Pain Management

Question 1

defin pain

Answer 1

unpleasant sensory and/or emotional experience typically associated with physical damage to the body

Question 2

define chronic pain

Answer 2

lasts longer than three months
can occur w/out known cause, after injry has healed, or a condition has been treated

Question 3

chronic primary pain

Answer 3

pain persists after body has healed or no identifiable causes

fibromyalgia, pelvic pain, musculoskeletal pain, lower back pain

Question 4

chronic secondary pain

Answer 4

occurs together with underlying diseases or issues

cancer pain, post-surgical pain, and rheumatoid arthritis

Question 5

__ in __ Canadians live with chronic pain

Answer 5

1 n 5

Question 6

__% of Canadians living with chronic pain have lived with it for over 10 years

Answer 6

50%

Question 7

how many Canadians over age 65 live with chronic pain?

Answer 7

1 in 3

Question 8

__ to __% of people with substance abuse disorder report chronic pain

Answer 8

31-55%

Question 9

highest prevalence of chronic pain in Canada

Answer 9

Indigenous people

Question 10

chronic pain conditions in Indigenous peoples

Answer 10

diabetes 16%

arthritis 18%

chronic back pain 12%

Question 11

direct healthcare cost for Canada regarding chronic pain

Answer 11

$7.2 billion/yr

Question 12

combined direct and indirect cost of chronic pain in Canada =

Answer 12

$ 56-60 billion/ yr

Question 13

the most common and most expensive cause of work-related disability in the population younger than 45 y/o

Answer 13

chronic back pain

Question 14

the leading cause of long-term disability in adults, esp. in the 45-65 age range

Answer 14

arthritis

Question 15

60% of ppl with chronic pain will…

Answer 15

• loss their jobs
• will have reduction in responsibilities
• suffer income loss

Question 16

people with chronic pain who are employed will lose ____ days of work per year

Answer 16

28.5

Question 17

how many ppl in Alberta are estimated to have chronic pain

Answer 17

940 000

Question 18

total health expenditure spent on chronic pain in Alberta

Answer 18

6-8%

Question 19

how many people in AB take opioids for pain relief?

Answer 19

596 000

Question 20

how many ppl who use opioids in AB ar considered problematic users?

Answer 20

58 000

Question 21

how many deaths in 2023 (Jan-April) are from opioids?

Answer 21

613

Question 22

define non-specific low back pain

Answer 22

pain, muscle tension, or stiffness that occurs between the rib cage and inferior gluteal folds, with or without leg pain and has no identifiable cause

Question 23

specific low back pain

Answer 23

associated with an identified cause =
infection, fracture, arthritis, tumor

Question 24

what is the percentage of non-specific back pain in the total cases of back pain?

Answer 24

90%

Question 25

in the majority of pople with chronic back pain, the pain will resolve in __ weeks

Answer 25

2 - 20% to 40% will xperience another episode within the year - 2 to 7% = chronic lower back - 10% of cases cause more than 80% of the cos for low back pain

Question 26

what percentage of people return to work from sick leave from lower back pain within 1 week?

Answer 26

66% - 90% within 2 months - less than 50% = after 6 months - virtually no one will return to work after 2 years

Question 27

patients with disabling pain or functional limitation should be referred to a specialist within...

Answer 27

2-6 weeks

Question 28

approach to pain treatment

Answer 28

- indivs with chronic pain benefit from a multidisciplinary treatment approach - combined exercise and patient education significantly reduce pain - efficacy for chronic opioid therapy for chronic noncancer pain is limited - nonetheless, COT for chronic noncancer pain increased between 1980 and 2000

Question 29

T or F. Chronic pain and SUDs overlap

Answer 29

T - 3-48% of chronic pain patients have SUDs - 24-67% of patients with SUDs have chronic pain - substance use may be a maladaptive coping response to pain

Question 30

broad spectrum analgesics used for treatment of

Answer 30

nociceptive and neuropathic pain

Question 31

published rates of abuse and/or addiction in chronic pain populations are __ to __%

Answer 31

3 to 19%

Question 32

known risk factors for addition to any substances are good predictors for ..

Answer 32

problematic prescription opioid use - past cocaine use, h/o alcohol or cannabis use - lifetime history of substance use disorder - family history of substance abuse, a history of legal problems and drug and alcohol abuse - tobacco dependence - history of severe depression or anxiety

Question 33

risk of not Rx

Answer 33

continue addiction unsuccessful detoxification increase distress and anxiety may trigger relapse

Question 34

risk of Rx

Answer 34

may trigger relapse pressured to supply opioids to addicted friends maybe tempted to sell opioids to supplement income

Question 35

COT guidelines for high risk patients monitoring tools:

Answer 35

- opioid treatment agreements - urine drug testing - opioid risk assessments helpful for long term use - pill counts also: - consultation with mental health/addiction spcialist - constant need for re-eval - discontinuation of COT for diverting opioids or serious aberrant behaviours

Question 36

______ drug testing is another tool in the tool box for appropriate care of patients with SUD and/or chronic pain

Answer 36

urine

Question 37

predictors of UDS ordering

Answer 37

younger age positive cage questionnaire results early stage of cancer or no disease status high pain intensity lower fatigue scores

Question 38

a primary care, managed approach to opioid therapy in chronic pain patients at risk for substance use

Answer 38

opioid renewal clinic

Question 39

45% of pts with previously demonstrated aberrant drug related behaviours were able to adhere to their medication regimes after:

Answer 39

- management with urine drug monitoring - signed agreements - multispecialty care

Question 40

R03 recommendation statement

Answer 40

when using UDS t establish a baseline measure of risk or to measure compliance, be aware of benefits and limitations, appropriate test ordering and interpretation and have a plan to use results