Free Pain Management Board Review Questions
This week's FREE CME Quick Quiz offers pain management treatment board review questions. Topics include: back pain, opioids, chronic pain, acute pain, substance abuse, and more. Here's a sample...
This week’s free board review question…
A 59-year-old man presents to you with severe low back pain that he says he has had for 8 years. He initially injured his back while working on his home. He has just completed 8 weeks of physical therapy, and he has been receiving chiropractic care for 1 year. He had been evaluated by a neurosurgeon and has declines any surgical interventions. He elects medical management of his pain.
He has attempted multiple nonpharmacologic therapies, including tai chi, cognitive behavioral therapy, acupuncture, exercise, low-level laser therapy, and electromyography biofeedback. However, none of these modalities have reduced his pain.
Past medical history includes heroin use disorder, which is in remission. Current medications include baclofen 10 mg every 8 hours as needed for spasms and meloxicam 15 mg daily. He has tried duloxetine, tramadol, carbamazepine, gabapentin, nortriptyline, and amitriptyline for pain management, but he has had no success. He has also tried multiple skeletal muscle relaxants, but they have only minimally reduced his pain.
His vital signs are: 98.6 °F (37 °C), pulse 84 beats/minute, blood pressure 136/81 mm Hg, respiratory rate 12 breaths/minute, and oxygen saturation 100% on room air. His body mass index is 25.3 kg/m2. He rates his pain as a 9 on a 10-point scale.
Laboratory studies are as follows:
- Glucose: 96 mg/dL (normal range, 70-100 mg/dL)
- Sodium: 143 mmol/L (normal range, 136-145 mmol/L)
- Potassium: 4.4 mmol/L (normal range, 3.5-5.4 mmol/L)
- Creatinine: 0.9 mg/dL (normal range, 0.6-1.1 mg/dL)
- Urea nitrogen: 14 mg/dL (normal range, 7-18 mg/dL)
- Hemoglobin: 13.6 g/dL (normal range, 11-14 g/dL)
- Hematocrit: 41% (normal range, 32%-42%)
X-ray of the lumbar spine shows diffuse, severe arthritis and degenerative disc disease at L4 to L5.
Which of the following is the most appropriate next treatment option?
Use a risk-stratification tool such as the Opioid Risk Tool or the Screener and Opioid Assessment for Patients with Pain (v 1) to determine risk of abuse or misuse.
Refer him to physical therapy for extended treatment, with emphasis on ultrasonography and transcutaneous electrical nerve stimulation (TENS).
Consider referring him to pain-management and substance use disorder specialists for additional evaluation and management given his history of substance abuse.
Evaluate risk factors for opioid-related harms, discuss pain treatment goals, and, if the benefit outweighs the risk, begin immediate-release opioid therapy (= 50 morphine milligram equivalents [MMEs)/day).
This question is a just sample from this week’s Free online medical education Quick Quiz.
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