5. What is the best way to determine whether opioid analgesics are beneficial for an individual patient with chronic pain?
A. Ask the patient if the medication is reducing the pain
B. Determine whether the medication is increasing the patient’s level of functioning
C. Ask if the medication makes the patient less depressed
D. Ask if the medication makes the patient less anxious
Discussion: Although reducing the levels of pain, depression, and anxiety in patients with chronic pain is important, measuring the impact of any treatment modality for chronic pain is best done by determining its effect on the level of functioning. If there is no improvement in functioning, the benefits of the treatment should be questioned.3
Answer: B. Determine whether the medication is increasing the patient’s level of functioning
6. Which of the following has been identified as a risk factor for the development of an opioid use disorder in patients who take opioids prescribed for legitimate pain complaints?
A. Past history of substance abuse
B. Major depression
C. Younger age
D. The use of psychotropic medications
E. All of the above
Discussion: All of these have been identified as risk factors for the development of opioid use disorder.2 However, even patients without any of these factors are still at risk for a substance use disorder, and it is unclear how many patients who develop the disorder have these risk factors.
Answer: E. All of the above
1. Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. 2016;374:154-163.
2. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain: United States, 2016. MMWR. 2016;65:1-150.
3. Sullivan MD, Ballantyne JC. Must we reduce pain intensity to treat chronic pain? Pain. 2016;157:65-69.
4. Gilron I, Tu D, Holden RR, et al. Combination of morphine with nortriptyline for neuropathic pain. Pain. 2015;156:1440-1448.
5. Smith TJ, Saiki CB. Cancer pain management. Mayo Clin Proc. 2015;90:1428-1439.