1. TheanswerisC.

2. The answer is B. Hippocrates described the humors as related to one of the four constitutions, each of which was also correlated with the changing seasons and representative natural elements.

3. The answer is D. Radiofrequency ablation destroys the nerve fiber by heating it and thereby producing analgesia.

N. Vadivelu et al. (eds.), Essentials of Pain Management,

DOI 10.1007/978-0-387-87579-8, © Springer Science+Business Media, LLC 2011

Chapter 2: Multidisciplinary Approach to Pain Management

1. The following is true of chronic pain:

A. Analgesics have no role in the multidisciplinary management of chronic pain

B. Perpetuating factors may be remote from the originating cause

C. It can be effectively managed in a primary care setting

D. Immobilization of the affected part helps in the healing process

2. Ann is 35-year-old woman who has been suffering from a headache for the last 6 months. She is on various medications and the side effects of these are affecting her work and daily activities. During assessment for the MPC (Multidisciplinary Pain Center) program she mentions that she recently has suffered two episodes of jerky movements of the right arm which made her wake up from sleep. Which of the following would be appropriate?

A. Conduct a detailed psychological assessment to rule out a somatization disorder

B. Advise her to reduce or stop her current medications

C. Ask her to increase the dose of diazepam that she is taking at bedtime

D. Refer to a physician for further clinical evaluation and investigations

3. Which of the following is part of a multidisciplinary approach to pain management?

A. Emphasize active patient participation and responsibility

B. Provide education and training in the use of specific skills

C. Help the patient re-conceptualize pain and associated problems from uncontrollable to manageable

D. All of the above

4. Which of the following statements regarding the role of medications in pain management program is not true?

A. Analgesics are given on a time-contingent basis

B. Patients in an MPC program do not generally derive adequate pain relief from analgesic medication

C. Pain cocktail technique involves mixing various opioids and NSAIDs in a masking vehicle

D. Long-term use of other medications is discouraged both because of their potential side effects and the philosophy that the patient must learn to control his or her pain

5. Success of a pain management program can be measured by all EXCEPT

A. Utilization of health care system following treatment

B. Elimination or reduction of opioid medication

C. Pain reduction

D. Oswestry Disability Index (ODI)


1. The answer is B. Pain persisting after the healing process is complete does not serve any meaningful purpose. On the other hand, acute pain serves to protect the affected body part and it actually helps the healing process. Multidisciplinary management, though it encourages the patient to reduce analgesics, has a role in during acute exacerbations.

2. The answer is D. One of the aims of assessment for MPC is to rule out those patients who have a medical or psychological contraindication to such a program. Ann could be having a focal seizure and this needs to be investigated.

3. The answer is D. In patients suffering from chronic pain, complete freedom from pain is often impossible to achieve. Programs usually emphasize physical conditioning, medication management, acquisition of coping and vocational skills, and gaining knowledge about pain so that the pain becomes manageable.

4. The answer is C. The pain cocktail technique is a method of converting all opioids to an equivalent dose of sustained acting opioids or methadone and delivered with a masking vehicle. The dose is then tapered over the period of treatment. Most of the medications except antidepressants are finally stopped.

5. The answer is D. ODI is used to assess disability due to pain.

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