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Behavioral and Psychological Aspects of Pain

Primary affective symptoms that are present with chronic pain

(A) generally resolve when the pain is treated adequately

(B) require treatment independent of the pain

(C) are rare among the elderly

(D) are always reactive or secondary to the pain

(E) require thorough assessment by a psychopharmacologist

(B) Reviews clearly suggest that affective symptoms require treatment independent of the patient's pain, either through pharmacotherapy, behavioral therapies, or both. Depression is common in chronic pain populations, with rates that exceed 50% within some populations. Unfortunately, physician adherence with respect to depression screening is poor. Risk of suicide can be significant with an untreated depression, and the elderly often fail to undergo adequate assessment. While consultation by a psychopharmacologist is desirable, many primary care physicians and other subspecialists elect to pharmacologically manage depression.

Which of the following include risk factors for completed suicide?

(A) Age

(B) Substance abuse

(C) History of prior suicide attempts

(D) Chronic medical conditions

(E) All of the above

(E) While the ability to predict suicide is poor even among mental-health clinicians, the above illustrate commonly accepted risk facts. The presence of past suicide attempts is another predictor. The elderly, males, and those with chronic medical conditions are at great risk for suicide completion.

Tricyclic antidepressants

(A) have been shown to assist with reducing neuropathic pain

(B) have been shown to assist with chronic headache

(C) should be closely monitored in depressed patients because of suicide risk and possible lethality of an overdose

(D) have been infrequently used in the treatment of major depression

(E) A, B, and C

(E) While commonly used in pain practice, dosing of tricyclic antidepressants is rarely sufficient to cover comorbid major affective symptoms. Other commonly used antidepressant agents or proper dosing should be considered when significant affective symptoms are present, with close monitoring given the risk factors associated with an overdose.

Substance abuse risk assessment

(A) is required as a minimum standard of care with chronic pain


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