Chronic Pain

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. An example of acute pain is:

a) migraine headache
b) a painful procedure
c) sickle cell crisis
d) postsurgical pain

2. Chronic pain is associated with changes in physiological responses and behavioral responses including _____________ ____________.

a) financial distress
b) sleep deprivation
c) severe depression
d) pain perception

3. Nociception is the process of detection and transmission of pain signals from the site of injury to the:

a) central nervous system
b) peripheral nervous system
c) brain stem
d) medulla

4. Fibromyalgia is a ___________ and the cause is not known.

a) disease
b) syndrome
c) neuralgia
d) neuropathy

5. The leading cause of worker disability in the United States is:

a) the common cold
b) infections
c) back disorders
d) carpal tunnel syndrome

6. The treatment goals of chronic pain are to:
  1. reduce duration
  2. reduce pain severity
  3. improve function
  4. cure the pain

a) all the above
b) all but 4
c) 2 and 3
d) 1 and 2

7. ________________ is the conscious production or exaggeration of physical symptoms for secondary gain and ______________ is considered to be an unconscious process.

a) Somatization, malingering
b) Malingering, somatization

8. A common comorbidity in chronic pain is:

a) sleep disorders
b) gastrointestinal symptoms
c) physical complaints
d) sexual symptoms

9. One reason it is difficult to obtain accurate estimates of the prevalence of depression and chronic pain is because there are overlapping symptoms.

a) TRUE
b) FALSE

10. Completed suicides in the chronic pain population occur at ______ - ______ times the rate of those in the general population.

a) 1,2
b) 2,3
c) 3,4
d) 4,5

11. Generalized anxiety disorder is characterized by excessive worry or apprehension lasting at least six weeks.

a) TRUE
b) FALSE

12. A need for a higher and higher dose of an opioid to achieve the same pain-relieving effect is called:

a) addiction
b) physical dependence
c) substance abuse
d) tolerance

13. Pseudoaddiction mimics addictive behavior but:

a) resolves when pain is adequately treated
b) is shorter in duration
c) can be life threatening
d) produces physical and psychological addiction

14. Which pain tool is most appropriate for the pediatric patient:

a) Verbal Rating Scale
b) Visual Analog Scale
c) Picture Scale
d) Numerical Rating Scale

15. If pain and level of disability were consistent with the degree of injury or other physical findings, it was considered to be:

a) psychogenic
b) physiological
c) a somatoform disorder
d) somatogenic

16. The “gating” mechanism in the gate-control theory:

a) was developed by Wilbur Fordyce
b) is at the site of pain
c) is located at the dorsal horn of the spinal cord
d) requires opioids to control

17. In the operant conditioning model, family members are taught about:
  1. pain
  2. wellness and illness behavior
  3. reinforcement contingencies
  4. ways to maintain treatment gains in the home

a) 2 and 4
b) 1 only
c) 3 only
d) all the above

18. Cognitive-behavioral therapy requires active involvement from the patient and __________.

a) physician
b) therapist
c) family
d) psychologist

19. Multidisciplinary treatment of pain led to:

a) pain clinics in the 1940s and 1950s to serve the needs of soldiers injured in World War II
b) the development of the biopsychosocial model of 1977
c) behavioral treatment using positive and negative reinforcers
d) cognitive therapy for chronic pain, PTSD, alcohol dependence and anxiety

20. When the patient states “nothing helps” regarding pain treatment, there may be depression, fear, or secondary gain interference.

a) TRUE
b) FALSE

21. This tool provides information about pain intensity, quality, emotional responding with subscales for sensory and affective dimensions.

a) Visual Analog Scale
b) Numerical Rating Scale
c) Pain Drawing
d) McGill Pain Questionnaire

22. A statement which represents overgeneralizing is:

a) “Nobody understands what I am going through.”
b) “I should be able to clean the house like I did before.”
c) “If my pain continues like this, I’ll end up in a wheel chair.”
d) “If I can’t keep up with my friends when we shop, there is no point in going with them.”

23. Five symptoms must be present nearly every day for at least two weeks with significant impairment in social, occupational or other areas of functioning is the definition of:

a) acute depression according to the Beck Depression Inventory
b) major depressive disorder according to DSM – IV criteria
c) suicidal tendencies according to the Epidemiological Studies and Depression Scale
d) major depression according to the DSM – IV criteria

24. Suicide occurs in the chronic pain population at a lower rate than the general population.

a) TRUE
b) FALSE

25. The primary goal of psychological interventions for the patient with chronic pain is:

a) decreasing their pain with opioids
b) assessing for anxiety and substance abuse
c) increasing pleasurable activities with family and friends
d) improving their ability to engage in normal daily activities

26. Anger is not a psychiatric disorder.

a) TRUE
b) FALSE

27. Which of the following risk factors would decrease the prognosis for a positive surgical outcome:

a) active psychosis
b) depression and suicidal ideation
c) current litigation or worker’s compensation
d) dementia

28. Which of the following behaviors are used by adults to express pain:
  1. crying out
  2. limping
  3. requesting assistance
  4. filing for disability

a) 1 and 2
b) 1, 2, and 3
c) 3 only
d) all the above

29. Which of the following is a nonopioid analgesic:

a) Ultram
b) Naprosyn
c) Vicodin
d) Darvocet

30. Which of the following are adverse effects of long-term use of opioids:
  1. impotence
  2. sweating and/or chills
  3. depression
  4. decrease in appetite
  5. vivid dreams

a) 1, 2, and 3
b) 1, 3, and 5
c) 4 and 5
d) all the above

31. Adjuvant analgesics may include anticonvulsants, antidepressants, and antipyretics.

a) TRUE
b) FALSE

32. The cost, complexity and risk of this therapy limits its use to cases of truly, intractable, incapacitating pain:

a) neurolytic techniques
b) medial branch nerve block
c) spinal analgesic infusion pump
d) radiofrequency ablation

33. Group sessions of CBT have the advantage of:
  1. social interaction
  2. peer support, modeling adaptive behavior
  3. tailoring treatment to specific needs
  4. sharing ideas, mutual validation of experiences

a) 1 and 2
b) 1, 2, and 4
c) all but 1
d) all the above

34. William Fordyce based his pain management program on the concept of:

a) effective communication
b) identifying dysfunctional thoughts and beliefs
c) operant conditioning
d) the gate-control theory

35. Which of the following are elements of all goals:
  1. goals should be attainable in small increments
  2. goals should be realistic
  3. goals should be desirable
  4. goals should be “patient-centered”

a) all but 1
b) 2 only
c) all but 4

36. According to Michael Nicholas, who developed suggestions for pacing, an increase of pain by more than two points when engaging in a task would require the person to:
  1. decrease time spent on the task
  2. perform stretching exercises
  3. spen

a) 1 and 2
b) 2 and 3
c) 1 and 4
d) all the above

37. Alternately tensing and relaxing the muscles is the definition of:

a) progressive relaxation
b) passive relaxation

38. Using autogenic techniques eliminates the dependence on a therapist or hypnotist.

a) TRUE
b) FALSE

39. Which of the following characteristics of hypnosis make it useful for managing pain:
  1. the subject will be asleep
  2. physical relaxation occurs
  3. there is an openness to suggestion
  4. the attention field is narrowed

a) all but 3
b) 2, 3, and 4
c) 1 and 3
d) all the above

40. This type of biofeedback is for subjects with Raynauds disease and migraine headaches and involves the use of a thermistor.

a) thermal biofeedback
b) electromyographic biofeedback

41. The efficacy of cognitive-behavioral therapy is difficult to evaluate because:
  1. studies vary in the definition of successful treatment outcome
  2. pain scales with control groups are difficult to ascertain
  3. many patients are taking prescr

a) all but 2
b) 1 and 2
c) 3 and 4
d) all the above

42. In this type of therapy, massage and chiropractic treatment is used:

a) mind-body connections
b) energy therapy
c) acupuncture
d) manipulation therapy

43. In this type of massage, focus is directed to small muscle spasms that develop after damage to a muscle:

a) sports massage
b) Shiatsu and traditional Thai massage
c) trigger point or pressure point massage
d) Swedish massage

44. One of the barriers to implementation of psychological treatment of chronic pain is the reliance on the _________ _________ in many settings.

a) proposed treatment
b) medical model
c) support groups
d) self-regulatory techniques

45. According to Green and colleagues (2003), analgesics given to patients in the emergency department revealed which of the following – even when injuries and pain ratings were comparable:

a) Hispanics and Blacks received higher dosages of analgesic medication than non-Hispanic Whites
b) Hispanics and Blacks received fewer analgesic medications compared to non-Hispanic Whites
c) non-Hispanic Whites, Hispanics, and Blacks received the same amount of analgesic medication