Pain Management and Analgesia
The Pain Management and Analgesia domain tests pain assessment, multimodal analgesia, drug selection, local blocks, and monitoring for adverse effects. The exam expects you to treat pain preemptively and reassess.
Core rules
- Use validated pain scales and observe behavior, posture, grooming, appetite, and response to palpation.
- Multimodal analgesia combines opioids, NSAIDs, local anesthetics, and adjuncts such as gabapentin or ketamine.
- NSAIDs are contraindicated with corticosteroids and in dehydration or renal disease; use the licensed dose and monitor renal values.
- Local blocks: calculate maximum lidocaine or bupivacaine dose by weight and avoid intravascular injection.
- Reassess pain and sedation after each intervention; record the response.
Worked example
A 10 kg dog needs meloxicam at 0.1 mg/kg. Dose = 1 mg. The oral suspension is 1.5 mg/mL, so volume = 1 ÷ 1.5 = 0.67 mL. Give with food and monitor for vomiting or melena.
Traps
Using a dog NSAID dose in a cat, combining an NSAID with prednisone, and assuming a sleeping patient is pain-free. Also, forgetting to calculate the maximum local anesthetic volume.