Trigger Point Injections for Myofascial Pain
Trigger point injections with bupivacaine in combination with standard therapy for myofascial pain syndrome of the low back are superior to standard therapy alone.
- True
- False
Pain Management
Treatment of Vertebral Compression Fractures
Which one of the following statements about the treatment of vertebral compression fractures is false?
- Initial therapy for pain includes nonsteroidal anti-inflammatory drugs and acetaminophen.
- Bisphosphonates are recommended to improve pain.
- Bracing beyond 8 weeks is recommended.
- Physical activity initiated within 2 weeks of fracture may contribute to greater vertebral collapse.
Volume 41.3 - Question 17
Pain Management in IUD Insertion
Misoprostol use during intrauterine device insertion is associated with increased pain.
- True
- False
Volume 41.3 - Question 11
Ibuprofen for Pediatric Pain
For children aged 6 to 17, with acute nonoperative limb injury, pain scores at 60 minutes after drug administration improved with ibuprofen plus acetaminophen compared with ibuprofen alone.
- True
- False
Volume 41.3 - Question 10
Prevention of Episodic Migraine Headache
A 37-year-old woman presents with recurrent headaches. The headaches occur once or twice a week. She describes them as very painful, pounding, and always on one side of the head, accompanied by sensitivity to light and sound. She is otherwise healthy and uses only ibuprofen, which provides partial relief. She has never tried other abortive medications. The headaches last 5–7 hours, improve in a dark room, and have occurred about twice a week for several years, significantly affecting her quality of life. Physical examination shows no neurological deficits or other abnormalities. You diagnose her with episodic migrane, you discuss treatment options with her. She is interested in preventive therapy.
Volume 41.2 - Question 39
Fibromyalgia
Which one of the following treatments has not been shown to be an effective treatment for fibromyalgia?
- Pregabalin
- Duloxetine
- Desvenlafaxine
- Pramipexole
Volume 41.2 - Question 33
Prophylactic Laxatives to Prevent Opioid Induced Constipation
Prophylactic laxatives are associated with a reduced incidence of opioid induced constipation.
- True
- False
Volume 41.1 - Question 21
Gabapentinoids and Heart Failure
Compared to new users of gabapentin, new users of pregabalin had higher rates of incident heart failure hospitalizations in patients aged 65 to 89 years with chronic non cancer pain and no history of heart failure.
- True
- False
Volume 41.1 - Question 23
Neuropathic Pain
Which one of the following statements about the treatment of neuropathic pain is false?
- Duloxetine results in at least a 50% reduction in pain.
- There is good evidence to support the use of venlafaxine.
- Pregabalin at dosages of 300 mg/day or greater leads to at least moderate benefit.
- Topiramate has no benefit.
Volume 41.1 - Question 22
Methoxyflurane for Traumatic Pain
For acute traumatic pain management in the Emergency Department, methoxyflurane can significantly reduce pain scores with pain relief occurring within 10-30 minutes.
- True
- False
Volume 41.1 - Question 17
Risk of Fall with Gabapentin vs Duloxetine
In older patients with diabetic neuropathy, postherpetic neuralgia, or fibromyalgia, treatment with gabapentin is associated with increased fall-related inpatient or outpatient visits compared to treatment with duloxetine.
- True
- False
Volume 40.6 - Question 7
Chronic Axial Spine Pain
In the treatment of chronic non-cancer axial spine pain, epidural injection of local anaesthetic and steroids provides significant relief.
- True
- False
Volume 40.5 - Question 20
Metformin for Osteoarthritis
In patients with knee osteoarthritis and overweight or obesity, metformin, 2000 mg/d, for 6 months had a moderate and statistically significant effect on knee pain reduction compared with placebo.
- True
- False
Volume 40.5 - Question 19
Nebulized Ketamine for Pain
Nebulized ketamine provides equivalent analgesia for acute pain in the emergency department compared to IV morphine.
- True
- False
Volume 40.5 - Question 17
Opioids for Headache
Opioid prescriptions for headache in the emergency department are associated with higher rates of long-term prescription opioid use.
- True
- False
Volume 40.5 - Question 11
Acupuncture for Sciatica
When compared to sham acupuncture, acupuncture resulted in less pain in patients with chronic sciatica from herniated disk.
- True
- False
Volume 40.4 - Question 23
Placebo Injections for Back Pain
A single nondeceptive placebo injection for chronic back pain reduces pain intensity more than usual care.
- True
- False
Volume 40.1 - Question 24
Telehealth Mindfulness-Based Interventions for Chronic Pain
Among veterans with chronic pain, telehealth mindfulness-based interventions improve pain-related function compared to usual care.
- True
- False
Volume 40.1 - Question 23
TENS for Diabetic Neuropathy
Treatment with transcutaneous electrical nerve stimulation (TENS) is preferable compared with other neuromodulatory techniques for the treatment of painful diabetic neuropathy.
- True
- False
Volume 39.5 - Question 32
Low- vs High-dose Dexamethasone for Patients with Moderate to Severe Migraine
When treating patients with migraine with both IV metoclopramide 10mg and IV dexamethasone, 16 mg of dexamethasone is more effective than 4mg.
- True
- False
Volume 39.4 - Question 25
Gabapentin and Chronic Pelvic Pain
Gabapentin significantly lowers pain scores in women with chronic pelvic pain with no obvious pelvic pathology at laparoscopy.
- True
- False
Volume 36.4 - Question 6
Postoperative Pain Management
Comparing NSAIDs with codeine in postoperative pain management in adults who undergo out-patient surgery, NSAIDs are more commonly associated with all of the following except:
- Lower pain scores
- Increased nausea
- Decreased drowsiness
- Decreased dizziness
Volume 37.1 - Question 14
Topical Analgesics
Which one of the following statements about topical NSAIDs in the treatment of acute pain is false?
- They provide up to 50% pain relief compared with placebo.
- The rates of local adverse events with topical NSAIDs are increased compared to topical placebo.
- They are a first line therapy for acute non-low back musculoskeletal pain.
- They have a low risk of gastrointestinal bleeding.
Volume 37.1 - Question 4
Cannabinoids for Pain
Moderate certainty evidence shows that among patients with chronic pain, non-inhaled medical cannabis or cannabinoids results in a small to very small improvement in pain.
- True
- False
Volume 37.1 - Question 3
Chest Wall Pain
CC, a 45-year-old female, has an office visit today because she has been experiencing bilateral parasternal chest wall pain for the past week. Deep breaths, coughing, and stretching exacerbate her chest wall pain. The upper second through fifth costochondral and costosternal junctions are the areas where she experiences most of her pain. She was seen a few days ago in the emergency department and she was told that she had a chest wall condition.
Volume 37.2 - Question 32
Medical Cannabis
Medical cannabis taken orally results in a very small improvement in physical functioning in patients with chronic pain.
- True
- False
Volume 37.2 - Question 1
Family Caregiver Challenges in Pain Management
In the setting of pain management for patients with advanced illness, about 30% of family caregivers are hesitant to administer analgesics for their care partners.
- True
- False
Volume 38.1 - Question 30
Painful Diabetic Neuropathy
Which one of the following approaches is most effective in treating painful diabetic neuropathy not well controlled with monotherapy?
- Amitriptyline supplemented with pregabalin.
- Pregabalin supplemented with amitriptyline.
- Duloxetine supplemented with pregabalin.
- There is no difference between the three options.
Volume 38.1 - Question 22
Physical Activity for Chronic Pain
In patients with osteoarthritis and/or chronic low back pain, wearable activity trackers increase physical activity in addition to counseling and education.
- True
- False
Volume 37.5 - Question 33
Problems with Opioids
Which one of the following statements about opioid use is false?
- Tolerance usually develops rapidly to the constipating effect of opioids.
- Opioid hyperalgesia has been reported in some patients treated with high doses of opioids.
- Use of morphine has been associated with an increased risk of myocardial infarction in patients taking clopidogrel after an acute coronary syndrome.
- Intranasal naloxone should be offered to opioid-treated patients who are also taking gabapentinoids.
Volume 38.4 - Question 22
Topical Nonsteroidal Anti-Inflammatory Drugs
Which one of the following statements about topical NSAIDS is false?
- They provide effective pain relief for acute strains and sprains.
- They are safer than oral NSAIDS.
- Systemic uptake is limited to around 5%
- They provide inferior pain relief to oral NSAIDS for patients with chronic osteoarthritis.
Volume 39.1 - Question 38
Buprenorphine Therapy and Acute Pain
Buprenorphine should be discontinued when treating acute pain.
- True
- False
Volume 38.3 - Question 32
Group Based Interventions for Opioid Reduction
A group based educational intervention supplemented by 1-on-1 support delivered for 12 months can reduce opioid use among patients using opioids for chronic non-malignant pain.
- True
- False
Volume 39.2 - Question 41
Fibromyalgia
A 45-year-old female patient comes to see you in follow-up. She is known for arthrosis and a long-standing issue with chronic pain. She states today that she feels exhausted and has pain “all over”. Her physical exam doesn’t reveal any sign of inflammation. You are considering a diagnosis of fibromyalgia.
Volume 38.6 - Question 43
Patient Satisfaction With Medical Care for Chronic Low Back Pain
Patient satisfaction with medical care for chronic low back pain is strongly associated with physician empathy.
- True
- False
Volume 38.6 - Question 33
Migraine
A 30-year-old patient presents to your office. She has had migraines since adolescence. Today she asks you how to manage the headaches and what you know about the new treatments for migraine.