Pain Management
Pain management items test assessment, multimodal analgesia, and drug safety. The exam expects you to recognize pain as a physiologic problem, not just a behavior.
Core rules
- Use species-appropriate pain scales; cats and dogs hide pain. Assess posture, grooming, appetite, interaction, and response to palpation.
- Multimodal analgesia combines drugs with different mechanisms: opioid, NSAID, local anesthetic, and adjuncts such as gabapentin or ketamine.
- Preemptive analgesia before surgery reduces wind-up and postoperative pain.
- NSAIDs are contraindicated in dehydration, renal disease, gastrointestinal ulceration, and coagulopathy; give with food and monitor.
- Opioids cause dose-dependent respiratory depression and bradycardia; monitor and have reversal available.
Worked example
A dog scheduled for ovariohysterectomy has no renal or GI contraindication. A plan might include a premedication opioid, an NSAID at the labeled dose, and a local anesthetic line block at the incision. Reasoning: each drug acts at a different point in the pain pathway, so lower doses of each can be used. Reassess with a pain score in recovery and add rescue analgesia if the score is high.
Traps
- Assuming a sleeping patient is comfortable; sedation can mask pain.
- Combining two NSAIDs or an NSAID with a corticosteroid.
- Using a human pain scale that does not fit veterinary patients.
- Ignoring chronic pain because the animal is still eating.