McGraw-Hill Specialty Board Review Pain Medicine

Salahadin Abdi, Pradeep Chopra, Howard Smith

Chapter 11 Behavioral and Psychological Aspects of Pain - all with Video Answers

Educators

Chapter Questions

Problem 833

Primary affective symptoms that are present with chronic pain
(A) generally resolve when the pain is treated adequately
(B) require treatment independent of the pain
(C) are rare among the elderly
(D) are always reactive or secondary to the pain
(E) require thorough assessment by a psychopharmacologist

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Problem 834

Which of the following include risk factors for completed suicide?
(A) Age
(B) Substance abuse
(C) History of prior suicide attempts
(D) Chronic medical conditions
(E) All of the above

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02:25

Problem 835

Tricyclic antidepressants
(A) have been shown to assist with reducing neuropathic pain
(B) have been shown to assist with chronic headache
(C) should be closely monitored in depressed patients because of suicide risk and possible lethality of an overdose
(D) have been infrequently used in the treatment of major depression
(E) A, B, and C

Akash M

Numerade Educator

Problem 836

Substance abuse risk assessment
(A) is required as a minimum standard of care with chronic pain
(B) is poorly conducted by most physicians
(C) can reduce medico-legal risk when chronic opioid therapy is being considered
(D) can be improved by use of brief, standardized screening questionnaires
(E) all of the above

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02:31

Problem 837

Patient self-report data is
(A) highly reliable when a spouse is present in the interview
(B) always subject to bias
(C) often unreliable with assessment of substance abuse, unless toxic screening is used
(D) more reliable when an anxiety disorder is present
(E) all of the above

Alexa Moschella

Numerade Educator

01:45

Problem 838

Spouse "oversolicitous" behavior
(A) can be assessed with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
(B) can contribute to poor treatment outcome
(C) controls most of the variance in predicting disability and substance abuse
(D) is generally a reflection of positive social support, and should be reinforced
(E) all of the above

Alexander Cheng

Numerade Educator

Problem 839

Somatization disorder
(A) commonly develops in the elderly, as a result of poor communication with health care providers
(B) precludes the presence of an organic disease or disorder
(C) develops in adolescence, with symptoms disappearing by the age of 35 years
(D) implies the patient is intentionally "making up" symptoms
(E) complicates the pain physician's ability to evaluate effectiveness of the treatment

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Problem 840

Anxiety symptoms are common among most patients with chronic conditions, and
(A) structured anxiety questionnaires can replace time-consuming interview questions, providing they have sufficient reliability and validity
(B) anxiety symptoms with acute pain often abate after adequate treatment of the pain
(C) posttraumatic stress disorder is common when a history of domestic abuse is present
(D) anxiety symptoms rarely abate after adequate treatment of pain
(E) both B and C

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Problem 841

With a work related spine injury, pain and disability are most dependent upon
(A) the level of the disc herniation
(B) the employee's appraisal of his work setting
(C) the patient's level of depression
(D) the adequacy of the patient's pharmacotherapy regimen
(E) all of the above

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Problem 842

In general, a successful return to work with back pain is more likely if
(A) the patient is placed on light duty
(B) the return to work is rapid, ideally within 12 months of the injury
(C) ergonomic job modifications are made at the work-site
(D) time-release versus short-acting analgesics are employed
(E) psychological job counseling is instituted shortly after the injury

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03:34

Problem 843

Biofeedback assisted relaxation has been shown to be effective in reducing frequency, duration, and severity of pain with
(A) myofascial pain conditions and migraine
(B) cluster headache
(C) trigeminal neuralgia
(D) postherpetic neuralgia
(E) all of the above

Melissa Geisel

Numerade Educator

Problem 844

In general, compliance rates or "adherence" with pharmacotherapy recommendations is
(A) $70 \%$ if a chronic medical condition is present
(B) dependent upon the severity of the chronic condition
(C) greater with elderly patients
(D) dependent on the patient's intelligence level
(E) improved when the pain clinician is "emphatic," and readily accepts the patient's report of pain severity

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Problem 845

Factors suggestive of a possible problematic course with chronic opioid therapy include
(A) tobacco use
(B) history of inpatient detoxification
(C) a high score on a standardized chronic opioid therapy-screening instrument
(D) comorbid psychiatric diagnosis such as posttraumatic stress disorder
(E) all of the above

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02:13

Problem 846

A diagnosis of posttraumatic stress disorder is
(A) uncommon among pain patients who have domestic violence histories
(B) a risk factor in the development of a treatment-resistant chronic pain disorder
(C) not predictive of poor adherence when treating chronic pain conditions
(D) present in 70\% of motor vehicle accidents who report neck pain after the first 12 months
(E) generally resolved within the first few weeks of a major trauma, provided that the patient has adequate treatment of acute pain

Alyssa Mae L.

Numerade Educator

Problem 847

Patient pain ratings
(A) should be documented by the clinician during each visit
(B) are not particularly reliable
(C) are poor predictors of disability
(D) should be supplemented by other measures when chronic pain is present
(E) all of the above

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00:45

Problem 848

Commonly used quality of life measures include
(A) Beck Depression Inventory and CES-D depression screening questionnaire
(B) Short Form-36 (SF-36) and the Sickness Impact Profile (SIP)
(C) Brief Pain Inventory
(D) Headache Disability Index
(E) $\mathrm{MMPI}-2$

Emily Himsel

Numerade Educator

Problem 849

Psychological screening for spinal column stimulation should
(A) weigh the patient's realistic and unrealistic expectations for outcome
(B) exclude patients with a major depression, given a probable poor prognosis
(C) underscore the patient's likelihood for improved work capacity after successful implantation
(D) address possible malingering by the use of standardized psychologic testing
(E) all of the above

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01:10

Problem 850

There is a greater likelihood of improved function and return to work when
(A) passive rehabilitation approaches are paired with biobehavioral approaches
(B) interventional approaches are paired with cognitive therapies
(C) active rehabilitation approaches are combined with cognitive therapies
(D) complimentary medicine approaches are combined with cognitive therapies.
(E) opioid therapy is combined with a light duty return-to-work schedule.

Asma Venkitta

Numerade Educator

01:17

Problem 851

In part, factors associated with the placebo effect include
(A) patient and clinician expectations
(B) past learning and conditioning
(C) neurotransmitter responses
(D) credibility of the treatment intervention
(E) all of the above

Emily Himsel

Numerade Educator

Problem 852

A patient with chronic daily headache and myofascial neck pain improves after a series of trigger point injections. The effect could be attributed to
(A) the treatment intervention
(B) the natural course of the illness or "regression to the mean"
(C) placebo effect associated with the injections
(D) other concurrent treatment changes that may have occured, for example, patient terminated a prophylactic treatment in anticipation of the injection series
(E) all of the above

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Problem 853

Pain support groups and online support organizations
(A) may reinforce the patient's somatic overconcern and promote disability behavior
(B) provide a valuable resource of information with chronic pain conditions, and help to minimize distress and tendency to feel isolated
(C) may provide the pain patient with critical evaluations of his/her health care provider
(D) are not a replacement for psychologic or psychiatric treatments
(E) all of the above

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02:01

Problem 854

Historically, the traditional operant-conditioningpain-rehabilitation programs
(A) expected the patient to increase activity levels until pain became severe
(B) measured level of pain as an integral component of assessment
(C) regarded as-needed analgesic consumption as a "pain behavior"
(D) established objective functional and recreational goals after the pain was adequately controlled
(E) all of the above

Asma Venkitta

Numerade Educator

01:45

Problem 855

The Minnesota Multiphasic Personality Inventory (MMPI-2)
(A) is a brief, "clinician-friendly," self-report questionnaire that does not require interpretation by a clinical psychologist
(B) has rarely been challenged with respect to its utility in chronic pain settings, with most pain psychologists accepting the MMPI-2 as the testing instrument of choice
(C) is a 566 item true/false self-report instrument used to assist with the assessment of overall psychopathology
(D) has limited utility in clinical settings, primarily because of the lack of chronic pain normative data
(E) can assess whether a patient is malingering with respect to report of pain level

Alexander Cheng

Numerade Educator

01:42

Problem 856

Which of the following are commonly employed cognitive behavioral techniques with pain conditions?
(A) Cognitive restructuring, problem solving, and dialectical behavior therapy
(B) Progressive muscle relaxation, autogenic training, and psychoanalytic psychotherapy
(C) Contingency management, stimulus generalization, and operant conditioning
(D) Surface electromyographic (EMG) biofeedback, thermal biofeedback, and muscle reeducation
(E) All of the above

Tanner Fonjweng

Numerade Educator

03:15

Problem 857

A patient returns to work despite a fear of reinjury, and remains in the work setting until the fear gradually subsides. From a learning theory standpoint, this is considered
(A) punishment
(B) in vivo exposure
(C) negative reinforcement
(D) intermittent reinforcement
(E) systematic desensitization

Alexa Moschella

Numerade Educator

02:09

Problem 858

Hypnosis is often used to
(A) reduce acute pain and relax the patient
(B) improve adherence
(C) treat posttraumatic stress disorder
(D) treat cluster headache
(E) both $\mathrm{A}$ and $\mathrm{D}$

Sarah Howell

Numerade Educator

Problem 859

A patient is being considered for an implantable opioid pump. Which of the following can be considered a reasonable outcome, based upon current evidence-based reviews?
(A) Reduced side effects from oral opioid therapy
(B) Return to work and increase in recreational activity
(C) Reduced pain and depression
(D) Improved aerobic capacity and reduced side effects from opioids
(E) None of the above

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03:34

Problem 860

"Mind-body" and structured "stressmanagement" programs often employ
(A) short-term, time-limited treatment techniques
(B) monitoring of stressors and precipitants of pain
(C) cognitive therapy to reduce perception of pain and control over all symptoms
(D) relaxation training
(E) all of the above

Melissa Geisel

Numerade Educator

01:29

Problem 861

Cognitive behavioral treatments with pain in children might typically include all of the following EXCEPT
(A) enlisting parents to assess mediating stressors and reinforce positive coping skills
(B) structured play therapy
(C) relaxation training with possible adjunctive use of biofeedback
(D) rehearsal of positive cognitions
(E) efforts to return the child to school in order to minimize school phobia and disability behavior

Alexa Moschella

Numerade Educator

01:01

Problem 862

Functional sleep disorders are common with chronic pain conditions, with as many as $80 \%$ of pain patients reporting problems with sleep. Behavioral approaches have consistently been shown to be superior to pharmacotherapy approaches. Which of the following is included in a behavioral approach to functional sleep disorder?
(A) Instruction in proper sleep hygiene and use of stimulus-control techniques
(B) Relaxation training and cognitive interventions
(C) Self-monitoring of sleep, with particular focus on sleep habits and anxiety symptoms
(D) Addressing common precipitants of poor sleep such as depression, inappropriate use of pharmacologic sleep aids, and/or substance use
(E) All of the above

Nick Johnson

Numerade Educator

Problem 863

Temporomandibular disorders have been most effectively treated by a combination of
(A) interventional and biobehavioral techniques
(B) biobehavioral and oral/dental/occlusal appliance therapy
(C) physical therapy and biobehavioral techniques
(D) low-dose chronic opioid therapy and thermal biofeedback
(E) none of the above

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Problem 864

A patient presents with symptoms of chronic hand-arm pain, possibly neuropathic in origin, as well as a diagnosis of fibromyalgia with associated disability and depression. Which of the following is best treatment for this patient?
(A) Referral to cognitive therapy
(B) Multidisciplinary treatment, where behavioral interventions are integrated into the patient's care
(C) Interventional treatments, where appropriate, while concurrently referring the patient to a psychologist with a specialty in pain management
(D) Pharmacotherapy as a first-line treatment, with appropriate psychologic screening for risk factors if opioids are considered
(E) Treatment modalities that directly address the patient's presenting diagnosis, for example, a diagnosis of complex regional pain syndrome may require interventional procedures and/or neurostimulation, referral for behavioral treatment, and eventual referral to physical therapy

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Problem 865

Addiction can co-occur with chronic pain disorders. If chronic pain and an addictive disorder co-occur, the patient
(A) can be effectively managed when the clinician primarily relies on interventional treatments
(B) requires referral for comanagement by an addiction specialist
(C) may show a decrease in addictive behavior, as many patients engage in addictive behavior because of inadequate treatment of pain
(D) requires an inpatient detoxification from the addictive substances prior to pain treatment
(E) should never be treated with chronic opioid therapy

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Problem 866

In population-based studies, women suffering from pain
(A) typically do not report more severe and frequent pain than men
(B) may be at greater risk for specific pain disorders, for example, fibromyalgia, temporomandibular disorders, and migraine
(C) have been shown to be at greater risk because of endogenous and exogenous sex hormone changes
(D) may be subject to multiple psychosocial and cultural influences that impact on report of pain
(E) B, C, and D

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02:06

Problem 867

A person's degree of belief that he/she can successfully manage aspects of their pain, including their pain level, is termed
(A) catastrophizing
(B) self-esteem
(C) cognitive coping skill
(D) self-efficacy
(E) locus of control

Anna Mcbride

Numerade Educator

00:33

Problem 868

The construct of operant conditioning would apply to the following patient vignette:
(A) A worker has an acute back injury while lifting an object at work, experiences immediate pain and associated anxiety, and thereafter develops an unrealistic fear of any future lifting behavior
(B) A patient uses a short-acting opioid after an exacerbation of pain. He learns to take his pill when his pain reaches a certain level. His pill-taking behavior is initially reinforced by the effect of the analgesic or other nonspecific factors that contributed to his pain reduction
(C) A patient in physical therapy engages in her exercise "until I can't stand the pain," then discontinues the exercise, seeks bedrest, and rapidly feels better. She learns that escaping from physical therapy and lying down reduces her pain, and continues this behavior
(D) A patient becomes markedly anxious during the preparation for an interventional procedure, and the procedure is terminated prematurely owing to her anxiety. Upon returning to the pain clinic, the patient leaves the procedure room as her anxiety escalates. She has become phobic of interventional procedures
(E) Both B and C

Aadit Sharma

Numerade Educator

Problem 869

There is empirical evidence to support
(A) the construct of a "pain prone personality"
(B) the concept that chronic pain is "masked depression"
(C) malingering as being rare, less than $1 \%$ with work injury-related chronic pain conditions
(D) the assumption that psychologic trauma may increase the likelihood of developing a treatment-resistant chronic pain disorder
(E) all of the above

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Problem 870

A patient arrives at the pain center with persistent facial pain, secondary to a fall 6 months earlier. She has a history of other pain complaints, and reports that she follows with a counselor for "stress." When evaluating the patient, the diagnostic interview content should include psychosocial questions that address
(A) depression and suicidal ideation
(B) substance use
(C) risk of domestic violence
(D) all of the above
(E) none of the above, while the patient should grant permission to the pain physician to speak with her counselor

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Problem 871

Patients with cognitive impairments and pain
(A) may require administration of specific assessment tools relevant for their impairment, as standard pain assessment may be inadequate
(B) may be at risk for undertreatment of pain because of communication difficulties with the pain clinician
(C) are at higher risk for accidental injury
(D) do not necessarily have an intellectual disability
(E) all of the above

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01:10

Problem 872

Adjunctive psychologic treatments for cancer pain might include
(A) cognitive therapies to improve patient's control over the medical treatment sequence
(B) autogenic relaxation training
(C) hypnosis
(D) brief family therapy
(E) all of the above

Asma Venkitta

Numerade Educator