Continuing Education Quiz

Earn continuing education credits by taking this quiz on the article that begins on page 30 of this issue. A grade of 70% or above will earn you a certificate of completion for two nationally certified continuing education hours. This is an open-book quiz. After reading the article, complete the quiz by circling one of the three multiple-choice answers for each question. Please give only one response per question. Incomplete questions will be marked as incorrect. Send a photocopy of the page along with your payment of $35. Please complete fully the information section below; print clearly.

Opioid Treatment for Pain: When Does Use Become Misuse?

1. A person's development of tolerance and withdrawal from long-term administration of opiates can occur without the presence of this symptom, which would be critical to a diagnosis of addiction.

   a. Hyperalgesia

   b. Euphoria

   c. Loss of control

2. Nitric oxide and this neurotransmitter are believed to contribute to long-term central nervous system changes in pain transmission.

   a. Acetylcholine

   b. Serotonin

   c. Glutamate

3. Opiates stimulate production of dopamine, which in concert with this neurochemical results in reinforcing feelings of well-being.

   a. Norepinephrine

   b. GABA

   c. Glutamate

4. Healthcare professionals lack this tool in their effort to assess the individual with chronic pain.

   a. A protocol for differentiating between adaptive response to pain medication and substance misuse

   b. Accepted thresholds for pain

   c. Familiarity with the most effective pain medications

5. Prescribers of pain medication generally will impose this safeguard against substance misuse.

   a. Writing a refill amount that is smaller than the original prescription

   b. Not calling in an emergency refill more than once

   c. Requiring a patient to answer a formalized series of questions before receiving a refill

6. Approximately this percentage of chronic pain patients will develop a pathologic substance dependence.

   a. 3%

   b. 13%

   c. 33%

7. A patient who may appear to be misusing pain medication may in fact be:

   a. suffering from a co-occurring mental illness.

   b. experiencing euphoria.

   c. in need of an evaluation for undertreated pain.

8. Mu-opioid receptors are primarily found in this area of the brain.

   a. Reward system

   b. Hippocampus

   c. Medulla

9. Patients with significant chronic pain will not misuse pain medication to experience euphoria because:

   a. They probably are not capable of experiencing euphoria.

   b. They associate euphoria with addiction.

   c. They are so fearful of the medication that they don't take enough to experience euphoria.

10. Patients who need long-term narcotic treatment should have one prescriber and one:

    a. medication.

    b. caregiver.

    c. pharmacy.