Pain management

Question 1

Which of the following is false in terms of pain management?

a) Chronic pain is defined as pain present for a period greater than 3 months or pain present for 4 weeks than expected time for recovery
b) Paracetamol due to its excellent safety in therapeutic doses makes it first line analgesic for mild to moderate pain
c) It should be administered with caution in patients with kidney and liver dysfunction
d) GI discomfort, ulceration and bleeding are not associated with aspirin use
e) Codeine is methylmorphine which is metabolised to morphine and not shown to be more effective than 600mg of aspirin

Answer 1

d) GI discomfort, ulceration and bleeding are not associated with aspirin use

Question 2

Which of the following statements are not true regarding opioid pain management?

a) Morphine is the most effective and gold standard relief of cancer pain
b) Injections of morphine are most effective than oral administration in achieving pain relief
c) It should be titrated according to patient needs
d) Methadone is unsuitable for acute pain but valuable in chronic pain
e) Hydromorphone is structurally similar to morphine but about five times more potent

Answer 2

b) Injections of morphine are most effective than oral administration in achieving pain relief

Question 3

Which of the following are not true about opioid use in pain management?

a) The advantages of tramadol are minimal sedation and low abuse potential
b) Vertigo, nausea, tremor and somnolescence are known side effects of tramadol
c) Buprenorphine is not useful in the management of opioid dependence
d) Neonates do feel and remember pain
e) If a child complains of pain, they are serious and it is organic until proven otherwise

Answer 3

c) Buprenorphine is not useful in the management of opioid dependence

Question 4

Which of the following are not true about opioid use in pain management?

a) Aspirin not used in < 18 years due to risk of Reye syndrome
b) Contraindications to NSAID use include hypersensitivity, severe asthma, bleeding disorders, nasal polyposis and peptic ulcer disease
c) For ongoing pain, aim prn pain relief rather than fixed times
d) Aspirin, ibuprofen, indomethacin and diclofenac have shorter half lives
e) Naproxen and piroxicam have a long half life and useful in treatment of chronic pain such as bony metastases

Answer 4

c) For ongoing pain, aim prn pain relief rather than fixed times

Question 5

Individuals at higher risk from NSAID induced side effects include all of the following except

a) Age >65 years
b) Prior ulcer disease or complication
c) High dose, multiple NSAIDs and duration > 3 months
d) Concomitant corticosteroid therapy
e) Male sex

Answer 5

e) Male sex

Question 6

Which of the following is not true with regards to NSAIDs?

a) There is evidence that using enteric coated NSAID or rectal route reduces gastric damage
b) H2 receptor antagonists have low or no role in preventing NSAID gastrointestinal complications
c) An anti-inflammatory dose of fish oil should be considered as part of long-term treatment to minimise NSAID use
d) COX-2 inhibitors have less GI side effect but have increased risk of BP, thrombosis and impairment of kidney function
e) Ibuprofen is usually first choice in elderly and intermittent doses for maximum of 14 days work well in chronic conditions

Answer 6

a) There is evidence that using enteric coated NSAID or rectal route reduces gastric damage

Question 7

Which of the following are not true about neuropathic pain?

a) Mostly refractory to NSAIDs
b) Phantom limb pain, post herpetic neuralgia and trigeminal neuralgia are some examples
c) Amitryptyline/gabapentin is first line
d) Amitryptyline is first line for trigeminal neuralgia
e) Drowsiness, dizziness and generalised fatigue are side effects of gabapentin

Answer 7

d) Amitryptyline is first line for trigeminal neuralgia (Carbamazepine)

Question 8

All of the following are causes of peripheral neuropathy except?

a) Alcoholism
b) Diabetes/PVD
c) B12 deficiency
d) Uraemia
e) Venous insufficiency

Answer 8

e) Venous insufficiency

Question 9

Which of the following is true regarding peripheral neuropathy?

a) Doses of TCAs are much larger than those for depression
b) Gabapentin has no proven efficacy for diabetic neuropathy and post-herpetic neuralgia
c) First line treatment is TCAs and then gabapentin
d) Carbamazepine is not the drug of choice for trigeminal neuralgia
e) Pain due to a stimulus that does not provoke pain is called anaesthesia dolorosa

Answer 9

c) First line treatment is TCAs and then gabapentin
e) Allodynia