Understanding the mechanisms behind acute pain in dogs and cats
Abstract
A basic understanding of the processes involved in nociception is a pre-requisite for successful management of acute pain. Peripheral and central sensitisation are key components contributing to pain in most cases, and a number of important concepts are now widely recognised as being crucial with regard to minimising their occurrence, and thereby improving the effectiveness of analgesia therapy. Although somewhat controversial in human medicine, pre-emptive analgesia — whereby analgesic agents are administered in advance of noxious stimulation — appears to be of importance in animals. Optimal pain relief is only likely to be achieved if a multimodal approach to analgesia is undertaken, utilising pharmaceutical agents acting at different points within the ‘pain pathway’. In addition, preventive analgesia — wherein adequate pain relief is provided throughout the peri-operative period and well into recovery — is now considered one of the most significant areas in which acute pain management can be advanced.
The International Association for the Study of Pain (IASP) define pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’ (IASP website, 2013). Thus, pain has a physiological (sensory) component as well as subjective (emotional and psychological) aspects. While the subjective aspects of pain play a significant role in the overall experience of the pain process in humans, the contribution in animals is more difficult to clearly define.
Pain can be sub-divided into physiological and pathological pain (Zhuo, 2005). With physiological pain, the perception of the pain is proportional to the intensity of the inciting noxious (harmful or potentially harmful) stimulus. Physiological pain serves an important protective purpose, in that it is a defensive mechanism designed to limit damage to the body from a noxious stimulus. With pathological pain, on the other hand, the perception of the pain is greater than would be suggested by the inciting noxious stimulus. This occurs for two main reasons:
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