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PAIN
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PAIN

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Questions and Answers

Which of the following statements about tension-type headache (TTH) is correct?

  • TTH exact pathophysiology is still unknown. (correct)
  • TTH is caused by muscle stiffness.
  • The exact pathophysiology of TTH is well-understood and involves a single mechanism.
  • TTH has a lifetime prevalence of less than 30% globally.

    • Which of the following is NOT a characteristic of medication overuse headache (MOH)?

  • Caused by the overuse of prophylactic headache medications. (correct)
  • Headaches occurring on ≥15 days/month in a patient with a pre-existing headache disorder.
  • Regular overuse of acute headache medication for >3 months.
  • Overuse defined as ≥10 days/month for ergot derivatives, triptans, opioids, and combination analgesics.

    • Which of the following statements about medication overuse in the context of headache is correct?

  • Overuse can involve a combination of agents from different drug classes, even if they are not individually overused. (correct)
  • Overuse of triptans is defined as ≥15 days/month.
  • Overuse of ergot derivatives is defined as ≥15 days/month.
  • Overuse of non-opioid analgesics is defined as ≥10 days/month.

    • Which of the following drug classes is NOT mentioned in the definition of medication overuse headache?

    <p>Anticonvulsants</p> Signup and view all the answers

    According to the information provided, which of the following statements is correct?

    <p>Medication overuse headache is not better accounted for by another ICHD-3 diagnosis.</p> Signup and view all the answers

    How many episodes of episodic tension headache must occur for a diagnosis according to the ICHD-3 criteria?

    <p>10 episodes</p> Signup and view all the answers

    Which type of headache is classified as a secondary headache disorder?

    <p>Medication-overuse headache</p> Signup and view all the answers

    Which headache disorder is characterized by occurring at 10-15 days per month for a duration longer than 3 months?

    <p>Episodic Tension Headache</p> Signup and view all the answers

    What is the primary goal of acute drug therapy for migraine headaches?

    <p>To alleviate headache pain and associated symptoms within 2 hours of treatment and/or 24 hours of sustained headache relief</p> Signup and view all the answers

    Which of the following is NOT a recommended treatment for tension-type headache (TTH)?

    <p>Triptans</p> Signup and view all the answers

    Which of the following statements about the treatment of tension-type headache (TTH) is correct?

    <p>Mild TTH may not require pharmacological treatment.</p> Signup and view all the answers

    Which of the following is the most common type of headache mentioned in the text?

    <p>Tension-type headache</p> Signup and view all the answers

    Which of the following is a key recommendation for the acute treatment of migraine headaches?

    <p>Acute treatments should be taken at the onset of the migraine attack.</p> Signup and view all the answers

    Which of the following is NOT a red flag that requires further investigation or referral for headaches?

    <p>Occasional tension-type headache</p> Signup and view all the answers

    Which of the following conditions is associated with a positional headache?

    <p>Intracranial hypertension or hypotension</p> Signup and view all the answers

    Which of the following is NOT a potential cause of a secondary headache?

    <p>Tension-type headache</p> Signup and view all the answers

    Which of the following red flags is associated with a potential vascular disorder?

    <p>Sudden or abrupt onset of headache</p> Signup and view all the answers

    Which of the following is a potential side effect or cause of headache that requires further investigation?

    <p>Analgesic overuse or drug-induced headache</p> Signup and view all the answers

    Which of the following is NOT one of the reasons why codeine, tramadol, butalbital and butorphanol are not recommended for acute migraine treatment?

    <p>Lack of evidence of superior effectiveness</p> Signup and view all the answers

    Which of the following statements about triptans is NOT true?

    <p>They are recommended for use in patients with cardiac disorders</p> Signup and view all the answers

    What is the maximum number of days per month that triptans should be used to avoid medication-overuse headache (MOH)?

    <p>10 days</p> Signup and view all the answers

    Which of the following is NOT one of the triptans mentioned in the text?

    <p>Ergotamine</p> Signup and view all the answers

    What type of headache disorder is specifically mentioned in the text as a contraindication for triptans?

    <p>Basilar migraine</p> Signup and view all the answers

    Which of the following statements about the efficacy of triptans is true?

    <p>They are effective for alleviating both headache pain and migraine-associated symptoms</p> Signup and view all the answers

    Which of the following statements about the safety and tolerability of triptans is NOT supported by the text?

    <p>They can cause liver toxicity in some patients</p> Signup and view all the answers

    Which of the following is a potential problem associated with the use of codeine, tramadol, butalbital and butorphanol for acute migraine treatment?

    <p>Medication-induced headache</p> Signup and view all the answers

    Which of the following statements about the use of analgesics for migraine treatment is supported by the text?

    <p>They do not provide adequate pain relief when used alone</p> Signup and view all the answers

    Which of the following statements about published trials of nonprescription agents in migraine is true?

    <p>They have systematically excluded patients with more severe attacks</p> Signup and view all the answers

    Which type of headache is most commonly associated with overuse of analgesics?

    <p>Tension-type headaches (TTH)</p> Signup and view all the answers

    What is the typical effect of pregnancy on migraine for most women?

    <p>Migraine worsen in 30-40% of cases</p> Signup and view all the answers

    Which of the following is NOT a potential maternal complication associated with migraine during pregnancy?

    <p>Preterm labor</p> Signup and view all the answers

    Which type of medication for migraine should be discontinued before attempting to conceive, if possible?

    <p>Medications that can interfere with folate function (e.g., valproic acid)</p> Signup and view all the answers

    Which of the following statements regarding the management of medication-overuse headache (MOH) is correct?

    <p>Tapering and stopping the offending agent(s), providing bridge therapy, and starting a prophylactic medication are part of the recommended management strategy.</p> Signup and view all the answers

    Which of the following statements regarding the preventive therapy for tension-type headache (TTH) is correct?

    <p>Tricyclic antidepressants, such as amitriptyline, have moderate clinical evidence for efficacy in TTH prevention.</p> Signup and view all the answers

    Which of the following drug classes is NOT mentioned in the context of preventive therapy for tension-type headache (TTH)?

    <p>Anticonvulsants</p> Signup and view all the answers

    Based on the information provided, which of the following statements regarding the treatment of different types of headaches is correct?

    <p>Psychological comorbidities, such as depression, should be managed concurrently for both migraine and tension-type headaches.</p> Signup and view all the answers

    What is the primary basis for choosing a pharmacologic agent for low back pain?

    <p>Risk versus benefit, cost, and patient preference</p> Signup and view all the answers

    What is the recommended duration for trying pharmacologic therapies in low back pain?

    <p>2-4 weeks</p> Signup and view all the answers

    What is the primary recommendation for patients with nonspecific low back pain?

    <p>Staying active and maintaining usual activity</p> Signup and view all the answers

    What should individuals with low back pain be advised to do according to the information provided?

    <p>Stay active and only avoid specific activities that may worsen pain or injury</p> Signup and view all the answers

    How should reassurance be provided to individuals with acute or subacute low back pain according to the text?

    <p>By informing that the condition improves over time regardless of treatment</p> Signup and view all the answers

    What type of therapy is recommended for low back pain as a first-line treatment in the text?

    <p>provide patients with information and education ontreatment options and the expected course of disease, and to advise them to maintain usual activity.</p> Signup and view all the answers

    Which of the following is NOT mentioned as a conservative treatment for low back pain in the text?

    <p>Weight Lifting</p> Signup and view all the answers

    What is the main therapy recommended to be used with exercise for short-term benefit in managing low back pain?

    <p>Education</p> Signup and view all the answers

    Which of the following treatments is NOT backed by low-quality evidence but recommended based on a lack of harms and a small to moderate effect on either pain and/or function?

    <p>Acupuncture</p> Signup and view all the answers

    What type of therapy may provide a greater improvement in pain symptoms and function at 26 weeks compared to usual treatment?

    <p>Mindfulness-based stress reduction</p> Signup and view all the answers

    In the context of low back pain, which approach may result in larger improvements in pain and daily function compared with usual care or interventions aimed only at physical factors?

    <p>Multidisciplinary biopsychosocial treatment approach</p> Signup and view all the answers

    What is a recommended treatment for chronic low back pain specifically mentioned in the text?

    <p>Incorporating behavioural therapy</p> Signup and view all the answers

    Which combination may decrease disability and pain and improve quality of life in individuals with low back pain, as per the text?

    <p>Behavioural therapy and exercise</p> Signup and view all the answers

    When should surgical therapy be considered for individuals with common degenerative spinal changes or spinal stenosis?

    <p>When all other therapies have failed</p> Signup and view all the answers

    What is the primary advice given to patients regarding treatment of low back pain?

    <p>To use nonpharmacologic measures concurrently with medication</p> Signup and view all the answers

    What is Cauda equina syndrome characterized by?

    <p>Dull pain in the lower back and upper buttock region with bowel and bladder dysfunction</p> Signup and view all the answers

    Which patient group is at an increased risk of hepatotoxicity when using acetaminophen for low back pain?

    <p>Individuals with excessive alcohol intake</p> Signup and view all the answers

    Why is it important for patients to increase their level of activity based on pain tolerance?

    <p>To promote faster recovery by gradually increasing activity levels</p> Signup and view all the answers

    What is one of the key pieces of advice given to patients regarding treatment of low back pain?

    <p>Maintain ordinary activities and gradually increase activity based on pain tolerance</p> Signup and view all the answers

    Which statement about acetaminophen for the treatment of low back pain is correct?

    <p>Evidence suggests that acetaminophen may be ineffective for low back pain and have greater risks than previously thought.</p> Signup and view all the answers

    Which of the following statements about the use of NSAIDs for low back pain is supported by the text?

    <p>NSAIDs are the only pharmacologic option endorsed by current guidelines</p> Signup and view all the answers

    Based on the information provided, which of the following statements about non-pharmacologic therapy for low back pain is correct?

    <p>Continuous heat wrap therapy may provide better pain relief than regular doses of acetaminophen or ibuprofen.</p> Signup and view all the answers

    Which of the following statements about the use of opioid analgesics for low back pain is true, based on the information provided?

    <p>Opioid analgesics are among the common treatments listed for nonspecific low back pain.</p> Signup and view all the answers

    Which of the following statements about the evidence for pharmacologic treatments for low back pain is correct?

    <p>The evidence of efficacy for all pharmacologic agents is generally weak.</p> Signup and view all the answers

    Which of the following is the MOST important initial step in assessing low back pain?

    <p>Ruling out potential serious underlying conditions or &quot;red flags&quot;</p> Signup and view all the answers

    The text recommends that pharmacologic therapy for low back pain should be used in what manner?

    <p>In combination with nonpharmacologic options</p> Signup and view all the answers

    Which of the following is a key principle of therapy for low back pain according to the text?

    <p>Nonpharmacologic options should be the initial approach</p> Signup and view all the answers

    The text states that current pharmacologic therapies for low back pain may provide what type of relief?

    <p>Symptomatic relief only</p> Signup and view all the answers

    According to the information provided, what is the recommended duration for trying each analgesic at an optimal dose before assessing its impact on daily activities and functioning for low back pain?

    <p>2-4 weeks</p> Signup and view all the answers

    What is the recommended timing for taking an analgesic in relation to activities that may exacerbate low back pain?

    <p>Take the dose at least 1 hour before the activity</p> Signup and view all the answers

    Which of the following is the recommended approach for timing of analgesic medication for low back pain?

    <p>Either around-the-clock or PRN dosing is acceptable</p> Signup and view all the answers

    Which of the following is NOT mentioned as a potential method for quantifying and characterizing pain relief in low back pain patients?

    <p>McGill Pain Questionnaire</p> Signup and view all the answers

    Based on the information provided, which of the following statements about the monitoring of therapy for low back pain is correct?

    <p>Both a) and b)</p> Signup and view all the answers

    Which of the following statements regarding the standardization of active ingredients in products for low back pain is supported by the information provided?

    <p>Both a) and b)</p> Signup and view all the answers

    According to the information provided, which of the following statements about the safety and efficacy of the substances mentioned for long-term use in low back pain is correct?

    <p>There is no evidence that any of these substances are safe or efficacious for long-term use</p> Signup and view all the answers

    Which of the following statements about the action to be taken if low back pain symptoms are not relieved after an adequate trial of analgesics is correct?

    <p>The patient requires further assessment by an appropriate healthcare practitioner</p> Signup and view all the answers

    According to the information provided, which of the following statements about the timing of pain assessment in low back pain patients is NOT correct?

    <p>Pain relief should be assessed at the end of the treatment period only</p> Signup and view all the answers

    What is the recommended course of action if after two weeks of self-care a patient's pain symptoms have not improved?

    <p>Immediate referral to a health-care practitioner</p> Signup and view all the answers

    Which of the following is a warning sign that a patient may need immediate referral to a health-care practitioner?

    <p>Worsening pain despite drug therapy</p> Signup and view all the answers

    What is the initial course of action for patients experiencing worsening pain despite drug therapy?

    <p>Immediate referral to a health-care practitioner</p> Signup and view all the answers

    What preventive measure should be taken if a patient's pain symptoms do not improve after 14 days of self-care?

    <p>Seek nonpharmacologic therapy</p> Signup and view all the answers

    What should a health-care practitioner recommend if a patient's pain is not improving despite adequate drug therapy?

    <p>Refer the patient for immediate assessment</p> Signup and view all the answers

    Which of the following is a recommended nonpharmacologic therapy for managing low back pain according to the text?

    <p>Gradually increasing physical activity</p> Signup and view all the answers

    What is a potential warning sign or red flag that would require further investigation or referral for headaches, according to the information provided?

    <p>Headaches that are positional in nature.</p> Signup and view all the answers

    What is the primary goal of acute drug therapy for migraine headaches?

    <p>To provide rapid relief of migraine symptoms.</p> Signup and view all the answers

    Which of the following is the primary rationale for limiting the number of local corticosteroid injections to 3 per year?

    <p>To minimize the risk of atrophy, tendon rupture, and osteoporosis</p> Signup and view all the answers

    According to the information provided, which of the following is a key recommendation for the extemporaneous compounding of topical NSAID products?

    <p>Use of special commercial bases like Phlojel or Diffusimax</p> Signup and view all the answers

    Which of the following is the primary conclusion drawn from the meta-analysis of randomized, placebo-controlled trials on the use of topical NSAIDs?

    <p>Topical NSAIDs are effective in relieving pain in both acute and chronic conditions</p> Signup and view all the answers

    Which of the following is the main contraindication for the use of corticosteroid injections mentioned in the text?

    <p>Achilles tendonitis</p> Signup and view all the answers

    According to the information provided, which of the following is the primary indication for the use of topical diclofenac?

    <p>Osteoarthritis of the knee and Acute pain caused by injury to joints or muscles</p> Signup and view all the answers

    What is the recommended course of action if a patient's pain symptoms have not improved after 14 days of self-care?

    <p>Immediate referral to a health-care practitioner for further assessment</p> Signup and view all the answers

    Which drug class does acetaminophen belong to as per the information provided?

    <p>Analgesics</p> Signup and view all the answers

    What is the potential risk associated with chronic use of acetaminophen at high doses?

    <p>Increased risk of hepatotoxicity</p> Signup and view all the answers

    Which drug may decrease the effectiveness of acetaminophen and increase hepatotoxicity?

    <p>Isoniazid</p> Signup and view all the answers

    If a patient's pain is worsening despite drug therapy, what is the recommended course of action?

    <p>Refer the patient for immediate assessment by a health-care practitioner</p> Signup and view all the answers

    What is the recommended duration for applying ice therapy to an injury?

    <p>Regularly with a few hours between treatments</p> Signup and view all the answers

    Which activity is recommended for an individual undergoing long-term rest due to a muscle injury?

    <p>Exercising the unaffected joint(s)</p> Signup and view all the answers

    What does compression with an elasticized bandage primarily aim to do?

    <p>Reduce swelling and provide support</p> Signup and view all the answers

    When should heat therapy replace the RICE regimen for soft-tissue injuries?

    <p>After initial swelling subsides, typically after 48 hours</p> Signup and view all the answers

    What is the main reason for raising the injured area above heart level during elevation?

    <p>To help drain fluid and reduce swelling</p> Signup and view all the answers

    Which of the following is false about why muscle relaxants are not routinely recommended as first-line therapy for acute musculoskeletal injuries?

    <p>They are not effective in providing pain relief for acute musculoskeletal injuries.</p> Signup and view all the answers

    According to the information provided, which of the following is a KEY principle of therapy for the management of acute musculoskeletal injuries like bone fractures?

    <p>Short-term use of acetaminophen plus codeine combinations may be warranted for extremely painful injuries.</p> Signup and view all the answers

    Which of the following is a key reason why health care providers should avoid prescribing opioids for patients with concussion, according to the information provided?

    <p>Opioids can impair the patient's ability to undergo a proper neurological examination.</p> Signup and view all the answers

    According to the information provided, which of the following is a key recommendation regarding the use of external analgesic products (e.g., methyl salicylate, menthol, camphor, capsaicin) for the treatment of acute musculoskeletal injuries?

    <p>External analgesics have limited value but may be useful as cooling or heating rubs or as accompaniments to massage therapy.</p> Signup and view all the answers

    According to the information provided, which of the following is a potential benefit of using herbal products like Arnica montana for the treatment of acute musculoskeletal injuries such as sprains?

    <p>Herbal products like Arnica montana can reduce bruising and swelling associated with acute musculoskeletal injuries.</p> Signup and view all the answers

    Which of the following is a key principle of therapy for sports injuries according to the text?

    <p>Advising patients to take the lowest effective dose of analgesics to relieve pain and inflammation</p> Signup and view all the answers

    According to the information provided, which of the following is a recommended treatment approach for chronic sports injuries that may result in larger improvements in pain and daily function compared to usual care?

    <p>Combining pharmacologic therapy with targeted physical therapy and exercise</p> Signup and view all the answers

    What is the recommended duration for trying each analgesic at an optimal dose before assessing its impact on daily activities and functioning for sports injuries, according to the information provided?

    <p>The text does not provide a specific recommended duration</p> Signup and view all the answers

    Which of the following statements about the use of codeine-containing products for the treatment of sports injuries is supported by the information in the text?

    <p>Codeine-containing products have limited use for most sports injuries and are primarily reserved for severe acute pain or cancer pain.</p> Signup and view all the answers

    According to the information provided, which of the following is a key recommendation for the acute treatment of sports injuries?

    <p>Advising patients to take the lowest effective dose of analgesics to relieve pain and inflammation</p> Signup and view all the answers

    Which of the following statements about the use of topical anesthetic preparations (vapocoolants or refrigerants) for pain management is correct?

    <p>They may cause cutaneous sensitization as a side effect.</p> Signup and view all the answers

    According to the information provided, which of the following statements about the use of NSAIDs for treating tendinopathies is correct?

    <p>NSAIDs can be used for short-term pain relief of tendinopathies.</p> Signup and view all the answers

    Based on the information provided, which of the following statements about the monitoring of therapy for soft tissue sports injuries is correct?

    <p>Patients should monitor their symptoms on a daily basis until the endpoint of therapy is reached.</p> Signup and view all the answers

    Which of the following statements about the use of the "spray and stretch" technique with topical anesthetic preparations is correct?

    <p>It involves spraying the anesthetic onto the injured area and then stretching the muscle to its normal length in a pain-free state.</p> Signup and view all the answers

    According to the information provided, which of the following statements about the use of topical nitroglycerin, including the patch, for treating tendinopathies is correct?

    <p>Its role in treating tendinopathies is not clearly defined.</p> Signup and view all the answers

    Why may children and adolescents be particularly at risk for sports injuries?

    <p>As young athletes of similar age vary greatly in size and physical maturity</p> Signup and view all the answers

    What is an important factor contributing to an increased risk of sports injury in children?

    <p>Early sport specialization</p> Signup and view all the answers

    How do the benefits of exercise compare to the potential risks in healthy adults?

    <p>The benefits far outweigh the potential risks</p> Signup and view all the answers

    What should be avoided in children for reducing the risk of sports injuries?

    <p>Early sport specialization</p> Signup and view all the answers

    What can increase the risk of sports injuries among young athletes?

    <p>Improper technique</p> Signup and view all the answers

    Why might certain children try to perform at levels beyond their ability in sports?

    <p>To keep up with peers</p> Signup and view all the answers

    Which group is stated to have physical activity guidelines as part of a healthy active lifestyle movement?

    <p>All age groups (children, adolescents, and adults)</p> Signup and view all the answers

    What are factors that can contribute to an increased risk of sport injury?

    <p>Lack of or poorly fitting protective equipment, improper technique, and early sport specialization</p> Signup and view all the answers

    What can increase the risk of sport injury among children and adolescents according to the text?

    <p>Improper performance, lack of protection, and proper training</p> Signup and view all the answers

    Which adverse effect is associated with chronic use of acetaminophen, especially at high doses?

    <p>Nephrotoxicity</p> Signup and view all the answers

    What drug interaction is reported between acetaminophen and warfarin-treated patients?

    <p>Increased INR</p> Signup and view all the answers

    Which medication may decrease the effect of acetaminophen and increase hepatotoxicity?

    <p>Phenytoin</p> Signup and view all the answers

    What is the primary adverse effect of aspirin on the gastrointestinal system?

    <p>Duodenal ulcers</p> Signup and view all the answers

    Which medication interaction with aspirin can lead to an increased risk of bleeding?

    <p>Anticoagulants</p> Signup and view all the answers

    What patient population should avoid aspirin due to specific contraindications?

    <p>Patients with peptic ulcers</p> Signup and view all the answers

    Which medication should be discontinued prior to surgery to prevent bleeding complications?

    <p>Aspirin</p> Signup and view all the answers

    Which adverse effect is NOT commonly associated with the use of diclofenac diethylamine (topical)?

    <p>Hypersensitivity</p> Signup and view all the answers

    What is the maximum recommended daily dosage of naproxen sodium?

    <p>440 mg</p> Signup and view all the answers

    In which patient population should ibuprofen be avoided based on the comments in the text?

    <p>Patients in the third trimester of pregnancy</p> Signup and view all the answers

    Which topical diclofenac formulation has a higher risk of skin dryness or irritation as an adverse effect?

    <p>Diclofenac sodium (topical)</p> Signup and view all the answers

    What is a potential adverse effect associated with the chronic or frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs) mentioned in the text?

    <p>Hepatotoxicity</p> Signup and view all the answers

    Which drug interaction is NOT noted for both naproxen and ibuprofen in the text?

    <p>No significant drug interactions</p> Signup and view all the answers

    What is an important caution mentioned for diclofenac diethylamine (topical) when considering its applications?

    <p>Avoid using in combination with other NSAIDs</p> Signup and view all the answers

    What is the main difference between ibuprofen dosage recommendations and naproxen dosage recommendations in the text?

    <p>$200-400$ mg every 4 to 6 hours for ibuprofen; $220-440$ mg every 8 to 12 hours for naproxen sodium</p> Signup and view all the answers

    Which drug's maximum recommended dose aligns with the dosage schedule of applying it three to four times daily topically on the affected area?

    <p>(c) Diclofenac Diethylamine (Topical)</p> Signup and view all the answers

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