><ul><li>Appearance </li></ul></ul><ul><ul><li>Locomotion </li></ul></ul><ul><ul><li>Behavior </li></ul></ul><ul><ul><li>Activity level </li></ul></ul><ul><ul><li>Daily habits </li></ul></ul><ul><ul><li>Response to people </li></ul></ul>
  34. 34. Physiologic signs of pain <ul><li>Increase in monitoring parameters </li></ul><ul><ul><li>blood pressure </li></ul></ul><ul><ul><li>heart rate </li></ul></ul><ul><ul><li>respiratory rate </li></ul></ul><ul><li>Peripheral vasoconstriction </li></ul><ul><li>Stress leukogram </li></ul><ul><ul><li>These signs do not rule pain in or out! </li></ul></ul>
  35. 35. Common behavioral responses to pain <ul><li>Pain recognition </li></ul><ul><ul><li>Whine, whimper </li></ul></ul><ul><ul><ul><li>Intermittent vocalization </li></ul></ul></ul><ul><ul><ul><ul><li>Continuous vocalization </li></ul></ul></ul></ul><ul><ul><li>Arched or abnormal posture </li></ul></ul><ul><ul><ul><li>Standing with head down, bowing/praying position, hunched </li></ul></ul></ul><ul><ul><li>Guarding of injured tissue </li></ul></ul><ul><ul><ul><li>Abdominal splinting/muscle tensing </li></ul></ul></ul><ul><ul><ul><ul><li>Reaction to palpation of site around injured tissue </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Snapping/reacting when approaching injured tissue </li></ul></ul></ul></ul></ul>Dogs are pack animals, they share emotions with pack members to receive support
  36. 36. Behavioral responses to pain <ul><ul><li>Restlessness </li></ul></ul><ul><ul><ul><li>Frequent position changes </li></ul></ul></ul><ul><ul><ul><ul><li>Inability to sleep </li></ul></ul></ul></ul><ul><ul><li>Behavior change </li></ul></ul><ul><ul><ul><li>Animal becomes timid or aggressive </li></ul></ul></ul><ul><ul><li>Increased heart rate and blood pressure </li></ul></ul><ul><ul><li>Hypersalivation </li></ul></ul><ul><ul><li>Appetite reduction </li></ul></ul><ul><ul><li>Dilated pupils </li></ul></ul><ul><ul><li>Altered voiding behavior </li></ul></ul>
  37. 37. Behavioral responses to pain <ul><li>Pain recognition </li></ul><ul><ul><li>Over grooming </li></ul></ul><ul><ul><ul><li>Growling at nothing </li></ul></ul></ul><ul><ul><ul><ul><li>Purring </li></ul></ul></ul></ul><ul><ul><li>Hiding </li></ul></ul><ul><ul><ul><li>Aggression </li></ul></ul></ul><ul><ul><li>Squinting </li></ul></ul><ul><ul><ul><li>Refusal to change body position </li></ul></ul></ul><ul><ul><li>Guarding injured tissue </li></ul></ul><ul><ul><ul><li>Skin flicking, muscle tensing </li></ul></ul></ul><ul><ul><li>Desperate attempts to flee </li></ul></ul><ul><ul><li>Reduced grooming </li></ul></ul><ul><ul><li>Appetite reduction </li></ul></ul><ul><ul><li>Pupil dilation </li></ul></ul><ul><ul><li>Salivation </li></ul></ul><ul><ul><li>Restlessness </li></ul></ul><ul><ul><ul><li>Inability to sleep </li></ul></ul></ul><ul><ul><ul><ul><li>Sleeping all the time </li></ul></ul></ul></ul><ul><ul><li>Increased heart rate and blood pressure </li></ul></ul>Cats are more solitary animals, they are generally more stoic than dogs; showing pain highlights a cats vulnerability
  38. 38. Common procedures & pain <ul><li>No/temporary pain </li></ul><ul><ul><li>PE </li></ul></ul><ul><ul><li>Nail trim </li></ul></ul><ul><ul><li>Suture removal </li></ul></ul><ul><li>Analgesics typically not necessary </li></ul><ul><ul><li>Don’t forget about stress! </li></ul></ul><ul><li>Minor pain </li></ul><ul><ul><li>Suturing </li></ul></ul><ul><ul><li>Urinary catheterization </li></ul></ul><ul><ul><li>IV catheterization </li></ul></ul><ul><ul><li>Dental cleaning </li></ul></ul><ul><li>Mild analgesics beneficial </li></ul><ul><ul><li>Decrease stress of animal and handler </li></ul></ul>
  39. 39. Common procedures & pain <ul><li>Moderate pain </li></ul><ul><ul><li>OHE/castration </li></ul></ul><ul><ul><li>Declaw </li></ul></ul><ul><ul><li>Extractions </li></ul></ul><ul><li>Analgesics are necessary! </li></ul><ul><ul><li>Butorphanol alone is not adequate for these procedures! </li></ul></ul><ul><li>Severe pain </li></ul><ul><ul><li>Fracture repair </li></ul></ul><ul><ul><li>Cruciate repair </li></ul></ul><ul><ul><li>Amputation </li></ul></ul><ul><ul><li>Ear canal ablation </li></ul></ul><ul><li>Analgesics are essential! </li></ul><ul><ul><li>Multi-modal is best </li></ul></ul>
  40. 40. Pain Scoring <ul><li>Assigns a numerical value to observed behaviors </li></ul><ul><li>Makes pain assessment more objective </li></ul><ul><li>Helps puts everybody on the same page </li></ul>
  41. 41. Pain Scoring <ul><li>Comfort </li></ul><ul><li>Movement </li></ul><ul><li>Appearance </li></ul><ul><li>Behavior </li></ul><ul><li>Interaction </li></ul><ul><li>Vocalization </li></ul><ul><li>Heart rate </li></ul><ul><li>Trust your instincts </li></ul><ul><ul><li>If you feel that an animal is uncomfortable it probably is </li></ul></ul><ul><ul><li>Pain scores help you to communicate this to the doctor </li></ul></ul><ul><ul><li>Decreases stress! </li></ul></ul>
  42. 42. Questions?

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