Chapter 7. Pain Assessment Flashcards
1
Q
- Regarding Minnesota Multiphasic Personality
Inventory (MMPI) which of the following statement
is true?
(A) It has 547 questions
(B) Conversion V is often present in
patients with chronic pain
(C) It can be interpreted by anyone treating
the patient
(D) Is not commonly used in evaluation of
patients for spinal cord stimulation
(SCS) trial
(E) Can point out reliably the psychogenic
part of the pain behavior
A
- (B) The MMPI is a long test and has 566 questions.
It does not reliably distinguish between the
psychologic and physical pain. It needs expertise
to review the test results, and the conversion V
(hypochondriasis, depression, and hysteria) is
seen in patients with chronic pain and does
respond to treatment. The MMPI is commonly
used in evaluating patients for SCS trial.
2
Q
607. Visual analogue scale (VAS) (A) correlate highly with pain measured on verbal and numerical rating scales (B) is minimally intrusive (C) assumes that pain is a unidemnsional experience (D) measures the intensity of pain (E) all of the above
A
- (E) The VAS-like verbal and numerical rating
scales assumes that pain is a unidimentional
experience and measures the intensity of the
pain. Although pain intensity is a salient dimension
of pain, it is clear that there are many
dimensions to pain
3
Q
608. Which of the following tests is used as a more objective determination of disability? (A) The most thoroughly studied is the Sickness Illness Profile (B) Physical examination is an objective and consistent method of assessing impairment (C) McGill Pain Questionnaire (D) Patient’s subjective report of pain (E) MMPI
A
- (A) The most commonly studied instrument is
the Sickness Illness Profile. This has been used
in many studies to demonstrate the effect of a
variety of treatment methods in patients with
pain.
Studies have shown poor reproducibility
between physicians in evaluating patients
with back pain especially regarding nonneurologic
findings like muscle spasm and guarding.
At present time there is no reliable test to
measure patient’s subjective feeling of pain.
4
Q
- What is the Symptom Checklist 90 (SL-90) and
its revised version (SLR-90-R)?
(A) Is a screen for psychologic symptoms
and overall levels of distress
(B) Self-report measure of patient’s perception
of his or her general health status
(C) It is a 136-item scale
(D) It is a measure of one’s mood state
(E) It is the most widely used personality
test
A
- (A) The SL-90 or Sl-90-R screens for psychologic
symptoms and levels of distress. It is one
of the personality test and has 90 items describing
a physical or psychologic symptom. This is
one not categorized as mood test. The most
widely used personality test is MMPI.
5
Q
610. Which of the following tests assess limitations in activities of daily living (ADL)? (A) Spielberger State-Trait Anxiety Inventory (B) Oswestry Low Back Pain Disability Questionnaire (C) Beck Depression Inventory (D) SL-90 (E) MMPI
A
- (B) Spielberger State-Trait Anxiety Inventory
is a 40-item self-report questionnaire that measures
anxiety levels.
Oswestry Low Back Pain Disability
Questionnaire assesses limitations in ADL. Ten
multiple choice items cover nine aspects of
daily functioning including personal care, lifting,
walking, sitting, standing, sexual activity,
and traveling. The patient chooses from among
six statements relating to impact of pain on a
particular activity. Apercentage score is derived
allowing for classification of patients ranging
from mildly to profoundly impaired.
Beck Depression Inventory is a self-report
measure of depression.
The SL-90 or Sl-90-R screens for psychologic
symptoms and levels of distress.
MMPI is commonly used personality test
to gain an overall picture of the patient’s general
psychologic status.
6
Q
- Beck Depression Inventory
(A) is used to look at basic coping styles
(B) is a 21-item self-report measure of
depression for the last 30 years
(C) is not commonly used in pain literature
(D) is a measure of malingering
(E) all of the above
A
- (B) Beck Depression Inventory is one of the
most commonly used instruments in pain literature.
It is a 21-item self-report measure of
depression and has been in use for 30 years.
Responses require the endorsement of one of a
series of four statements, rank ordered according
to the severity of content. The scores on
each item are tabulated to yield a total depression
score. It is not a measure of coping styles
or malingering.
7
Q
- In pain assessment
(A) patient’s self-report of pain is the most
valid measure of the pain experience
(B) behavioral measure of pain is the most
valid measurement
(C) the health care provider’s observation is
the most valid measurement
(D) none of the above
(E) all of the above
A
- (A) The studies point to obtaining multiple
measures of soft pain and because pain is a
subjective phenomenon the patient’s self-report
is the most valid measure of the experience.
8
Q
613. A conscious exaggeration of physical or psychologic symptoms for some easily recognized goal or secondary gain is (A) symptom magnification (B) malingering (C) hysteria (D) hypochondriasis (E) depression
A
- (B) Malingering is a conscious exaggeration of
physical or psychologic symptoms for some easily
recognized goal or secondary gain. It should be
differentiated from symptom exaggeration or magnification that could be secondary to personality
characteristics such as hysteria or conditioning
factors.
9
Q
614. McGill Pain Questionnaire (A) consists of three major measures (B) was developed by McGill (C) is not widely used (D) is a single-dimensional pain scale (E) does not ask about the location of pain
A
- (A) McGill Pain Questionnaire was developed in
1975 by Ronald Melzack at McGill University in
Canada. It consists of three major measures: pain
rating index, total number of words chosen, and
the present pain intensity. This is a multidimensional
scale for measurement of pain. The questionnaire
tries to assess the there components of
pain postulated by the gate theory: the sensory,
the affective, and the evaluative dimensions.
10
Q
- McGill Pain Questionnaire assesses
(1) location of the pain
(2) pattern of the pain over time
(3) sensory, effective component of pain
(4) intensity of the pain
A
- (E) There are two types of tools for assessment of
pain. Unidimentional single-item scales or multidimensional
measure scales. The former includes
the VAS or the VNS, the Verbal Descriptor Scale
(VDS), and the Pain Thermometer. Each of these
single-item scales measures only the intensity of
the pain experienced. The multidimensional prototype
is McGill Pain Questionnaire. It assesses the
location of pain; the pattern of pain over time; the
sensory, effective, evaluative, and miscellaneous
components of pain; and the intensity of pain.
11
Q
- Advantages of MMPI-2 include:
(1) It provides 10 clinical scales, 3 validity
scales
(2) Is considered the gold standard
(3) Is well-normed and extensively
researched
(4) Its test results are easy to interpret
A
- (A) MMPI-2 measures psychologic traits and
overall psychologic status. It is considered the
gold standard and is scored by a computer.
MMPI-2 has 10 clinical scales, 3 validity scales,
and numerous other subscales. It is well-normed
and highly researched and provides data about
patient’s test-taking approach; however, it is not
normed on pain patients, scales 1 to 3 often evaluated
in pain patients (this may unfairly label
patients as neurotic). MMPI-2 requires highly
skilled evaluator to interpret the test results.
12
Q
617. In evaluating patients for SCS using MMPI Richard North’s group noted that (1) patients with high scores on scale 1 (hypochondriasis)t ended to proceed from SCS trial to implant (2) patients with higher scores on scale 3 (hysteria) were not offered SCS trial (3) patients with higher scores on scale 3 (hysteria) had positive short-term but not long-term outcome (4) patients with high score on scale 1 (hypochondriasis) tended not to proceed from SCS trial to implant
A
- (B) MMPI has been widely used in patients undergoing
SCS. North’s group noted that patients with
higher scores on hypochondriasis tended to proceed
from trial to implantation; however, scale 3
(hysteria) tended to correlate with a positive shortterm
but not long-term outcome.
13
Q
- In regard to MMPI as a predictor of treatment
outcome
(1) it is standardized on chronic pain
patients
(2) it is based on common diagnoses of
1930s
(3) can be used alone in assessment of pain
patients
(4) items overlapping a great degree across
the 10 clinical scales
A
- (C) Keller and Butcher reinforced the lack of
support found in the literature for using the
MMPI as a predictor of treatment outcome.
Common disadvantages of MMPI are that it is
not standardized to chronic pain or medical patients; it is based on common diagnoses of
1930s; the items bear no face validity in regard
to underlying psychotherapy; items overlap to
a great degree across the 10 clinical scales; and it is excessively long.
14
Q
619. Multidimensional pain assessment inventories include (1) pain disability index (2) illness behavior questionnaire (3) Sickness Impact Profile, West Haven- Yale Multidimensional Pain Inventory (4) Dallas Pain Questionnaire
A
- (E)
15
Q
- Regarding pain scores on the numeric rating
scale
(1) decreased pain scores suggest positive
outcome from the treatment of pain
(2) it should be used only occasionally
(3) it correlates highly with pain measured
on in verbal scale and VAS
(4) correlates highly with anxiety and
depression
A
- (B) The numerical rating scale correlates with
scores on VAS or verbal rating scales. It should
be used at each evaluation. It is sensitive to
pharmacologic procedures that affect the pain
intensity.
