Question of the Month Archives - Page 7 of 16 - Society for Pediatric Pain Medicine

Question of the Month – February 2023

A 17-year-old male patient presents to the OR for emergent right ankle open reduction internal fixation for fracture of the right ankle obtained when playing basketball. The patient has a past medical history of well-controlled asthma, eczema, and seasonal allergies. He also has a history of opioid use disorder that was diagnosed after he was noted to have aberrant behavior in his classroom and his mother found her post-operative oxycodone pill bottle was empty. Six months ago, he was placed on medication for opioid use disorder (MOUD) that included buprenorphine 4 mg sublingual twice per day. Which of the following is NOT a correct statement regarding buprenorphine?

A. Buprenorphine should not be routinely discontinued or tapered in the perioperative setting.

B. Buprenorphine is extensively metabolized by the liver via CYP3A4 with first pass metabolism and has low oral bioavailability.

C. In order for a clinician to prescribe buprenorphine they need to first obtain a DATA-waiver (X-waiver).

D. Buprenorphine is 25-40 times more potent than morphine.

Correct! Wrong!

Question of the Month - February 2023

Question of the Month – January 2023

A 17-year-old girl presents to your chronic pain clinic with neuropathic pain of her right leg secondary to osteosarcoma of the right femur. She has severe persistent neuropathic pain despite treatment with pregabalin, duloxetine, physiotherapy, and psychological treatments. The teen and her parents are interested in exploring cannabinoids for treatment of her pain and want to discuss this further with you. Which one of the following statements is incorrect?

A. Recent systematic review on cannabinoids as medical treatment in children and adolescents showed insufficient evidence for its use in chronic pain conditions such as spasticity and neuropathic pain.

B. There is evidence from recreational cannabis users suggesting the chronic use of cannabis may have adverse effects on the developing brain.

C. Nabilone is an orally administered synthetic cannabinoid and analogue of cannabidiol (CBD).

D. In a small cohort study on the use of nabilone in children with severe non-cancer pain, the most common reported side effects were sedation and cognitive slowing.

Correct! Wrong!

Question of the Month - January 2023

Question of the Month – December 2022

A 9-year-old female child presents to your clinic with complaints of right ankle pain after having a sprain 9 months ago when she fell during a soccer game. Mother states that the child’s foot often turns reddish purple, and is extremely painful. Since the injury she will only wear sandals as socks or shoes are intolerable. Exam reveals allodynia and hyperalgesia with color and temperature changes involving the dorsal and ventral aspect of the right foot.

After comprehensive consultation with the family and negative work up for any red flags please choose the correct answer. Which of the following is correct?

A. High suspicion for Complex Regional Pain Syndrome type I

B. Early physical therapy modalities and desentization improves outcomes

C. Behavioral therapy and biofeedback increase coping

D. Virtual reality therapy can be an avenue for using distraction and increased engagement

E. All are correct

Correct! Wrong!

Question of the Month - December 2022

Question of the Month – November 2022

Author: Terri Voepel-Lewis, PhD, RN

Prescription opioid misuse is defined as using a prescribed drug without a physician’s order (i.e., taking someone else’s prescription) or taking a prescribed drug in a higher dose, more frequently, or as otherwise not intended. Despite decreases in prescription opioid misuse over the past decade, 5% to 15% of U.S. teens have recently admitted to misusing a prescribed opioid. Which of the following factors have been associated with increased risk for prescription opioid misuse?

A. Having been prescribed an opioid in the past

B. Current or past substance use (including smoking, alcohol use)

C. Having a diagnosis of ADHD

D. Having a parent who misused a prescribed opioid

E. All of the above increase the risk for opioid misuse

Correct! Wrong!

Question of the Month - November 2022

Question of the Month – October 2022

Authors: Rita Agarwal, MD, FAAP, FASA and Julie Good, MD, FAAP: Stanford University School of Medicine - Stanford, CA

18 y.o man with incurable, recurrent metastatic Ewing Sarcoma presents acutely with severe abdominal pain. His abdomen is distended, and a mini laparotomy reveals diffuse intraabdominal metastasis and inoperable multi-location bowel obstruction. At a post-operative care discussion, he and his family express a primary goal of better pain control, and the patient further states he wants to be more alert. The patient is currently on Hydromorphone PCA 500 mCg per hour basal rate, 300 mCg demand dose with 8-minute lockout, Celebrex 200 mg po bid, gabapentin 1200 mg po tid and acetaminophen 650 mg po every 6 hours. The worst pain is in his bilateral lower abdominal and pelvic area which he rates as 8/10. He is DNAR/DNI and is unable to move much due to pain. He can’t sit up in bed, nor can he comfortably lie on his side. His INR is 1.4.

The patient, family and oncologists are requesting a regional technique to help manage his pain.

All of the following interventions should be considered EXCEPT:

A. An epidural under deep sedation /general anesthesia

B. Adjust or rotate opioids and adjuvant medications

C. Intrathecal morphine catheter

D. Refuse a regional technique because of increased INR and aspiration risk

Correct! Wrong!

Question of the Month - October 2022

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