Mixed / Miscellaneous Topics MCQs

Chronic lower back pain is one of the top reasons for physician office visits and also one of the greatest reasons for work absence. Lumbosacral strain, degenerative disk disease, and myofascial syndromes are the most common causes, and fibromyalgia is not typically associated with a diagnosis of lower back pain. Reference: lippincott's anaesthesia review pg 212.

Presence of hyperesthesia, allodynia, and hyperalgesia usually associated with overreaction, and persistence of the sensation after the stimulus is known as hyperpathia. Reference: Morgan and Mikhail's clinical anesthesiology 6th edition pg 1050 table 47-1.

Enhanced sympathetic tone increases sphincter tone and decreases intestinal and urinary bladder motility, promoting ileus and urinary retention and not increased peristalsis. Cardiovascular effects of acute pain often include hypertension, tachycardia, enhanced myocardial irritability, and increased systemic vascular resistance. An increase in total body oxygen consumption and carbon dioxide production due to pain, necessitates a concomitant increase in minute ventilation which in turn increases the work of breathing. Reference: Morgan and Mikhail's clinical anesthesiology 6th edition pg 1062.

Overdose of intrathecal opiates would not be a sign of an intradural mass lesion. Granulomas at the tip of intrathecal catheters used with intrathecal drug delivery systems are gaining increased attention. Granulomas are more frequently associated with high concentrations and doses of either morphine (> 10 mg/day) or hydromorphone (> 10 mg/day). Most patients who will develop granulomas receive the intrathecal medications for more than 6 months. Presenting symptoms may include loss of drug effect, new pain or paresthesias, or neurologic deficits. Patients should be routinely screened for signs and symptoms of granuloma formation at scheduled intrathecal pump refill appointments. In suspicious cases, patients should undergo prompt diagnostic imaging, and neurosurgical consultation should be considered. Reference: Miller: Miller's Anesthesia, ed 8, pp 1911-1912

Acute pain can be Nociceptive and Neuropathic Nociceptive pain is caused by activation or sensitization of peripheral nociceptors , specialized receptors that transduce noxious stimuli. Acute pain is almost always nociceptive. Nociceptive pain serves to detect, localize, and limit tissue damage. All other statements given above regarding acute pain are true. Reference: Morgan and Mikhail's clinical anesthesiology 6th edition pg 1050.

Neuropathic pain can be very difficult to treat effectively and often requires multiple therapeutic modalities for treatment. These include anticonvulsants, antidepressants, antiarrhythmic, α2-adrenergic agonists, topical agents, and analgesics (nonsteroidal anti-inflammatory drugs and opioids). Sympathetic blocks as well as spinal cord stimulation work for certain patient's resistant to pharmacological interventions. Reference: lippincott's anaesthesia review pg 213.

IASP definition of chronic postsurgical pain: Chronic postsurgical or posttraumatic pain is defined as chronic pain that develops or increases in intensity after a surgical procedure or a tissue injury and persists beyond the healing process, i.e., at least 3 months after the surgery or tissue trauma . Reference: https://pubmed.ncbi.nlm.nih.gov/30586070/

CRPS is associated with trauma. The main feature is burning, with continuous pain that is exacerbated by normal movement, cutaneous stimulation, or stress, usually weeks after the injury. The pain is not anatomically distributed. Other associated features include cool, red, clammy skin and hair loss in the involved extremity. Chronic cases may be associated with atrophy and osteoporosis. Reference: Barash: Clinical Anesthesia, ed 8, p 161