52: Pain

Question 1

1. Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence the:
2. Sensory aspects of pain
3. Discriminative aspects of pain
4. Motivational aspects of pain
5. Cognitive aspects of pain

Answer 1

3. Motivational aspects of pain

Question 2

2. Patients need to be questioned about all pain sites because:
3. Patients tend to report the most severe or important in their perception.
4. Pain tolerance generally decreases with repeated exposure.
5. The reported pain site is usually the most important to treat.
6. Pain may be referred from a different site to the one reported.

Answer 2

1. Patients tend to report the most severe or important in their perception.

Question 3

3. The chemicals that promote the spread of pain locally include:
4. Serotonin
5. Norepinephrine
6. Enkephalin
7. Neurokinin A

Answer 3

4. Neurokinin A

Question 4

4. Narcotics are exogenous opiates. They act by:
5. Inhibiting pain transmission in the spinal cord
6. Attaching to receptors in the afferent neuron to inhibit the release of substance P
7. Blocking neurotransmitters in the midbrain
8. Increasing beta-lipoprotein excretion from the pituitary gland

Answer 4

2. Attaching to receptors in the afferent neuron to inhibit the release of substance P

Question 5

5. Age is a factor in different responses to pain. Which of the following age-related statements about pain is NOT true?
6. Preterm and newborn infants do not yet have functional pain pathways.
7. Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child.
8. Increases in the pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness.
9. Decreases in pain tolerance are evident in older adults.

Answer 5

1. Preterm and newborn infants do not yet have functional pain pathways.

Question 6

6. Which of the following statements is true about acute pain?
7. Somatic pain comes from body surfaces and is only sharp and well-localized.
8. Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates.
9. Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site.
10. Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area.

Answer 6

3. Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site.

Question 7

7. One of the main drug classes used to treat acute pain is NSAIDs. They are used because:
8. They have less risk for liver damage than acetaminophen.
9. Inflammation is a common cause of acute pain.
10. They have minimal GI irritation.
11. Regulation of blood flow to the kidney is not affected by these drugs.

Answer 7

2. Inflammation is a common cause of acute pain.

Question 8

8. Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs?
9. All opiates are scheduled drugs which require a DEA license to prescribe.
10. Opiates stimulate only mu receptors for the control of pain.
11. Most of the adverse effects of opiates are related to mu receptor stimulation.
12. Naloxone is an antagonist to opiates.

Answer 8

2. Opiates stimulate only mu receptors for the control of pain.

Question 9

9. If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use?
10. NSAIDs, opiates, corticosteroids
11. Low-dose opiates, salicylates, increased dose of opiates
12. Opiates, non-opiates, increased dose of non-opiate
13. Non-opiate, increased dose of non-opiate, opiate

Answer 9

4. Non-opiate, increased dose of non-opiate, opiate

Question 10

10. The goal of treatment of acute pain is:
11. Pain at a tolerable level where the patient may return to activities of daily living
12. Reduction of pain with a minimum of drug adverse effects
13. Reduction or elimination of pain with minimum adverse reactions
14. Adequate pain relief without constipation or nausea from the drugs

Answer 10

3. Reduction or elimination of pain with minimum adverse reactions

Question 11

11. Which of the following statements is true about age and pain?
12. Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.
13. Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs.
14. Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.
15. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

Answer 11

4. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

Question 12

12. Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to:
13. Determine if the diagnosis of source of pain is correct
14. Determine if the current regimen is adequate or different combinations of drugs and non-drug therapy are required
15. Determine if the patient is willing and able to be an active participant in his or her pain management
16. All of the above

Answer 12

4. All of the above

Question 13

13. Pathological similarities and differences between acute pain and chronic pain include:
14. Both have decreased levels of endorphins.
15. Chronic pain has a predominance of C-neuron stimulation.
16. Acute pain is most commonly associated with irritation of peripheral nerves.
17. Acute pain is diffuse and hard to localize.

Answer 13

2. Chronic pain has a predominance of C-neuron stimulation.

Question 14

14. A treatment plan for management of chronic pain should include:
15. Negotiation with the patient to set personal goals for pain management
16. Discussion of ways to improve sleep and stress
17. An exercise program to improve function and fitness
18. All of the above

Answer 14

4. All of the above

Question 15

15. Chronic pain is a complex problem. Some specific strategies to deal with it include:
16. Telling the patient to “let pain be your guide” to using treatment therapies
17. Prescribing pain medication on a “PRN” basis to keep down the amount used
18. Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment
19. All of the above

Answer 15

3. Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment

Question 16

16. Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency?
17. Use of more than one drug to treat the pain
18. Multiple times when prescriptions are lost with requests to refill
19. Preferences for treatments that include alternative medicines
20. Presence of a family member who has abused drugs

Answer 16

2. Multiple times when prescriptions are lost with requests to refill

Question 17

17. The Pain Management Contract is appropriate for:
18. Patients with cancer who are taking morphine
19. Patients with chronic pain who will require long-term use of opiates
20. Patients who have a complex drug regimen
21. Patients who see multiple providers for pain control

Answer 17

2. Patients with chronic pain who will require long-term use of opiates