Pain Management

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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

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

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

Total Knee Replacement

What percentage of total knee replacements last 25 years?

  • 20%
  • 40%
  • 60%
  • > 80%
Volume 35.61 - Question 27

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

Celiac Plexus Neurolysis

Which one of the following statements about celiac plexus neurolysis is false? 

  • Anticoagulation that cannot be stopped is a contraindication.   
  • Common side effects include transient diarrhea.   
  • The median duration of benefit is four to six months.    
  • There is a high risk of paresthesias. 
Volume 36.2 - Question 13

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

Epidural Infusions in Palliative Care

Epidural infusions of local anesthetic combined with opioids can be an effective therapy for patients with intractable cancer pain in the trunk and / or lower extremities and life expectancies of days to weeks. 

  • True
  • False
Volume 36.1 - Question 10

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

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

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.
Volume 38.5 - Question 42

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