1. Briefly Define the Following

Study Guide for Interns

1. Briefly define the following:

(a) Addiction

(b) Physical dependence

(d) Pseudoaddiction

(e) Drug misuse

(f) Hyperalgesia

2. Briefly describe the risks, benefits, and alternatives to an opioidrotation

3. A patient is diagnosed with fibromyalgia in clinic. Briefly discuss the anatomy, pathophysiology, and differential diagnosis as you would with the patient and her family.

4. Briefly describe the pharmacodynamic and pharmacokinetic properties unique to methadone. How would you convert someone on a 100mcg fentanyl patch to methadone?

5. A 28 year old woman presents to the chronic pain clinic. She has chronic low back pain. She is otherwise healthy. She is 18 weeks pregnant. Briefly describe her treatment options.

6. A 28 year old woman presents to the chronic pain clinic. She has chronic low back pain. She has erosive rheumatoid arthritis that has not been responding well to biologic and disease modifying agents. She is 18 weeks pregnant. Briefly describe her treatment options throughout pregnancy and upon delivery.

7. Briefly describe the following:

(a) Somatic pain

(b) Visceral pain

(c) Neuropathic pain

8. What are the maximum doses of the most common local anesthetics and what are the ciinical signs and symptoms of local anesthetic toxicity? Treatment?

9. Discuss the anatomy, physiology, and diagnosis of lumbar facet syndrome as you would with a patient and her family.

10. Discuss lumbar medial branch blocks and lumbar facet denervation (including risks, benefits, and alternatives) as you would with a patient and her family.

11. A 75 year old man presents to the chronic pain clinic with chronic end stage left knee osteoarthritis. He is not a surgical candidate. He is otherwise healthy. Briefly discuss his treatment options as you would with him and his three children, who are also present.

12. A 75 year old man presents to the chronic pain clinic with chronic end stage left knee osteoarthritis. He is not a surgical candidate. He has CHF with an EF of 25%, Stage 3 CKD, an A1C of 12%. He has failed intraarticular steroid and viscosupplementation.Briefly discuss his treatment options as you would with him and his three children, who are also present.

13. A 31 year old woman cuts the palm of her right hand while chopping vegetables and making dinner for her three children. Within days her right hand and arm are too painful to touch and the extremity “feels cold all the time.” The patient is otherwise healthy.How do you confirm or refute a working diagnosis of CRPS? If confirmed, what is your approach to managing the CRPS?

14a. List the mechanism of action (if known) and three common side effects for each.

Medication / Mechanism of Action / Side Effects
Gabapentin
Pregabalin
Amitriptyline
Opioids
NSAIDs (llist 4 common prescripiton NSAIDs)

14b. List the most common antidepressants from each of the following classes and their mechanism of action (if known): TCAs, SSRIs, SNRIs, and dopaminergic agents:

14c. List the common muscle relaxantss and their mechanism of action (if known).

14d. List the opioid receptor types (and subtypes) and and their actions.

15. A 45 year old man presents to you with regional low back pain. He is otherwise healthy. He has seen PT, a spine surgeon, and he's had X-rays and an MRI. The workup is unremarkable. PT and spine surgery have nothing more to offer.The patient tells you "I don't want to be on pills" and he mainly "wants to discuss interventional management."What are three options you would offer him and what would be the rationale for each?

16. A 52 year old man with chronic low back pain and right leg pain is referred to you for a spinal cord stimulator. He has been thoroughly evaluated and treated and there are no other options for him. He asks you to inform him about spinal cord stimulation / neuromodulation. What are the indications? How does it work? What process does he have to go through? What are the risks? What are the complications?

17. A 69 year old woman with metastatic breast adenocarcinoma presents to the chronic pain clinic. She is on extended release oxycodone 80 mg three times daily and oxycodone / acetaminophen 10/325 every four hours for breakthrough pain. Her medication regimen provides her adequate analgesia and yet the side effects of sedation and constipation are negatively impacting her quality of life. She wants to pursue an intrathecal pump. What are the indications? How does it work? What process does she have to go through? What are the risks? What are the complications?

18. A 53 year old man with lumbar spinal stenosis and left leg pain has been following with the chronic pain clinic for a while. He is frustrated that he’s not improving and he wants to have surgery. What are the indications for referral to a spine surgeon? What are the indications for spine surgery?

19. Briefly describe the following and recommended first and second lines of therapy:

(a) Migraine headache

(b) Tension headache

(e) Rebound headache (medication overuse)

(f) Trigeminal neuralgia

(f) Sinus headache

20. Briefly describe the following:

(a) Allodynia

(b) Hyperalgesia

(d) Hypersensitivity

(e) Hypesthesia

21. List four types of sympathetic nerve blocks and discuss the most common indications for each one.

22. Briefly describe the following:

(a) Conversion disorder

(b) Factitious disorder

(d) Malingering

(e) Somatization disorder with psychological factors

22. What is Buprenorphrine and what preperations are commercially available currently?

23. What are the CDC guidelines for the treatment of chronic, non-cancer pain with opioids?

24. What is the WHO Analgesic Stepladder?

25. List several weak and strong opioids.

26. What is ziconitide?

27. Review the ASRA Anticoagulation Guidelines for Neuraxial Anesthesia in the Anticoagulate Patient. How long must Heparin SC, Heparin IV, Coumadin, Lovenox, Plavix, Asprin, and Xarelto be held prior to neuraxial anesthesia?

28. Briefly describe when you might refer a patient to a palliative care specialist