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1. Chronic noncancer pain (CNCP) is common in the general population as well as in people who have a substance use disorder (SUD), and it has physiological, social, and psychological dimensions that can seriously harm health, functioning, and well-being
A. True
B. False
2. The term that encompasses substance use issues, mental health issues, and the prevention of both is:
A. Psychosocial health
B. Emotional health
C. Behavioral health
D. Environmental health
3. Both pain and responses to pain are shaped by culture, temperament, psychological state, and:
A. Memory and cognition
B. Beliefs and expectations
C. Co-occurring health conditions, gender, and age
D. All of the above
4. Chronic pain often results from a process of neural sensitization following injury or illness in which thresholds are lowered, which is known as hyperalgesia.
B. True
C. False
5. The primary rewarding effects of addictive substances occur in the cortico-mesolimbic dopamine systems, where several structures link to control the basic emotions and connect them to memories, which drive behavior.
A. True
B. False
6. Which of the following is NOT an accurate statement about cross-addiction?
A. Cross addiction occurs when an individual who voluntarily or involuntarily decreases use of one substance may increase use of another substance with similar effects on the brain
B. Cross-addiction is now considered diagnostic nomenclature as it refers to a person with an addiction to one substance who may develop addiction to a subsequent substance
C. Individuals with chronic pain and histories of SUDs may be at increased risk of cross-addiction to any medication that acts on the brain as a reinforcing agent
D. Because of cross-addiction, persons who abuse marijuana may be at increased risk for opioid addiction
7. People with alcohol use disorders have been found to be approximately 12 times as likely to report nonmedical use of prescription medications as people who do not drink.
A. True
B. False
8. Standardized instruments provide ways to assess and track patient pain levels, __________, substance use, and other factors important to managing CNCP.
A. Function
B. History
C. Stability
D. Emotional state
9. Contingency elements of a comprehensive patient assessment include:
A. Findings of other clinicians, prior and current
B. Pharmacist concerns, where relevant
C. Data from state electronic prescription monitoring programs
D. Family support of wellness versus illness behavior
10. Clinicians are especially likely to underestimate and, therefore, to under treat pain and disability in:
A. Adolescents
B. People with mental illness
C. Young men
D. The elderly
11. When initiating a conversation about alcohol and drug use, clinicians should approach the topic matter-of-factly and incorportate questions about drug and alcohol use into a general behavioral health inventory.
A. True
B. False
12. Criteria for substance abuse includes which of the following?
A. Tolerance, as defined by either of the following: (a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect, or (b) markedly diminished effect with continued use of the same amount of the substance
B. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
C. Withdrawal, as manifested by either of the following: (a) the characteristic withdrawal syndrome for the substance, or (b) the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
D. There is persistent desire or unsuccessful efforts to cut down or control substance use
13. The Alcohol Use Disorders Identification Test (AUDIT) is a 20 question yes/no screening tool which addresses questions about current and past use.
A. True
B. False
14. Adults with chronic pain often exhibit fear about the loss of control over routine aspects of daily life and experience apprehension that clinicians will view their pain reports as exaggerated, imaginary, or contrived.
A. True
C. False
15. Somatization, an inordinate preoccupation with and communication about physical symptoms, is a common disorder in patients who have chronic pain.
A. True
B. False
16. The patient’s belief that there is more to life than pain, that being completely free of pain is unrealistic, and that activities should be pursued, even at the price of some increase in pain is known as:
A. Self-efficacy
B. Compliance
C. Recognition
D. Acceptance
17. Patients who have a history of injected-related diseases are at high risk of developing problematic opioid use
A. True
B. False
18. The clinician should regularly assess all patients who have CNCP to determine adherence to the recommended treatment modalities and to assess patient reactions to the treatment regimen.
A. True
B. False
19. Treatment plan elements that should be documented during patient visits include each of the following EXCEPT:
A. Pharmacological and nonpharmacological treatments
B. Treatment goals and anticipated time course
C. Informed consent which includes patient's responsibilities and clinic policies
D. Adherence measures
20. The vast majority of chronic pain syndromes in patients who do not have major psychopathology or histories of SUDs are managed by primary care physicians rather than specialists.
A. True
B. False
21. A multidisciplinary team approach to chronic pain management provides a breadth of perspectives and skills that can enhance outcomes and reduce stress on individual providers.
A. True
B. False
22. Addiction specialists can make significant contributions to the management of chronic pain in patients who have SUDs and may reinforce behavioral and ________ components of pain management.
A. Self-care
B. Psychological
C. Functional
D. Social
23. Benzodiazepines pose significant risk for addiction relapse and functional impairment when used to treat chronic pain.
A. True
B. False
24. Common nonpharmacological therapies for CNCP include each of the following EXCEPT:
A. Therapeutic exercise
B. Physical therapy (PT)
C. Interpersonal therapy
D. Complementary and alternative medicine
25. Many antidepressants are effective for chronic pain and may be used to treat comorbid anxiety and depression, and both desvenlafaxine and milnacipran have been approved by the Food and Drug Administration for treatment of generalized anxiety disorder.
A. True
B. False
26. Serotonin syndrome, a potential adverse effect of both opioids and some medications used to treat behavioral health disorders, can cause agitation, confusion, fever, and seizures, and it can be lethal if undetected or untreated.
A. True
B. False
27. Which of the following is NOT one of the recommendations for reducing the euphoric effects of opioids for patients with histories of SUDs?
A. Select opioids with minimal rewarding properties (e.g., tramadol, codeine), when effective
B. Avoid prescribing supratherapeutic doses (usually demonstrated by presence of sedation, lethargy, functional impairment)
C. If higher potency opioids are required, prescribe slow-onset opioids with prolonged duration of action
D. Use short-acting medications preemptively before activities known to cause pain or for pain limited to certain times of the day
28. For patients on chronic opioid therapy who have minor relapses and quickly regain stability, provision of substance abuse counseling may suffice.
A. True
B. False
29. To optimize the analgesic efficacy of buprenophine, the drug should be given 4-5 times a day when pain reduction is a goal.
A. True
B. False
30. Tolerance develops rapidly to the sedating, euphoric, and _________ effects of opioids.
A. Analegisic
B. Anxiolytic
C. Constipating
D. None of the above
31. When an opioid is ineffective, becomes ineffective, or produces intolerable side effects, it is common practice to rotate opioids, based on the observation that particular opioids affect people differently.
A. True
B. False
32. Those who are on agonist therapy for addiction or pain may be continued on their current opioid or on an equivalent dose of an alternative, which should be expected to control acute pain.
A. True
B. False
33. Patients with HIV/AIDS are often both indigent and negatively viewed by clinicians, conditions that lead to reduced access to pain care, and the patients may be sick, frail, and cachectic, creating challenges in the use of pharmacotherapies.
A. True
B. False
34. In the context of pain treatment, a _______________ approach refers to a minimum standard of care applied to all patients who have CNCP, whatever their assessed risk.
A. Global protection
B. Comprehensive safeguard
C. Universal precautions
D. General cautionary
35. Factors that may impact how often chronic pain patients visit a clinician include history of SUDs and each of the following EXCEPT:
A. The degree to which the patient’s support network is monitoring progress
B. The complexity of pain diagnosis
C. The medications being prescribed
D. The status of the pain management
36. Immunoassays (IA) have limited utility for monitoring adherence to opioid treatment, so a “no limits” test to identify small amounts of substances or specifically sought substances may be needed.
A. True
B. False
37. Behavior that suggests substance misuse, abuse, or addiction is known atypical drug-related behavior.
A. True
B. False
38. Tools such as the Addictions Behaviors Checklist and the Current Opioid Misuse Measure have been shown to have substantial validity in determining whether opioids have become a problem for the patient.
A. True
B. False
39. A clinician may demonstrate empathy by specifically acknowledging the effort required to cope with pain daily, and should educate patients so they form reasonable expectations about outcomes.
A. True
B. False
40. SIGNS of opioid withdrawal include:
A. Abdominal cramps, nausea, and vomiting
B. Anxiety and insomnia
C. Hypertension and fever
D. Bone and muscle pain
41. In cases in which the clinician-patient relationship is hostile or dangerous or in which the patient presents a danger to the clinician, it is acceptable for the clinician to discharge the patient verbally with face-to-face contact or to do so over the phone.
A. True
B. False
42. Numerous randomized trials have specifically evaluated the effect of patient education on treatment outcomes and have determined that adequate education improves adherence and completion of treatment goals.
A. True
B. False
43. The specifics of patient education vary from patient to patient and over time, but general content areas for patient education include information about:
A. The patient’s condition and the nature of the patient’s chronic pain
B. Treatments available, including risks and benefits
C. How and when to take medications and medication interactions
D. All of the above
44. If a clinician chooses to use an opioid treatment agreement, it should include all of the following stipulations EXCEPT:
A. Emphasize opioid use as a part of a comprehensive pain management plan that also includes physical therapy, counseling, and other medications for co-occurring disorders, as needed
B. Emphasize the patients’ responsibility to work with their family and other support systems to ensure adherence to treatment
C. Explain that the agreement protects the patient’s access to scheduled medications and protects the clinician’s license to prescribe them
D. Describe behaviors that are incompatible with chronic opioid therapy
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