Unit 2

Question 1

What is the chief mandate of the Canadian Psychological Association (CPA)?

Answer 1

To improve the health and welfare of all Canadians

CPA supports and promotes the development, dissemination, and application of psychological knowledge.

Question 2

How many apparent opioid-related deaths occurred in Canada between January 2016 and September 2018?

Answer 2

More than 10,300 deaths

This figure reflects the severity of the opioid crisis in Canada.

Question 3

What percentage of opioid-related deaths was accidental between January and September 2018?

Answer 3

93%

This statistic highlights the unintentional nature of most deaths.

Question 4

What demographic accounted for most opioid-related deaths in 2018?

Answer 4

Males (75%)

The distribution by sex varies by province or territory.

Question 5

Which age group had the highest percentage of opioid-related deaths in 2018?

Answer 5

Individuals aged 30 to 39 years (27%)

Other significant age groups included 20-29 years (20%), 40-49 years (21%), and 50-59 years (21%).

Question 6

What substances were involved in 75% of accidental opioid-related deaths?

Answer 6

One or more types of non-opioid substances

Examples include alcohol, benzodiazepines, cocaine, and methamphetamine.

Question 7

What is a major contributor to the high rates of opioid-related deaths in Canada?

Answer 7

Increase in illicitly manufactured fentanyl and analogues

Fentanyl is often mixed with other drugs or sold as counterfeit pills.

Question 8

What percentage of accidental opioid-related deaths involved fentanyl or its analogues between January and September 2018?

Answer 8

73%

This is an increase from 55% in 2016.

Question 9

What public health concern is associated with opioids prescribed for pain relief?

Answer 9

Overprescribing of opioids

This includes high-dose opioids for chronic pain management.

Question 10

What fraction of Canadians report living with chronic pain?

Answer 10

One in five Canadians

About one-third of these individuals describe their pain as severe.

Question 11

What is Canada’s rank in the world for prescription opioid consumption?

Answer 11

Second largest consumer

This high rate of consumption contributes to the opioid crisis.

Question 12

Fill in the blank: The increase in opioid prescribing can be linked to an increase in _______ in the environment.

Answer 12

supply of opioids

More drugs in circulation increases the availability for misuse.

Question 13

True or False: The opioid crisis in Canada has led to a decrease in hospitalizations due to opioid poisonings.

Answer 13

False

There was an average of 17 hospitalizations every day in Canada due to opioid poisonings in 2016-17.

Question 14

What is the first step of Universal Precautions in Pain Medicine?

Answer 14

Make a Diagnosis with Appropriate Differential

Treatable causes for pain should be identified, and therapy directed to the pain generator.

Question 15

What should be included in the psychological assessment for pain management?

Answer 15

Inquiry into past personal and family history of substance misuse

A sensitive and respectful assessment of risk is essential.

Question 16

What is the purpose of patient-centered urine drug testing (UDT)?

Answer 16

Assist in therapeutic decision making

UDT should be discussed with all patients, especially those on opioids.

Question 17

What must health care professionals discuss with patients regarding their treatment?

Answer 17

Informed Consent

Discuss proposed treatment plans, benefits, and risks.

Question 18

What is the role of a treatment agreement in pain management?

Answer 18

Clarify expectations and obligations of both patient and practitioner

It forms the basis of the therapeutic trial.

Question 19

What must be documented before starting a treatment plan?

Answer 19

Pre-intervention pain scores and level of function

This is crucial for assessing the success of therapy.

Question 20

What is the recommendation regarding opioid therapy in pain management?

Answer 20

Opioids should not routinely be treatment of first choice

They must be individualized based on clinical findings.

Question 21

What should be regularly reassessed in pain management?

Answer 21

Pain score and level of function

This helps document the rationale for continuing or modifying therapy.

Question 22

What are the ‘Four A’s’ of Pain Medicine?

Answer 22

Analgesia, activity, adverse effects, aberrant behavior

A fifth ‘A’, affect, may also be useful.

Question 23

Why is it important to periodically review pain diagnosis and comorbid conditions?

Answer 23

Underlying illnesses evolve and treatment focus may need to change

Coordination of treatment for concurrent addictive disorders is crucial.

Question 24

What is essential for documenting patient evaluations?

Answer 24

Careful and complete recording of evaluations

Thorough documentation reduces medicolegal exposure.

Question 25

Fill in the blank: The second step of Universal Precautions in Pain Medicine is _______.

Answer 25

Psychological Assessment Including Risk of Addictive Disorders

Question 26

True or False: Informed consent includes discussing the potential for addiction and tolerance.

Answer 26

True

Question 27

What are the two important respects in which opioid prescribing for pain differs from the standard case?

Answer 27

* Patient pain is occurrent * Harms include third parties and society

Question 28

Why does the presence of pain affect the clinician's need for action?

Answer 28

Pain is present and certain, unlike future harms which are uncertain

Question 29

What is the primary reason a clinician has more reason to act when treating a patient in pain?

Answer 29

The patient is currently in pain

Question 30

What types of conditions do non-pain patients seek treatment for?

Answer 30

* Loss of function * Depression * Other presently occurring conditions

Question 31

How does the presence of pain influence the clinician's assessment of treatment?

Answer 31

It reduces uncertainty about the need for action

Question 32

What should guide a clinician's treatment decisions regarding pain management?

Answer 32

Evidence and clinical experience

Question 33

True or False: A doctor can always trust a patient's report of pain without doubt.

Answer 33

False

Question 34

What is the moral distinction made regarding discounting current harm versus future harm?

Answer 34

Discounting future harm involves prediction; discounting current harm involves assessing patient reliability

Question 35

What duty must a doctor uphold regarding a patient's report of pain?

Answer 35

The doctor must trust the patient and accept her testimony

Question 36

What negative consequences can arise from a physician distrusting a patient's report of pain?

Answer 36

* Missing a serious disease * Patients may fear sharing symptoms * Experience of humiliation and distress

Question 37

What is the doctor's duty of loyalty towards the patient?

Answer 37

To show respect and believe the patient as an agent

Question 38

Under what circumstance may a doctor justifiably doubt a patient's report of pain?

Answer 38

If the doctor thinks the patient may be misusing drugs and likely to harm herself

Question 39

What is 'testimonial injustice' as defined by philosopher Miranda Fricker?

Answer 39

The phenomenon of discounting or challenging the testimony of marginalized groups

Question 40

What slogan does the 'Me Too' movement use to confront testimonial injustice?

Answer 40

'Believe Women'

Question 41

How does the disproportionate disbelief of chronic pain patients relate to the physician's obligations?

Answer 41

It provides an additional reason to correct injustice and 'Believe Pain'

Question 42

What does the presence of a patient's current pain signify in the context of treatment decisions?

Answer 42

It weighs distinctly in favor of action

Question 43

Fill in the blank: The presence of pain ______ the need for future prediction about the imperative to treat.

Answer 43

obviates