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Types of Pain

A 45-year-old patient with metastatic breast carcinoma is prescribed 30 mg of sustained-release morphine (MS Contin) twice a day and one 15-mg tablet of immediate-release morphine (MSIR) every 6 hours as needed for breakthrough pain. On her routine follow-up visit she reports that she routinely uses MSIR four times a day with satisfactory pain control on most days and no major side effects. What would be your best course of action in this situation?

(A) Prescriptions should be left unchanged

(B) MS Contin should be changed to 40 mg of OxyContin twice a day and 5 mg of oxycodone every 6 hours as needed for breakthrough pain

(C) Fentanyl patch of 25 μg/h should replace MS Contin with 15 mg of MSIR every 6 hours as needed for breakthrough pain

(D) MS Contin should be increased to 60 mg twice a day with MSIR 15 mg every 6 hours as needed for breakthrough pain

(E) MS Contin should be increased to 60 mg twice a day, and MSIR should be discontinued

(D) If a patient routinely uses breakthrough medications, the daily total amount should be converted to a sustained-release dose and added to the current maintenance dose.

Approximately in what percentage of patients with malignancies does pain unrelated to cancer occur?

(A) Less than 2%

(B) 3%

(C) 7.5%

(D) 11%

(E) 25%

(B) Approximately 3% of pain syndromes in cancer patients are unrelated to the underlying malignancy or cancer treatment. Most commonly, pain is caused by degenerative disc disease, arthritis, fibromyalgia, or migraine and has often predated the diagnosis of cancer.

There is a significant incidence of neuropathic pain in a cancer patient with brachial plexopathy. The etiology of the brachial plexopathy in such a patient may be caused by direct tumor infiltration or radiation fibrosis. Electrophysiologic evaluation with nerve conduction velocity (NCV) study and electromyography (EMG) helps to distinguish between the two etiologies. Which of the following findings of NCV/EMG is the most helpful to differentiate between the direct tumor infiltration and the radiation fibrosis etiologies of brachial plexopathy?

(A) Segmental nerve conduction slowing

(B) Myokymia

(C) Fibrillation potentials

(D) Positive sharp waves

(E) Decreased ...

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