Page 97 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir proactive and advocate early intervention for administration has been shown to induce
these patients. Enteral feeding via feeding
long lasting e ects on visceral pain responses.
tubes, such as oesophagostomy tubes, is
As the mechanisms by which gut microbiota
associated with minimal complications. in uence or reduce visceral hypersensitivity are
Visceral pain disorders are observed further understood, great potential bene ts for
commonly in veterinary patients. Visceral pain veterinary patients will arise.
can range in intensity. Common conditions seen Feeding techniques for pets are constantly
are irritable bowel syndrome, pancreatitis and evolving. Various techniques should be utilized
interstitial cystitis. Visceral pain signals travel more readily in veterinary practice for inpatient
through both spinal and vagal routes, and enrichment. Studies in dogs investigating
sensitization of peripheral nerves can induce di erent food receptacles and pu le feeders
central sensitization at both spinal and demonstrate increased time spent on both
supraspinal levels. We often use dietary feeding behaviour and activity. Furthermore, the
changes when managing conditions such as frequency of barking behaviour was reduced
feline idiopathic cystitis, for example, low-fat (Schipper et al., 8 . In cats, antes et al.
high bre regimes, sometimes combined with 16 reviewed the use and introduction of
behavioural modi cations. In acute ares, these puzzle feeders. Another option for cats is the
patients may be admitted for supportive care NoBowl eeding System . evised by a US
and analgesia. Treatment options for cats with veterinary surgeon, it allows a meal to be split
feline idiopathic cystitis or patients with between ve NoBowls, which are then hidden
pancreatitis are often unsatisfactory due to around the house. It allows for natural feeding
various factors that a ect the perception and behaviour by encouraging cats to hunt, nd,
maintenance of this type of pain. pounce and manipulate the device to dispense
There has been a recent interest in small meals.
examining the role of gut microbiota in
regulating visceral pain in humans. Gut Further considerations
microbiota are commonly associated with The placement of a peripheral venous cannula
maintenance of intestinal homoeostasis, is standard care for many inpatients. These
peristalsis, intestinal mucosal integrity, cannulae are often placed by veterinary
protection against pathogens and priming of surgeons, nurses or nurses in training to
the immune response. A review by O’Mahony et administer medications and infusions. Cannula-
al. 17 discusses several mechanisms by associated phlebitis results in pain, erythema,
which the microbiota in uence brain function swelling, and both increased morbidity and cost
and that this microbiome likely works in concert in veterinary patients. Quality of cannula
with reciprocal signalling from the brain. A material, site, placement and maintenance
growing body of literature links central nervous technique, duration of insertion and type of
system (CNS) diseases to the mechanism of infusions have been identi ed as factors
communication between the gut microbiota in uencing the occurrence of phlebitis. Palese
and the CNS. Furthermore, a study done by et al. 16 found a robust link between nursing
Braniste et al. 14 showed that the blood care and level of nursing experience in rates of
brain barrier integrity in the frontal cortex, phlebitis in human care. Peripheral venous
hippocampus, and striatum is in uenced by gut cannulation is an unpleasant experience; it can
microbiota. Enhanced pain signalling has been be time-consuming, exacerbate patient stress
shown in adult mice when they had disturbed and have associated increases in costs to both
gut microbiota. Human and animal models have clinics and clients. Instigating a cannulation
demonstrated that stress, either chronic or in policy is sensible, such as a ‘two stick’ rule to
early life, is a key factor potentiating visceral avoid incidences of multiple attempts, in
pain responses and some of the associated multiple limbs, by one individual. Certain patient
co-morbidities. Early life antibiotic groups are more susceptible to phlebitis, for

92

Ch06a Pain Management.indd 92 19/12/2018 10:37