Deck 50: Chronic Non-Malignant Pain Management

Question 1

Which statement about chronic nonmalignant pain (CNP) is false?

A) Anxiety and depression are common comorbid conditions.
B) CNP often interferes with a person's work and personal life.
C) It is rarely associated with autoimmune inflammatory conditions.
D) It affects more Americans than other leading causes of illnesses combined.

Answer 1

C

Question 2

Ms. D is a 40-year-old female, who has chronic low back pain, is being considered for chronic opioid therapy. You completed an opioid risk assessment. The assessment revealed that she has a brother and father with a history alcohol abuse. Based on this information, you would consider which of the following statements to be true:

A) She is at low risk for opioid-related aberrant behaviors.
B) She is at moderate risk for opioid-related aberrant behaviors.
C) She is at high risk for opioid-related aberrant behaviors.
D) None of the above statements are accurate, given her age and sex.

Answer 2

B

Question 3

One difficulty of managing opioid therapy for patients with chronic nonmalignant pain is that some persons may present with a history of risky behaviors or a potential for or history of substance abuse. To adequately assess the related risk, it is important to have a clear understanding of relevant terminology. One such term is pseudoaddiction, which refers to a person with:

A) A compulsive use of controlled substances that results in physical, psychological, and social harm to the user
B) Normal physiologic consequences of extended opioid therapy
C) A psychiatric disorder that is often mistaken as a substance abuse disorder
D) Relief-seeking behaviors, which resolve upon institution of effective analgesic therapy

Answer 3

D

Question 4

An adverse effect associated with chronic methadone therapy but not with other long-acting opiates includes:

A) A prolonged QT interval via electrocardiogram
B) Constipation
C) A distended bladder
D) Pruritus

Question 5

Mr. T and his primary care provider have developed, agreed upon, and signed a chronic pain agreement. Mr. T. has a comprehensive pain management plan that includes the use of a long-acting opiate. A major agreement break would include:

A) Missed appointments
B) Refusal for a urine toxicology screen
C) Seeking medications from another prescriber
D) None of the above

Question 6

Which reason is false as to why long-acting opiates are preferred to short-acting opiates in chronic nonmalignant pain management?

A) Long-acting opiates are easier than short-acting opiates to titrate up and down.
B) Short-acting opiates tend to cause rebound pain and headaches.
C) Short-acting medications have increased dependence and addiction potential.
D) Due to longer half-life, long-acting opiates can be taken less frequently at lower doses.

Question 7

Above what dose of acetaminophen do you have to be cautious when administering opiate medications to the elderly?

A) 4,000 mg/day
B) 4,000 mg/dose
C) 2,000 mg/day
D) 3,000 mg/day

Question 8

Why is the fentanyl patch not appropriate for opiate-naive individuals?

A) 10% of people do not metabolize this drug well, so they do feel effective relief.
B) It can cause rebound pain due to a short half-life.
C) It requires frequent and regular electrocardiogram monitoring.
D) Due to a variable and long half-life, some individuals report difficulty with pain relief after 48 hours.

Question 9

How is methadone dosed for chronic nonmalignant pain management?

A) Every 4 to 6 hours as needed due to a short half-life
B) Dosing methadone for opiate addiction and chronic pain is the same
C) Slow and gradual titration up and down due to highly variable half-life
D) Once daily dosing

Question 10

Ms. B has chronic hip pain due to osteoarthritis and recently has been taking up to six of her short-acting hydrocodone-acetaminophen tablets daily due to decreased time periods of pain relief with her regular regimen of four tablets per day. As a result, she runs out of her medication 5 days before her monthly refill. Which is the best strategy to address her chronic pain?

A) Physiologic dependence is common in chronic pain management and we should increase her total daily tablets to six hydrocodone-acetaminophen.
B) This is her first contract violation. Her pain meds should be tapered off.
C) She should be cross-tapered to a long-acting opiate to decrease rebound pain.
D) She should be referred to an opiate-addiction program because she is obviously displaying addictive behavior.