Chapter 7. Pain Assessment Flashcards Preview

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Flashcards in Chapter 7. Pain Assessment Deck (20):
1

606. Regarding Minnesota Multiphasic Personality
Inventory (MMPI) which of the following statement
is true?
(A) It has 547 questions
(B) Conversion V is often present in
patients with chronic pain
(C) It can be interpreted by anyone treating
the patient
(D) Is not commonly used in evaluation of
patients for spinal cord stimulation
(SCS) trial
(E) Can point out reliably the psychogenic
part of the pain behavior

606. (B) The MMPI is a long test and has 566 questions.
It does not reliably distinguish between the
psychologic and physical pain. It needs expertise
to review the test results, and the conversion V
(hypochondriasis, depression, and hysteria) is
seen in patients with chronic pain and does
respond to treatment. The MMPI is commonly
used in evaluating patients for SCS trial.

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607. Visual analogue scale (VAS)
(A) correlate highly with pain measured on
verbal and numerical rating scales
(B) is minimally intrusive
(C) assumes that pain is a unidemnsional
experience
(D) measures the intensity of pain
(E) all of the above

607. (E) The VAS-like verbal and numerical rating
scales assumes that pain is a unidimentional
experience and measures the intensity of the
pain. Although pain intensity is a salient dimension
of pain, it is clear that there are many
dimensions to pain

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608. Which of the following tests is used as a more
objective determination of disability?
(A) The most thoroughly studied is the
Sickness Illness Profile
(B) Physical examination is an objective
and consistent method of assessing
impairment
(C) McGill Pain Questionnaire
(D) Patient’s subjective report of pain
(E) MMPI

608. (A) The most commonly studied instrument is
the Sickness Illness Profile. This has been used
in many studies to demonstrate the effect of a
variety of treatment methods in patients with
pain.
Studies have shown poor reproducibility
between physicians in evaluating patients
with back pain especially regarding nonneurologic
findings like muscle spasm and guarding.
At present time there is no reliable test to
measure patient’s subjective feeling of pain.

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609. What is the Symptom Checklist 90 (SL-90) and
its revised version (SLR-90-R)?
(A) Is a screen for psychologic symptoms
and overall levels of distress
(B) Self-report measure of patient’s perception
of his or her general health status
(C) It is a 136-item scale
(D) It is a measure of one’s mood state
(E) It is the most widely used personality
test

609. (A) The SL-90 or Sl-90-R screens for psychologic
symptoms and levels of distress. It is one
of the personality test and has 90 items describing
a physical or psychologic symptom. This is
one not categorized as mood test. The most
widely used personality test is MMPI.

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610. Which of the following tests assess limitations
in activities of daily living (ADL)?
(A) Spielberger State-Trait Anxiety
Inventory
(B) Oswestry Low Back Pain Disability
Questionnaire
(C) Beck Depression Inventory
(D) SL-90
(E) MMPI

610. (B) Spielberger State-Trait Anxiety Inventory
is a 40-item self-report questionnaire that measures
anxiety levels.
Oswestry Low Back Pain Disability
Questionnaire assesses limitations in ADL. Ten
multiple choice items cover nine aspects of
daily functioning including personal care, lifting,
walking, sitting, standing, sexual activity,
and traveling. The patient chooses from among
six statements relating to impact of pain on a
particular activity. Apercentage score is derived
allowing for classification of patients ranging
from mildly to profoundly impaired.
Beck Depression Inventory is a self-report
measure of depression.
The SL-90 or Sl-90-R screens for psychologic
symptoms and levels of distress.
MMPI is commonly used personality test
to gain an overall picture of the patient’s general
psychologic status.

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611. Beck Depression Inventory
(A) is used to look at basic coping styles
(B) is a 21-item self-report measure of
depression for the last 30 years
(C) is not commonly used in pain literature
(D) is a measure of malingering
(E) all of the above

611. (B) Beck Depression Inventory is one of the
most commonly used instruments in pain literature.
It is a 21-item self-report measure of
depression and has been in use for 30 years.
Responses require the endorsement of one of a
series of four statements, rank ordered according
to the severity of content. The scores on
each item are tabulated to yield a total depression
score. It is not a measure of coping styles
or malingering.

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612. In pain assessment
(A) patient’s self-report of pain is the most
valid measure of the pain experience
(B) behavioral measure of pain is the most
valid measurement
(C) the health care provider’s observation is
the most valid measurement
(D) none of the above
(E) all of the above

612. (A) The studies point to obtaining multiple
measures of soft pain and because pain is a
subjective phenomenon the patient’s self-report
is the most valid measure of the experience.

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613. A conscious exaggeration of physical or psychologic
symptoms for some easily recognized
goal or secondary gain is
(A) symptom magnification
(B) malingering
(C) hysteria
(D) hypochondriasis
(E) depression

613. (B) Malingering is a conscious exaggeration of
physical or psychologic symptoms for some easily
recognized goal or secondary gain. It should be
differentiated from symptom exaggeration or magnification that could be secondary to personality
characteristics such as hysteria or conditioning
factors.

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614. McGill Pain Questionnaire
(A) consists of three major measures
(B) was developed by McGill
(C) is not widely used
(D) is a single-dimensional pain scale
(E) does not ask about the location of pain

614. (A) McGill Pain Questionnaire was developed in
1975 by Ronald Melzack at McGill University in
Canada. It consists of three major measures: pain
rating index, total number of words chosen, and
the present pain intensity. This is a multidimensional
scale for measurement of pain. The questionnaire
tries to assess the there components of
pain postulated by the gate theory: the sensory,
the affective, and the evaluative dimensions.

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615. McGill Pain Questionnaire assesses
(1) location of the pain
(2) pattern of the pain over time
(3) sensory, effective component of pain
(4) intensity of the pain

615. (E) There are two types of tools for assessment of
pain. Unidimentional single-item scales or multidimensional
measure scales. The former includes
the VAS or the VNS, the Verbal Descriptor Scale
(VDS), and the Pain Thermometer. Each of these
single-item scales measures only the intensity of
the pain experienced. The multidimensional prototype
is McGill Pain Questionnaire. It assesses the
location of pain; the pattern of pain over time; the
sensory, effective, evaluative, and miscellaneous
components of pain; and the intensity of pain.

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616. Advantages of MMPI-2 include:
(1) It provides 10 clinical scales, 3 validity
scales
(2) Is considered the gold standard
(3) Is well-normed and extensively
researched
(4) Its test results are easy to interpret

616. (A) MMPI-2 measures psychologic traits and
overall psychologic status. It is considered the
gold standard and is scored by a computer.
MMPI-2 has 10 clinical scales, 3 validity scales,
and numerous other subscales. It is well-normed
and highly researched and provides data about
patient’s test-taking approach; however, it is not
normed on pain patients, scales 1 to 3 often evaluated
in pain patients (this may unfairly label
patients as neurotic). MMPI-2 requires highly
skilled evaluator to interpret the test results.

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617. In evaluating patients for SCS using MMPI
Richard North’s group noted that
(1) patients with high scores on scale 1
(hypochondriasis)t ended to proceed
from SCS trial to implant
(2) patients with higher scores on scale 3
(hysteria) were not offered SCS trial
(3) patients with higher scores on scale 3
(hysteria) had positive short-term but
not long-term outcome
(4) patients with high score on scale 1
(hypochondriasis) tended not to proceed
from SCS trial to implant

617. (B) MMPI has been widely used in patients undergoing
SCS. North’s group noted that patients with
higher scores on hypochondriasis tended to proceed
from trial to implantation; however, scale 3
(hysteria) tended to correlate with a positive shortterm
but not long-term outcome.

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618. In regard to MMPI as a predictor of treatment
outcome
(1) it is standardized on chronic pain
patients
(2) it is based on common diagnoses of
1930s
(3) can be used alone in assessment of pain
patients
(4) items overlapping a great degree across
the 10 clinical scales

618. (C) Keller and Butcher reinforced the lack of
support found in the literature for using the
MMPI as a predictor of treatment outcome.
Common disadvantages of MMPI are that it is
not standardized to chronic pain or medical patients; it is based on common diagnoses of
1930s; the items bear no face validity in regard
to underlying psychotherapy; items overlap to
a great degree across the 10 clinical scales; and it is excessively long.

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619. Multidimensional pain assessment inventories
include
(1) pain disability index
(2) illness behavior questionnaire
(3) Sickness Impact Profile, West Haven-
Yale Multidimensional Pain Inventory
(4) Dallas Pain Questionnaire

619. (E)

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620. Regarding pain scores on the numeric rating
scale
(1) decreased pain scores suggest positive
outcome from the treatment of pain
(2) it should be used only occasionally
(3) it correlates highly with pain measured
on in verbal scale and VAS
(4) correlates highly with anxiety and
depression

620. (B) The numerical rating scale correlates with
scores on VAS or verbal rating scales. It should
be used at each evaluation. It is sensitive to
pharmacologic procedures that affect the pain
intensity.

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621. Regarding SF-36
(1) yields scores on 10 health scales relating
to physical, social, and emotional factors
(2) is easily administered
(3) does not have gender or age norms
(4) has been used to compare patient and
surgeon assessment regarding the outcome
of lumbar disc surgery

621. (C) The Medical Outcome Survey (MOS), the
36-item Short Form Health Survey (SF-36) is a 36-
item generic questionnaire that yields scores on
eight health scales relating to physical, social,
and emotional factors. It is easily administered
and has gender and age norms based on large US
populations, having been applied to more than
260 medical and surgical studies. It has been
used to compare patient and surgeon assessment
regarding the outcome of lumbar disc surgery.

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622. Physiologic correlations of pain (eg, heart rate
and blood pressure)
(1) are nonspecific to pain
(2) many habituate with time despite presence
of pain
(3) occur under conditions of general arousal
and stress
(4) is a great way of measuring the intensity
of pain

622. (A) Physiologic correlates of pain that can be
measured include blood pressure, heart rate, electrodermal
activity, electromyographic activity, and
cortical-evoked potentials. Despite initial correlation
between onset of pain and changes in these
parameters, many patients habituate over time
despite the persistence of pain. These responses
are also nonspecific to pain and occur under general
arousal or stress. Studies have shown that
although there are many physiologic responses
that occur with the experience of pain, many
appear to be general responses to stress and are
not unique to pain.

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623. According to Melzack and Casey (1968) the
three major psychologic dimensions of pain are
(1) sensory discriminative
(2) cognitive evaluative
(3) motivational affective
(4) past experiences

623. (A) Research on pain in the 20th century has
been dominated by the notion that pain is purely
a sensory experience. Yet pain has an unpleasant
affective component to it. It motivates the person
to do something to get rid of it. Higher cortical
processes such as evaluation of past experience
exert control over the other two dimensions.

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624. The most frequently used self-rating instruments
for measurement of pain in a clinical setting
are
(1) VAS
(2) behavioral observational scales
(3) McGill Pain Questionnaire
(4) physiologic responses

624. (B) The VAS and the McGill Pain Questionnaire
are the two most frequently used self-rating
instruments for measurement of pain in clinical and research testing. McGill Pain Questionnaire
is designed to assess the multidimensional
nature of pain experience and has been demonstrated
to be valid, reliable, and consistent
measurement tool. Because of complex nature
of pain, measurements from the behavioral
observational scales and physiologic responses
may not show high concordance.

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625. Cognitively impaired elderly patients
(1) do not respond to pain assessment questionnaire
(2) do respond appropriately if given VAS
or numerical rating scale (NRS)
(3) malingering by an elderly patient may
be an attempt to divert attention away
from possible need for institutionalization
(4) there are guidelines available for elderly
patients with dementia

625. (A) Assessing pain in cognitively elder patients
is very challenging and there are no guidelines
available. The cognitively impaired do not
respond quickly to pain assessment questionnaires
but can respond to easy to read and follow
scales like the VAS or NSR. In assessing pain in
patients with dementia one needs to be able to
differentiate between pain as a result of pathophysiologic
processes and pain symptoms manifesting
in an attempt to mask impaired mental
processes because of the fear of being institutionalized
and losing independence.