Acute pain: assessment and management

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Effective treatment of pain is one of the veterinary surgeon’s most important ethical responsibilities. To do this requires an appreciation of how painful certain procedures and conditions are likely to be, and the ability to recognize and quantify that pain. This chapter discusses Neurophysiology; Assessment of acute pain; and Management.

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2.2 The pain pathway. Peripheral nociceptors respond to noxious stimuli, and signals are transmitted to the spinal cord via small myelinated (Aδ) and unmyelinated (C) nerve fibres. Impulses arriving at primary afferent nerve endings in the dorsal horn cause release of a number of neurotransmitters, including glutamate, substance P, calcitonin gene-related peptide (CGRP) and neurokinin, which activate second-order neurons. These neurons then transmit the signals to the brain, where the information is integrated and finally perceived as pain. Tissue damage causes release of pain-promoting substances from both surrounding tissue and the nerve endings themselves, leading to peripheral sensitization of nociceptors. Modulation of these pain signals occurs within the spinal cord (both inhibition and facilitation) and is under the influence of descending pathways from supraspinal sites. Pharmacological interventions that act at specific points of the pathway are indicated by orange arrows. Partly drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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2.4 Signs indicative of pain in cats. (Reproduced from , , with the permission of AVMA).
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2.5 An approach to pain management in cats. (Adapted from , , with permission of the American Animal Hospital Association. Copyright © 2007. To order this resource or obtain more information, go to www.aahanet.org).


Pain assessment form for cats. (Reproduced, with permission, from Mahler and Reece, 2007)

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