Breakthrough Pain and Referred Pain Quiz

142 Questions

According to the text, what is the definition of pain?

Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does.

What is the most frequent reason for palliative consultations?

Unrelieved pain

What is predictive for advanced cancer in the last 6 months, as mentioned in the text?

Neurodegenerative diseases

What percentage of people experience pain in palliative care, as stated in the text?

80-90%

What type of pain typically goes down to a specific dermatome and may be accompanied by sensitivity to touch?

Neuropathic pain

What should be done to effectively assess and manage pain in patients with chronic illnesses?

Understand cultural traditions, customs, beliefs, and values

Which assessment tool can be used for comprehensive pain assessment?

The Edmonton Symptom Assessment System Revised (ESAS-R)

What can new pain in patients with chronic illnesses indicate?

New disease or recurrence

What can sensitivity to touch indicate in the context of neuropathic pain?

Allodynia

What should be assessed regularly and addressed promptly in palliative care patients?

Tiredness, anxiety, and pain

What should pain assessment involve?

Open communication with patients and their families as well as healthcare professionals

What can the Canadian Problem Checklist be used to assess?

A range of issues beyond pain

Which type of pain can be described as aching, throbbing, cramping, sharp, stabbing, burning, tingling, crawling, itchy, or squeezing?

Neuropathic pain

Which aspect should be included in pain assessment?

Location, duration, and severity of pain

What may Indigenous health services involve?

Traditional herbs and consulting with spiritual teams

What should be done to effectively manage common side effects in palliative care patients?

Assess and address tiredness, anxiety, and pain regularly

What is the definition of pain according to the International Association for the Study of Pain?

An unpleasant sensory and emotional experience linked to actual or potential tissue damage

According to the World Health Organization, what percentage of cancer patients could have their pain alleviated by following the treatment guidelines of the WHO analgesic ladder?

Up to 90%

What kind of pain is associated with organs and tissues from the endoderm, such as the stomach, bowel, liver, pancreas, kidney, and bladder?

Visceral pain

Which type of pain is localized and described as sharp or burning and is associated with nervous tissue?

Cutaneous pain

What type of pain is an umbrella term for visceral and deep somatic pain?

Nociceptive pain

How is deep somatic pain described?

Dull and aching

When developing a pain management plan, what should be discussed with patients and their families?

Goals of care, hopes, and expectations

What type of pain is associated with nerves and nerve plexuses?

Neuropathic pain

What is the characteristic feature of incident pain?

It occurs without warning

How is incident pain managed?

By giving analgesics 5-10 minutes before activity

Which medications are commonly used for managing breakthrough pain?

Intranasal fentanyl and sublingual sufentanil

What is the frequency of doses for managing breakthrough pain with fentanyl and sufentanil?

Every 10-15 minutes as needed

What is the impact of pain on patients' lives, especially those with moderate to severe pain?

Significant impact on daily functioning

What type of pain is characterized by well-localized, aching sensations?

Somatic pain

What type of pain is constant or crampy and poorly localized?

Visceral pain

What causes breakthrough pain in shingles patients?

Post-herpes neuralgia

How is neuropathic pain treated in shingles patients?

With medications that target the affected dermatomes

What is the duration characteristic of chronic pain?

Indeterminate duration

What event characterizes acute pain?

A specific event

What percentage of cancer patients experienced cancer-related pain according to the American Cancer Society survey?

65%

Which organization recommends a stepwise approach to pain management known as the Pain Ladder?

World Health Organization

What percentage of cancer pain is caused by the cancer itself?

75%

According to the Saunders concept of total pain, what components are included in pain?

Physical, emotional, interpersonal, financial, and spiritual

What is a common barrier to effective pain management fueled by unfounded fears of addiction and dependence?

Opioidphobia

Why is accurate assessment and diagnosis essential in pain management?

To plan appropriate interventions and improve overall quality of life

What are common reasons for unrelieved pain according to the text?

Patient or family beliefs that pain is untreatable

What is important to educate healthcare providers and patients about according to the text?

Benefits and risks of morphine and other opioids

What prevents effective pain management according to the text?

Fear of addiction and adverse effects

According to the passage, which symptom do many people fear most after a diagnosis of advanced cancer?

Pain

What has been defined as 'whatever the experiencing person says it is, existing whenever the experiencing person says it does'?

Pain

Which type of therapy is mentioned as being used for cancer in the context of palliative care?

Target therapy

What is predictive for advanced cancer in the last 6 months, as mentioned in the passage?

Neurodegenerative diseases

What is the recommended approach to pain management according to the World Health Organization?

Stepwise approach to pain management

What is the most common barrier to effective pain management as mentioned in the text?

Opioidphobia

What is considered the '5th vital sign' and is essential to assess and manage effectively?

Pain

What percentage of cancer pain is caused by the cancer itself?

75%

What is a common belief that can be a reason for unrelieved pain?

'Pain is inevitable and untreatable'

What is the characteristic feature of incident pain?

Predictable trigger

What percentage of cancer patients experienced cancer-related pain according to the American Cancer Society survey?

65%

What should be assessed regularly and addressed promptly in palliative care patients?

'Pain severity'

What does opioidphobia refer to?

'Fear of using opioids'

What does the Saunders concept of total pain emphasize in comprehensive pain management?

'Addressing all domains of pain'

'Pain in cancer patients can be caused by various factors, including tumor invasion of bone, nerves, and viscera.' What type of pain does this statement refer to?

'Visceral pain'

'Pain assessment should be done prior to treatment to determine the cause, type, severity, and impact of pain.' What does this statement emphasize on in pain management?

'Assessment before treatment'

What is the definition of pain according to the International Association for the Study of Pain?

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

Which organization recommends a stepwise approach to pain management known as the Pain Ladder?

World Health Organization (WHO)

What type of pain is associated with nerves and nerve plexuses?

Neuropathic pain

What can sensitivity to touch indicate in the context of neuropathic pain?

Nerve damage or irritation

What is predictive for advanced cancer in the last 6 months, as mentioned in the text?

Unexplained weight loss

What type of pain is constant or crampy and poorly localized?

Visceral pain

What should be assessed regularly and addressed promptly in palliative care patients?

All aspects of suffering

What should be done to effectively assess and manage pain in patients with chronic illnesses?

Involve patients and their families in developing a pain management plan

How is incident pain managed?

By escalating the dose of analgesics for breakthrough pain

What does the Canadian Problem Checklist assess?

All aspects of suffering including physical, psychological, social, and spiritual concerns

What is important to educate healthcare providers and patients about according to the text?

The impact of pain on patient's lives and the importance of patient and family involvement

What is the characteristic feature of end-of-dose failure?

It occurs prior to the next dose of the background analgesic.

What is the rapid onset short-acting analgesic commonly used for managing breakthrough pain?

Intranasal fentanyl

What type of pain is characterized by aching, throbbing, cramping, sharp, stabbing, burning, tingling, crawling, itchy, or squeezing sensations?

Neuropathic pain

What causes spontaneous breakthrough pain?

Unpredictable factors

Which aspect of pain should healthcare professionals assess regularly?

Impact on patients' lives

What is the main cause of cancer pain according to the text?

Metastatic cascade

What differentiates chronic pain from acute pain?

Indeterminate duration and unclear causation

What are antiviral medications given for in shingles outbreaks?

To target affected dermatomes

What is the most common subtype of breakthrough pain in cancer patients?

Incident pain

What type of medication is commonly used for managing breakthrough pain?

Rapid onset short-acting analgesics

What should healthcare professionals recommend for managing incident pain?

Analgesics before activity to cover the peak pain

What should healthcare professionals assess the impact of on patients' lives?

Pain

What type of pain is typically associated with nerves and nerve plexuses?

Neuropathic pain

Which assessment tool can be used for comprehensive pain assessment?

Edmonton Symptom Assessment System Revised (ESAS-R)

What should pain assessment involve?

Location, duration, and severity of pain

Which type of pain can be described as aching, throbbing, cramping, sharp, stabbing, burning, tingling, crawling, itchy, or squeezing?

Neuropathic pain

What may Indigenous health services involve?

Consulting with spiritual teams

What is the characteristic feature of incident pain?

Temporary and predictable

According to the text, what is the definition of pain?

'Aching, throbbing, cramping, sharp, stabbing, burning' sensations

What is important to educate healthcare providers and patients about according to the text?

'Cultural traditions, customs, beliefs, and values'

What is predictive for advanced cancer in the last 6 months, as mentioned in the text?

'Tiredness, anxiety, and pain'

What type of pain is constant or crampy and poorly localized?

Visceral pain

What can sensitivity to touch indicate in the context of neuropathic pain?

Allodynia

According to the text, what percentage of cancer patients experienced cancer-related pain according to the American Cancer Society survey?

90%

What symptom is mentioned as one of the most frequent reasons for palliative consultations?

Pain

What type of therapy is mentioned as being used for cancer in the context of palliative care?

Antineoplastic therapy

What is predictive for advanced cancer in the last 6 months, as mentioned in the text?

Neurodegenerative diseases

What is the symptom many people fear most after a diagnosis of advanced cancer?

Pain

What is the characteristic feature of incident pain?

It is precipitated by a movement or a voluntary action

Which type of pain is associated with organs and tissues from the endoderm, such as the stomach, bowel, liver, pancreas, kidney, and bladder?

Visceral pain

What is the rapid onset short-acting analgesic commonly used for managing breakthrough pain?

Fentanyl

What percentage of cancer patients experienced cancer-related pain according to the American Cancer Society survey?

60%

What type of pain is characterized by aching, throbbing, cramping, sharp, stabbing, burning, tingling, crawling, itchy, or squeezing sensations?

Neuropathic pain

What should pain assessment involve?

Assessing the impact of pain on patients' lives

What differentiates chronic pain from acute pain?

Duration

What does opioidphobia refer to?

Fear of prescribing opioids for chronic pain

What can sensitivity to touch indicate in the context of neuropathic pain?

'Allodynia'

What is a characteristic feature of neuropathic pain?

Localized to a specific area

What is the primary purpose of pain assessment according to the text?

To effectively assess and manage pain

Which pain rating scales are mentioned in the passage as effective for assessing pain?

NRS, VAS, and Wong-Baker FACES

What can be used for comprehensive pain assessment?

ESAS-R

Which common side effects should be assessed regularly and addressed promptly in palliative care patients?

Tiredness, anxiety, and pain

What may Indigenous health services involve?

Traditional herbs and consulting with spiritual teams

What may sensitivity to touch indicate in the context of neuropathic pain?

Allodynia

What is a common barrier to effective pain management as mentioned in the text?

'Opioidphobia'

What does the Canadian Problem Checklist assess?

A range of issues beyond pain

What is the definition of pain according to the International Association for the Study of Pain?

An unpleasant sensory and emotional experience

What is predictive for advanced cancer in the last 6 months, as mentioned in the text?

Decline in physical function

What type of pain can be described as aching, throbbing, burning, or tingling sensations?

Neuropathic pain

What is considered the '5th vital sign' and is essential to assess and manage effectively?

Pain

What is the main cause of cancer pain according to the text?

Tumor invasion of bone, nerves, and viscera

What is the characteristic feature of incident pain?

It is predictable and occurs during specific activities

What does opioidphobia refer to?

Fear of opioid addiction and dependence

What does the Saunders concept of total pain emphasize?

Importance of addressing all pain domains

What is predictive for advanced cancer in the last 6 months, as mentioned in the text?

Unrelieved pain

What are common reasons for unrelieved pain according to the text?

Patient or family beliefs that pain is inevitable and untreatable

'Pain assessment should be done prior to treatment to determine the cause, type, severity, and impact of pain.' What does this statement emphasize on in pain management?

Importance of accurate assessment and diagnosis for appropriate interventions

'Pain is not only physical but also includes intellectual, emotional, interpersonal, financial, and spiritual components.' What does this statement emphasize on in pain management?

'Total Pain' concept

What is important to educate healthcare providers and patients about according to the text?

Benefits and risks of morphine and other opioids

What can sensitivity to touch indicate in the context of neuropathic pain?

Involvement of nervous tissue.

How is deep somatic pain described?

Dull and aching

What is the umbrella term for visceral and deep somatic pain?

Nociceptive pain

What type of pain is associated with nerves and nerve plexuses?

Neuropathic pain

What is the characteristic feature of nociceptive and neuropathic pain?

Aching, throbbing, cramping

What can investigations, such as X-rays, CT scans, and MRI, be used for in pain management?

To determine the cause and severity of pain

What is the role of ongoing reassessment in effective pain management?

To review options, goals, and expectations

'Pain can be intermittent or continuous and can be localized or multifocal.' What does this statement emphasize in pain assessment?

The varied nature of pain experiences

'Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.' What does this definition emphasize?

The association with tissue damage

'Goals of care, hopes, and expectations should be discussed with patients and their families when developing a pain management plan.' Why is this important?

To tailor the treatment plan to individual needs

What are the options for managing pain mentioned in the text?

Pharmacological and non-pharmacological interventions

What is important to assess regularly in palliative care patients according to the text?

The goals and expectations of patients and their families

Study Notes

The American Cancer Society conducted a survey to understand the impact of pain on cancer patients and found that 65% experienced cancer-related pain, with 76% rating it as moderate to severe, but only 58% reported being asked about their pain during clinical visits (Cancer J Clin 59:285-289, 2009).
Pain in cancer patients can be caused by various factors, including tumor invasion of bone, nerves, and viscera, and tumor involvement of blood vessels. About 75% of cancer pain is caused by the cancer itself, while 10% is related to cancer therapy and 10% to cancer-induced debility (Table 4.5).
Pain is considered the "5th vital sign" and is essential to assess and manage effectively. The World Health Organization (WHO) Pain Ladder recommends a stepwise approach to pain management, starting with non-opioids and gradually increasing the use of opioids and interventional pain therapies.
Pain is not only physical but also includes intellectual, emotional, interpersonal, financial, and spiritual components. The Saunders concept of total pain emphasizes the importance of addressing all these domains to provide comprehensive pain management.
Common reasons for unrelieved pain include patient or family beliefs that pain is inevitable and untreatable, failure to contact healthcare providers, and lack of knowledge about pain management.
Opioidphobia, or fear of using opioids, is a common barrier to effective pain management. It is fueled by unfounded fears of addiction and dependence, and can be addressed through education, open communication, and consultation with pain specialists.
Pain assessment should be done prior to treatment to determine the cause, type, severity, and impact of pain. Accurate assessment and diagnosis are essential to plan appropriate interventions and improve overall quality of life.
Myths about morphine, such as addiction and respiratory depression, can prevent effective pain management. It is important to educate healthcare providers and patients about the benefits and risks of morphine and other opioids, and to develop individualized pain management plans.
Barriers to optimal pain assessment include poor assessment techniques, lack of knowledge and training, and fear of addiction and adverse effects. Addressing these barriers requires a multidisciplinary approach and ongoing education and training for healthcare providers.
Patients with chronic illnesses like arthritis may have additional pain, and new pain could indicate new disease or recurrence.
Indigenous health services may involve traditional herbs and consulting with spiritual teams.
Neuropathic pain, a type of pain, typically goes down to a specific dermatome and may be accompanied by sensitivity to touch.
Pain assessment requires understanding cultural traditions, customs, beliefs, and values to effectively assess and manage pain.
Neuropathic pain can be described as aching, throbbing, cramping, sharp, stabbing, burning, tingling, crawling, itchy, or squeezing, and sensitivity to touch could indicate allodynia.
Pain assessment should include the location, duration, and severity of pain.
Various pain rating scales, such as the NRS, VAS, and Wong-Baker FACES pain rating scale, can be used for assessing pain effectively.
The Edmonton Symptom Assessment System Revised (ESAS-R) can be used for comprehensive pain assessment.
Common side effects in palliative care patients include tiredness, anxiety, and pain, which should be assessed regularly and addressed promptly.
Pain assessment should be done through open communication with patients and their families as well as healthcare professionals.
The Canadian Problem Checklist can be used to assess a range of issues beyond pain.
A patient discussed the importance of managing pain to maintain a good quality of life. (Example of a personal experience)
According to the World Health Organization (WHO), up to 90% of cancer patients could have their pain alleviated by following the treatment guidelines of the WHO analgesic ladder. (Fact about cancer pain management)
Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. (Definition of pain from the International Association for the Study of Pain)
The prevalence of pain in advanced illnesses, such as cancer, is high, with many patients experiencing multiple pains with various causes. (Fact about prevalence of pain)
Pain is a multidimensional construct, and its assessment involves a thorough history and physical examination, including a neuro exam. (Approach to pain control)
Goals of care, hopes, and expectations should be discussed with patients and their families when developing a pain management plan. (Importance of patient and family involvement)
Investigations, such as X-rays, CT scans, and MRI, can be used to determine the cause and severity of pain and guide treatment options. (Role of investigations)
Treatment options for pain include pharmacological and non-pharmacological interventions, such as radiotherapy and interventional analgesia. (Treatment options)
Ongoing reassessment and review of options, goals, and expectations are essential in effective pain management. (Importance of ongoing assessment)
Pain can be classified based on its duration, cause, connections, and location. (Classification of pain)
Visceral pain refers to pain related to organs and tissues from the endoderm, such as the stomach, bowel, liver, pancreas, kidney, and bladder. (Description of visceral pain)
Deep somatic pain is localized and described as dull and aching and is associated with bones, muscles, ligaments, and fascia. (Description of deep somatic pain)
Cutaneous pain is localized and described as sharp or burning and is associated with nervous tissue. (Description of cutaneous pain)
Nociceptive pain is an umbrella term for visceral and deep somatic pain, while neuropathic pain is associated with nerves and nerve plexuses. (Description of nociceptive and neuropathic pain)
Pain can be intermittent or continuous and can be localized or multifocal. (Description of pain characteristics)

Test your knowledge on different types of breakthrough pain and referred pain, including their characteristics, causes, and associated conditions such as colorectal, breast, liver, and pancreatic cancer. Understand the symptoms of somatic pain and its impact on movement and localization.

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