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The Tightrope Walk

Pain Management and Opioid Stewardship

doi: 10.1097/NOR.0000000000000550
Departments: CE Tests


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Back to Top | Article Outline


GENERAL PURPOSE: To provide information on the opioid crisis and options for pain management.

LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:

  1. Summarize issues related to prescribing opioids.
  2. Select priorities for combating the opioid crisis.
  3. Recognize problems related to the use of opioids and options for effective pain management.
  1. What led to a four-fold expansion in opioid prescriptions between 1999 and 2010?
    1. an expiration of patents on the leading opioid products
    2. a heightened awareness of pain assessment and treatment
    3. an increase in the numbers and types of chronic pain conditions diagnosed
  2. Which organization issued guidelines for prescription practices in treating chronic pain in March, 2016?
    1. the Centers for Disease Control and Prevention (CDC)
    2. the National Institutes of Health
    3. the U.S. Department of Health and Human Services (HHS)
  3. According to the CDC (2017), about what percentage patients who were given prescriptions for chronic pain misused opioids?
    1. 12 – 20%
    2. 21 – 29%
    3. 30 – 38%
  4. An estimated 80% of users of which drug transitioned to that drug after misusing prescription opioids?
    1. cocaine
    2. marijuana
    3. heroin
  5. HHS (2018b) has identified all of the following as priorities to address the opioid crisis,except
    1. improving definitive care of conditions that cause pain.
    2. promoting use of overdose reversing drugs.
    3. improving access to opioid use disorder treatment and recovery.
  6. What do the authors report will increase understanding surrounding the extent of the opioid epidemic?
    1. outreach to the general public
    2. public health surveillance
    3. prescription drug monitoring programs (PDMPs)
  7. As noted in the article, what can support efforts to decrease the mortality related to the opioid epidemic?
    1. increasing the promotion and use of opioid reversal agents
    2. providing education to the public about the risks of opioid use
    3. establishing “drug consumption rooms” where persons can use drugs under supervision
  8. In addition to addiction, Wang et al. (2015) noted that potential side effects of opioids include
    1. anticoagulation.
    2. headaches.
    3. pruritus.
  9. In the 2014 study by Jo et al., unmanaged post-operative pain was associated with
    1. longer hospital stays.
    2. increased infection rates.
    3. a higher rate of falls.
  10. Research by Simmonds et al. (2015) revealed that, compared to patients taking a low-dose opioid, patients prescribed high-dose opioids for chronic pain were nearly three times as likely to be diagnosed with
    1. peptic ulcer disease.
    2. irritable bowel disease.
    3. depression.
  11. To reduce the need for post-operative opioids, Teng et al. (2014) reported that intra-operative surgical site injections may be administered that contain a combination of drugs, including
    1. acetaminophen.
    2. corticosteroids.
    3. propranolol.
  12. As noted in the article, post-operative multimodal pain management consists of partnering opioid medications with alternative drug therapies such as
    1. propofol.
    2. COX-II inhibitors.
    3. antiemetics.
  13. Non-pharmacological pain management methods noted in the article that may be used post-operatively include
    1. therapeutic touch.
    2. proper nutrition.
    3. biofeedback.
  14. The authors report that all of the following are important stakeholders for an effective pain steering committeeexcept
    1. palliative medicine.
    2. anesthesia.
    3. respiratory therapy.
  15. According to Ghafoor et al. (2013), functions of the pain steering committee include
    1. monitoring the frequency of opioid prescriptions.
    2. devising policies and procedures for dose monitoring.
    3. surveying patients regarding their pain management needs.
  16. One of the purposes of the prescription drug monitoring programs (PDMPs) noted in the article is to
    1. regulate the number of opioid prescriptions a prescriber can write.
    2. document a patient's indication(s) for receiving an opioid prescription.
    3. allow prescribers to verify a patient's prescription history.
  17. Which statement is true regarding PDMPs?
    1. The content and use of PDMPs is regulated and standardized by the HHS.
    2. In some states PDMPs have been associated with a decrease in overdose deaths.
    3. PDMPs are in use in all 50 states in the United States.
  18. Recommendations for safe trash disposal of uncrushed opioids includes
    1. combining them with an inedible substance in a sealable plastic bag.
    2. leaving them in the original prescription container.
    3. scattering them amongst other pieces of trash.
  19. Another method for managing leftover opioids, recommended by the U.S. Food & Drug Administration, is
    1. crushing and scattering them in the garden.
    2. storing them in a medicine cabinet.
    3. flushing them down the toilet.


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