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Chronic Pain -- Biomedical and Spiritual Approaches
by Harold G. Koenig, M.D. © 2003.
(The Haworth Pastoral Press: Binghamton, NY) [318 pages]
[Answer 18 of 25 questions correctly to receive 13 hours of Continuing Education credit.


Chapter 1: Pain Is a Common Problem (p. 9-26)
1. Pain can be the result of _____ in which a psychological conflict is expressed as a physical symptom.
a. a conversion disorder
b. malingering
c. nociceptive pain
d. neuropathic pain

2. In more than 80 percent of people who present lower back pain to their family physicians, the primary cause is
a. lack of physical activity.
b. poor posture.
c. uncertain.
d. scoliosis.

Chapter 2: A Giant Called Mr. Pain (p. 27-36)

3. After Anyone was captured by Mr. Pain, he was instructed by the Book of Life provided by Mr. Freedom to
a. try to escape.
b. get to know his fellow prisoners.
c. fight Mr. Pain.
d. remember his previous life.

Chapter 3: Back Pain -- Bob’s Story (p. 37-54)

4. When Dr. Koenig asked Bob, “What has helped you the most in coping emotionally with your pain?” Bob said
a. church friends.
b. prayer.
c. lying down for a brief rest.
c. physical therapy.

Chapter 4: Headache Pain -- Penny’s Story (p. 55-69)

5. Penny finally stopped having migraine headaches when she started taking the medication
a. Darvocet.
b. Midrin.
c. Inderal.
d. Darvon.

Chapter 5: Rheumatologic Pain -- Laura’s Story (p. 71-85)

6. On some days Laura’s pain is so bad she can “barely pick up a spoon.” In spite of this, she continues to be a caregiver by helping out at a
a. retirement home.
b. church nursery.
c. hospital.
d. homeless shelter.

Chapter 6: Generalized Pain -- Jackie’s Story (p. 87-98)

7. Jackie formed a very spiritual view of her pain from Colossians 1:24 which describes the experience of
a. taking on the sufferings of Christ for those around her.
b. helping others as though she was helping Christ Himself.
c. earning favor with God through her suffering.
d. doing for others what she would desire them to do for her.

Chapter 8: Assessment of Pain (p. 113-122)

8. Pain forces a person to think about it which then heightens the pain sensations and a desire to escape it. Attempts to stop or reduce the pain by decreasing movement results in
a. loss of muscle mass and strength.
b. increased rigidity of ligaments.
c. reduced bone density.
d. all of the above.

9. The most accurate and reliable method for determining the intensity of a person’s pain is
a. giving a comprehensive medical and neurological evaluation.
b. asking the person how bad the pain is.
c. identifying what caused it.
d. determining whether or not it is a constant or occasional pain.

Chapter 9: Medication for Pain (p. 123-144)

The treatment of first choice for chronic pain
is high-dose acetaminophen. (p. 126-7)

10. The safest and most effective drug treatment for persons with chronic pain, particularly the pain of arthritis, is
a. high-dose acetaminophen.
c. a muscle relaxant
d. a combination of a,b, &c.

11. Which is TRUE?
a. Most doctors underprescribe medication for people in chronic pain.
b. Physical dependence occurs when an individual seeks out a drug, has negative consequences resulting from use of the drug, and uses more and more of the drug than originally intended.
c. Addiction occurs when a person has been taking a drug for a long time and his or her body becomes used to the drug, to the extent that discontinuing use of the drug results in unpleasant withdrawal symptoms.
d. According to the American Academy of Pain Medicine and the American Pain Society, the incidence of addiction in patients taking opiods for pain is high.

Among opiods, the drug of first choice is morphine.
To date, no other drug has a faster onset, longer effect,
or better ratio of benefits to side effects. (p. 137)

12. Which is the best choice for severe continuous pain?
a. sustained-release morphine.
b. acetaminophen.
c. a combination of aspirin and ibuprofen.
d. immediate-release morphine.

Chapter 10: Psychosocial and Behavioral Treatments (p. 145-159)

How Physical Pain is Made Worse by Negative Cognitions

Negative cognitions release stress hormones
(cortical, epinephrine, etc.) that interfere with
immune and cardiovascular systems which may
be necessary for healing the physical condition
responsible for the pain. (p. 148)

13. _____ (is/are) the most disabling consequence(s) of chronic pain.
a. Depression
b. Anxiety
c. Sleep problems
d. Drug addiction

14. Ron Melzack developed the _____ theory of pain which stated that a mechanism exists in the dorsal part of the spinal cord which either inhibited or facilitated transmission of pain impulses. Pain could therefore be reduced by inhibiting the transmission of pain impulses through cognitive-behavioral therapy, hypnosis, biofeedback, relaxation training, meditation, prayer, and other techniques.
a. inhibition-center
b. gate-control
c. dynamic-locus
d. hypothalamic-pituitary

Chapter 11: Alternative and Complimentary Treatments (p. 161-184)

15. Which is TRUE concerning alternative medicines for pain?
a. The more strongly a person believes in the treatment, the more likely it will work.
b. The Food and Drug Administration (FDA) protects consumers from bad products sold in health food stores.
c. In the United States, St. John’s Wort has been clinically proven to successfully treat depression.
d. Eating one can of tuna every day provides the recommended 2 to 5 grams/daily of omega-3 fatty acids.

16. Which is TRUE concerning alternative medical procedures for
relieving pain?
a. Acupuncture has been scientifically proven to be more effective in relieving lower back pain than other treatments.
b. The Feldenkrais Method has been scientifically proven to relieve lower back pain.
c. Hypnotherapy is not effective in relieving the pain of fibromyalgia.
d. There is some clinical evidence that chiropractic treatments are effective for lower back pain.

Chapter 12: Surgical and Other Procedures (p. 185-199)

17. Transcutaneous electrical nerve stimulation (TENS) is very effective in the treatment of chronic pain. It works by
a. destroying the nerve endings and pathways which send pain messages to the brain.
b. stimulating large nerve fibers which close the spinal gating mechanism, thus preventing pain messages from smaller nerve fibers from reaching the brain.
c. destroying the sympathetic nerves responsible for the pain.
d. destroying either the left or right anterolateral spin thalamic tract which brings pain relief to the opposite side of the body.

18. Implantable nerve stimulators are becoming recognized by the medical community because
a. research shows this procedure to be effective, safe, and reliable.
b. the insertion of electrodes into the spinal cord to interfere with pain signals before they reach the brain does not destroy nerve tissue and is completely reversible.
c. they provide excellent pain relief for chronic low back pain following back surgery, painful neuropathies, and complex regional pain syndromes.
d. all of the above.

Chapter 13: Specific Disease Conditions (p. 201-225)

19. The treatment of first choice for osteoarthritis is
a. acetaminophen.
b. ibuprofen.
c. COX-2 inhibitors.
d. tricyclic antidepressants.

20. _____ have contributed enormously to the treatment of migraine headaches. They are highly effective in reducing or eliminating pain.
a. NSAIDS such as Naprosyn.
b. barbituate combinations such as Fiorinal.
c. Triptans such as Sumatriptan.
d. narcotics such as Percodan.

21. The use of _____ for relieving cancer pain is strongly endorsed by almost all national ands international experts, including the World Health Organization.
a. narcotic analgesics (opium-derived pain relievers)
b. adjuvant drugs
c. epidural drugs
d. radiation therapy

Chapter 14: Spiritual Approaches to Pain (p. 227-249)

22. Which is TRUE?
a. Submission to God is a one-time event.
b. Accepting your pain, after making every attempt to relieve it, means to stop hoping that God will someday relieve it.
c. Chronic pain can make us more real, more sensitve, more humble, and more fully human than ever before.
d. It is unrealistic to view chronic, severe pain as a blessing from God.

23, As a Christian and a medical doctor, the author teaches in this chapter that
a. the first commandment (“Thou shalt have no other gods before Me” Exodus 20:3) prohibits anything coming before God in our lives, even our preoccupation with chronic pain.
b. there is every reason to believe that strong faith in God’s ability to relieve pain could unconsciously send impulses from the brain down to the spinal cord and other pain-sensing areas to limit or stop the transmission of pain.
c. when we pray for physical healing, God may direct us to heal non-physical areas such as unforgiveness, resentment, greed, selfishness, anger, anxiety, depression, hopelessness, and lack of purpose.
d. all of the above.

Chapter 15: Ten Practical Steps for Slaying the Giant (p. 251-264)

24. According to Steps 3 & 6, proper sleep habits include
a. having a snack before bedtime. People sleep better on a full stomach.
b. going to bed at the same time every night and getting up at the same time every morning.
c. watching television before going to bed. This puts most people to sleep.
d. consuming one or two alcoholic drinks before bedtime. Alcohol produces drowsiness which usually leads to a good night sleep.

Appendix I -- Healing Scriptures for Those in Chronic Pain (p. 265-278)

25. From the Bible, the author lists 27 verses on suffering and 60 verses on healing. The author believes that these Scripture verses
a. are just as powerful as pain-relieving drugs.
b. are only effective for Christians.
c. must be read aloud in order to be effective.
d. must be accompanied by the laying on of hands.