Chronic Pain

Question 1

Pain is described as an unpleasant ____________ and ____________ experience associated with, or resembling that associated with, actual or potential ______________.

Answer 1

sensory

emotional

tissue damage

Question 2

Physiologically, pain can be described as _____________ or ______________, and classified as either acute or chronic, and primary or secondary in nature.

Answer 2

neuropathic

nociceptive

Question 3

Physiologically, it can be described as neuropathic or nociceptive, and classified as either ____________ or _____________, and ______________ or _______________ in nature.

Answer 3

acute

chronic

primary

secondary

Question 4

_______________ pain generally responds to treatment with conventional analgesics whereas ______________ pain responds poorly to conventional analgesics and can be difficult to treat.

Answer 4

Nociceptive

neuropathic

Question 5

Chronic pain is defined as pain that has been present for more than ______________ (beyond the expected time of wound healing).

Answer 5

12 weeks

Question 6

Chronic ____________ pain is defined as pain that has no clear underlying condition, or where the pain (or its impact) appears to be out of proportion to any observable injury or disease.

Answer 6

primary

Question 7

Chronic primary pain is defined as pain that has ___________________, or where the pain (or its impact) appears to be ________________ to any observable injury or disease.

Answer 7

no clear underlying condition

out of proportion

Question 8

Types of chronic primary pain include ________________, _______________ (chronic widespread pain), _______________, ______________, and ______________ pain.

Answer 8

complex regional pain syndrome

fibromyalgia

primary headache and orofacial pain

primary visceral

primary musculoskeletal

Question 9

_______________ pain however, is caused by an underlying condition (such as endometriosis, osteoarthritis, rheumatoid arthritis, and ulcerative colitis)

Answer 9

Secondary

Question 10

Secondary pain however, is caused by _________________

Answer 10

an underlying condition (such as endometriosis, osteoarthritis, rheumatoid arthritis, and ulcerative colitis)

Question 11

What are the 6 pain categories of secondary pain?

Answer 11

1. Cancer-related
2. Neuropathic
3. Post-surgical or post traumatic
4. Secondary headache or orofacial
5. Secondary MSK
6. Secondary visceral

Question 12

_________________ is a common comorbidity in those with chronic pain

Answer 12

Depression; individuals should be monitored and treated for depression as appropriate

Question 13

Optimizing ______________ therapy should be considered in individuals with _____________ and chronic pain.

Answer 13

antidepressant

moderate depression

Question 14

What are the aims of treatment of chronic pain? (3)

Answer 14

Reduce the impact of chronic pain on:

1. QoL
2. Mood
3. Function

Question 15

Where possible, treatment options for chronic pain should be guided by ___________________

Answer 15

any known underlying chronic pain condition(s)

Question 16

Consider specialist referral for chronic pain when ________________, _____________, the patient is ________________, and/or where a specialist intervention is being considered.

Answer 16

non-specialist management is failing

the pain is poorly controlled

experiencing significant distress

Question 17

What are the non-drug treatments available for chronic pain? (4)

Answer 17

1. Exercise and exercise therapy; strategies to improve adherence (such as supervised exercise sessions) should be implemented
2. TENS may be considered
3. Psychologically based interventions like CBT, biofeedback, progressive relaxation, education
4. Self-management resources (safe, low-tech, community-based, affordable) should be considered

Question 18

A variety of analgesics are used in the treatment of chronic pain and can be divided into _____________, ____________, and _____________ analgesics

Answer 18

non-opioid

opioid

adjuvant

Question 19

Although developed and validated for ___________ pain, the WHO analgesic ladder is widely used to guide the basic treatment of ____________ and __________ pain

Answer 19

cancer

acute

chronic

• whilst there is little evidence to support its use in chronic pain it may provide an analgesic strategy for non-specialists

Question 20

Individual responses to analgesia vary considerably, both in terms of ___________ and ___________; even with the same chronic pain syndrome, the underlying pain mechanisms may differ between individuals

Answer 20

efficacy

side-effects

Question 21

If an individual either fails to tolerate, or has an inadequate response to a drug, then it is worthwhile considering ________________

Answer 21

a different agent from the same class

Question 22

Individuals using analgesics to manage chronic pain should be reviewed at least ______________, with review frequency increased if there are any changes to their medication, underlying pain syndrome or comorbidities.

Answer 22

annually

Question 23

Non-opioid analgesics used in the management of chronic pain include ______________ and _______________ (in both oral and topical forms)

Answer 23

paracetamol

non-steroidal anti-inflammatory drugs

Question 24

The use of ______________ analgesics is preferred to allow for independent titration of each drug; however, _________________ may be considered for those with stable chronic pain

Answer 24

single-ingredient

fixed dose combination analgesics (except those with low-dose opioids)

Question 25

The use of single-ingredient analgesics is preferred to allow for _________________; however, fixed dose combination analgesics (except those with ____________) may be considered for those with _______________

Answer 25

independent titration of each drug

low-dose opioids

stable chronic pain

Question 26

Opioid analgesics can be divided into those used for mild-to-moderate pain (such as ______________) and those used for moderate-to-severe pain (such as ___________ or ____________).

Answer 26

codeine phosphate

morphine

oxycodone

Question 27

Opioid analgesics can be divided into those used for _______________ pain (such as codeine phosphate) and those used for ______________ pain (such as morphine or oxycodone hydrochloride).

Answer 27

mild-to-moderate

moderate-to-severe

Question 28

Opioids should only be considered in carefully selected individuals for the _________- to ________-term treatment of chronic ____________ pain, when other therapies have been insufficient

Answer 28

short

medium

non-malignant

• the benefits should outweigh the risks of serious harms (such as addiction, overdose and death)

Question 29

With continuous longer-term use of opioids, ___________ and _____________ compromise both safety and efficacy

Answer 29

tolerance

dependence

Question 30

When starting treatment with an opioid there should be an agreement between the prescriber and patient about the expected outcomes—with advanced agreement on the ___________ and ____________ of the opioid if these are not met

Answer 30

reduction

cessation

Question 31

Opioids should be reviewed at least _____________ but more frequently if required; consideration should be given to a _____________ reduction of the opioid to the lowest effective dose or complete cessation

Answer 31

annually

gradual

Question 32

Pain specialist advice or review should be sought for individuals taking doses >____ mg/day morphine equivalent

Answer 32

90

Question 33

There is a rationale for switching between opioids if the initial choice is _____________ or if _______________.

Answer 33

ineffective

side-effects are unacceptable

Question 34

What are the adjuvant analgesics used in the management of chronic pain? (8)

Answer 34

1. Antidepressants
2. Antiepileptics
3. Benzos and other muscle relaxants
4. Bone-modulating drugs
5. Corticosteroids
6. Topical capsaicin
7. Lidocaine
8. Rubefacients

Question 35

What are rubefacients?

Answer 35

Class of drugs that cause irritation and reddening of the skin due to increased blood flow eg salicylate, menthol, camphor; used as adjuvants in the treatment of chronic pain