Preventing Chronic Pain: A Human Systems Approach Quiz

Quiz 01: Module Quiz: Health Care Dilemma

Q1. Which statement about chronic pain is correct?

• It is the #1 reason people seek care
• It is the most common chronic condition
• It is the #1 cost driver of health care
• It is #1 cause of disability

• All of the above

Q2. Which of these statements about chronic pain conditions is correct?

• Orofacial pain is the most complex with many symptoms and risk factors.
• Headache is the most expensive.
• Joint pain and arthritis cause more disability.
• Back pain is the most common pain condition, with many causes and triggers.

Q3. Which of these statements about chronic pain conditions is correct?

• Most pain conditions have a limited set of common risk factors that if changed will improve the condition.
• Insurance reimbursement favors prevention and early intervention over high cost surgery and medications.
• Most pain conditions are complex physical and psychosocial problems and, thus, only specialists can manage them
• Many patients often have chronic pain diagnoses and risk factors that are well recognized and changed.

Q4. Which of these statement(s) about the health care that is provided for chronic pain conditions is correct?

• There are frequent unnecessary or overuse of treatments, medications, and surgery with many complications that lead to more chronic pain.
• Most health care providers have excellent training in chronic pain.
• Medications, including opioids, for chronic pain conditions are monitored closely to ensure positive outcomes.
• Trial and error treatments often result in success, since eventually one approach will work.

Q5. When talking to patients about preventing and caring for chronic pain, what paradigm shifts in a health care provider’s message could be beneficial:

• Since all pain is personal, the need for social support during recovery is rarely needed
• Finding the “fix” for a pain condition using the best combination of evidence-based medication and surgery
• Expect steady progress and gradual improvement in pain during the recovery process.
• Focus on personal motivation and long-term change, instead of relying short-term passive treatments

Q6. What paradigm shifts are needed in the health care delivery system to improve the prevention and care for chronic pain?

• In determining success of care for pain conditions, using outcomes that are patient-centered such as pain severity and functional status are important.
• Health care providers need to be more distant and objective to avoid being influenced by pain complaints
• Since most patients with pain conditions do not comply with self-management, more care needs to focus on treatments done to the patient instead of education and training
• Health care providers need to spend more time to identify the specific underlying disorder causing pain so that it can then be treated.

Quiz 01: Module Quiz: Personal Impact of Chronic Pain

Q1. What statement does NOT help us understand the personal impact of pain?

• Chronic pain often does not have a reason or cause.
• All pain is a real personal experience even if there are no objective findings.
• Pain impacts all aspects of our lives including mind, body, emotions, lifestyles, and relationships.
• Like acute pain, chronic pain is protective and reflects that something is wrong.

Q2. In relation to the subjective assessment of pain, the acronym “F.R.I.E.D.” stands for

• frequency, reinforcement, intensity, emotion, and disability
• frequency, reduction, integration, emotion, and determination
• frequency, restriction, intensity, emotion, and disability
• frequency, restriction, involvement, energy, and direction

Q3. The objective assessment of musculoskeletal pain condition includes:

• tenderness, imaging, range of motion, entrapment, dysfunction
• traction, inflammation, restriction, energy, dilation
• tightness, imaging, relevance, elevation, disorder
• traction, integration, restriction, energy, damage

Q4. Transformative care includes the following 4 components:

• Trials, teaching, tendencies, transforming.
• Tactile, triumph, tireless, transform
• Telling, tamper, triumph, tempest
• Testing, treatments, training, team.

Q5. The seven realms of our lives include the following;

• brightness, laziness, enlightenment, social relationships, science, and envy
• bottom, length, elevation, sagital, sequestration, mastering, emulate
• body, lifestyle, emotion, society, spirit, mind, environment
• brain, limbs, entropy, self, sorrow, mend, enlighten

Q6. Lifestyle risk and protective factors include which of the following:

• Behaviors and actions that we do on a regular basis, such sleep and diet.
• Social life and the people that we interact with regularly.
• Deeper concerns in our life such as the beliefs, faith, hopes and dreams that we maintain.
• Personal expressions of the feelings that we experience.

Q7. Emotional risk and protective factors include.

• Personal expression of feelings that we experience
• Attitudes, thoughts, and understanding of the world and our place in it.
• Physical characteristics and use of the body, e.g., exercise, posture, conditions.
• Physical environment that surrounds us, which we interact with everyday.

Q8. Examples of social protective and risk factors do NOT include which of the following:

• Improving your home for safety to prevent accidents.
• Creating peace or conflict in relationships
• Helping others or being self-centered
• Providing social support or being abusive

Quiz02: Module Quiz: The Balance Between Health and Illness

Q1. Which of the following is NOT an assumption of the Biomedical Model of disease and health

• The body is like a machine, and doctors can “fix” problems with treatments such as medication, rehabilitation, and surgery.
• It is the patient’s responsibility to correct lifestyle factors to prevent or improve medical conditions and improve their health.
• Illness can be understood by examining as many parts of the system as feasible and necessary to resolve it.
• Illness is due to external factors that invade the body or involuntary internal changes within the body, and the health care professional is responsible for correcting these changes.

Q2. Which of the following is NOT an assumption of the Human Systems Model of health and wellness:

• The primary factors that lead to physical illness are attitudes, lifestyles, emotions, and their interaction with social and physical environment.
• Illness can be understood by evaluating the whole person and identifying the risk and protective factors in the seven realms of our lives.
• An individual accepts responsibility for their health conditions since the causes are within the individual’s control.
• Illness is caused by external factors that lead to pathophysiological changes within the different systems of the body.

Q3. Holistic complexity refers to:

• An understanding of all the parts of a system and how they contribute to the functioning of the whole.
• The fact that all people are complex and their illnesses are difficult to manage.
• An appreciation for the innate complexity of holistic health concepts.
• An understanding of the complex nature of the neurological and musculoskeletal pain systems.

Q4. Which statement reflects the concepts of Chaos Theory?

• A chaotic lifestyle increases risk factors, which can create more illness.
• Small differences in initial conditions can yield widely divergent outcomes.
• Cluttered minds impact emotional and physical realms in unpredictable ways.
• Environmental chaos creates widely diverging individual outcomes and unsafe environments.

Q5. Lifestyle factors are the behaviors and actions that we do on a daily basis. Which of the following is NOT an example of a lifestyle risk factor involved in chronic pain?

• Sleep pattern
• Dietary habits
• Reducing safety risks at home
• Activity level

Q6. Emotional factors are the personal expressions of feelings that we experience. Which of the following is NOT an example of emotional risk or protective factors involved in chronic pain?

• Destructive Anger
• Prolonged Depression
• Persistent anxiety
• Happiness and contentment
• Poor social support and isolation

Q7. Social factors involve the relationships we have with the people or groups of people that we interact with. Which are NOT risk and protective factors for chronic pain in the social realm?

• Being intolerant and demanding or being tolerant and flexible in relationships
• Being dishonest or truthful with oneself or others
• Being self-centered versus helping others
• Creating conflict versus creating harmony
• Experiencing abuse versus receiving social support

Q8. What statements most accurately reflects the characteristics of 1st, 2nd, and 3rd order change in a person’s life to help prevent or improve chronic pain?

• 3rd order change is transformative change that occurs when a person makes a fundamental alteration in their belief systems.
• 2nd order change is reactive change that occurs when a person makes small changes in response to circumstances.
• 3rd order change is a physical change that occurs when a person changes their biochemical and physiological functioning through lifestyle changes.
• 1st order change is integrative change that occurs when a person brings in significant new knowledge and skills.

Quiz 01: Module Quiz: TMD and Orofacial Pain

Q1. Temporomandibular and orofacial pain conditions can have a significant personal impact on the individual because all of the following except;

• There are a broad array of symptoms and conditions that can confuse health professionals
• Chronic pain in this area can strongly influence appearance, self-esteem, and personal expression
• Treatments rarely work to alleviate the pain
• Care can be fragmented since many different health professionals often become involved in their care without working together
• The mouth and face structures are essential to eating, communication, sight, and hearing

Q2. Two different patients with the same orofacial pain conditions can have quite different treatment strategies because;

• The number and severity of contributing factors (risk and protective factors) that are present
• Men and women are often treated quite differently
• Health plans often pick and choose what they will reimburse
• There is little research in understanding the broad array of orofacial pain conditions
• Different health professionals treat the same condition in different ways

Q3. Persistent tooth pain can be a result of all of the following condition except;

• Incomplete tooth fracture resulting in pain on biting down on the tooth
• Salivary gland infection
• Dental decay that results in an abscess at the apex of the tooth
• Referred pain from the masticatory muscles to the teeth
• Peridontal ligament sensitivity from repeated oral habits such as clenching

Q4. Pain in the face that is sharp, paroxysmal or electric-like that can last for several seconds to minutes is consistent with which of the following disorders;

• Candidiasis or yeast infection
• Sinusitis
• Migraine in the face
• Myofascial pain in the masticatory muscles
• Trigeminal neuralgia

Q5. What statement best characterizes temporomandibular disorders (TMD)

• An set of acute conditions that rarely result in chronic pain
• A set of conditions primarily due to a poor bite or malocclusion
• They are functional disorders that occur in nearly 100% of the population
• An array of masticatory muscle and joint disorders
• They cause pain, clicking, and locking in the jaw but rarely headaches, earaches, or tooth pain

Q6. Masticatory myofascial pain disorders are characterized by;

• Chronic limited jaw opening with or without pain
• Dull pain with localized tenderness in taut muscle bands
• Pain with generalized tenderness over an entire muscle
• Brief spasms of pain from the muscles
• Acute pain with limited jaw opening from opening to wide

Q7. Early stage temporomandibular joint (jaw joint) disk disorder with reduction is characterized by

• Jaw feels locked with limited range of motion
• Jaw tremors or shaking
• Reciprocal clicking in the jaw joint (in front of ear) that can be reduced with forward positioning of jaw
• Frequent headache pain
• Infection in the joint with tenderness (arthralgia)

Q8. Late stage temporomandibular joint (jaw joint) disk disorder without reduction is characterized by

• Reciprocal clicking in the jaw joint (in front of ear) that can be reduced with forward positioning of jaw
• Jaw feels locked with limited range of motion
• Frequent headache pain
• Infection in the jaw joint with tenderness (arthralgia)
• Jaw tremors or shaking

Q9. The most common disorder associated with chronic pain in the jaw is;

• Neuropathic pain
• Myofascial pain
• Migraine
• Dental infections
• Arthritis

Q10. Persistence of temporomandibular muscle and joint (TMJ) pain can occur due to different risk factors. What are the most common risk factors for TMJ pain?

• Trauma such as a direct blow to the jaw, whiplash injuries and opening the mouth too wide or for too long a period of time
• Oral Habits such as clenching and bruxism that place repetitive strain on the masticatory system
• Stressful life events cause a person to cope with or change and increases muscle tensing, oral habits, and emotional strain.
• Emotional factors such as depression or anxiety decrease central inhibition of pain, increase central sensitization, and decreases a person ability to cope with pain
• All of the above

Q11. Oral parafunctional habits such as clenching and grinding of the teeth…

• Are the least common risk factors involved in chronic jaw pain and difficulty chewing.
• Add repeated strain to the jaw muscles and joints leading to muscle and joint pain.
• Are behaviors that we all have
• Can strengthen the muscles and joints and prevent chronic jaw pain
• Can be stopped by pressing the tongue hard against the teeth.

Q12. What is the most common onset event for jaw pain

• Biting on objects such as pens, pencils, and hair pins
• Opening mouth too wide or for too long e.g. during dental visits, eating, yawning
• Motor vehicle accidents
• Oral parafunctional habits
• Assault and blow to the jaw
• Heavy chewing including gum chewing

Q13. What statement is true about cognitive-behavioral training for TMD pain.

• It is one of the most successful treatment for TMD because it addresses the causes
• It can help reduce oral habits that put strain on the jaw
• It can help reduce stress that leads to an increase in oral habits
• It can be used to help people change the posture of the jaw, head, and neck
• All of the above

Quiz 01: Module Quiz: Headache

Q1. Headaches are common conditions. Which of the following statements is correct about headache?

• Men have the most frequent primary headaches
• Most headaches are due to an underlying neurological disorder
• Nearly all of the population experiences headache during their life
• Few people seek medical attention for headache since they usually mild

Q2. Some headaches may reflect an underlying neurological condition. Which of the following are red flags that suggest more diagnostic studies are warranted to rule out neurologic pathology?

• Systemic symptoms with the headache such as fever, weight loss, or other medical conditions
• Cognitive symptoms such as confusion, impaired alertness or loss of consciousness
• New onset and progressive headache in older individuals
• Headache intensity changes with changes in postural, position, or exertion
• All of the above

Q3. A person has a steady dull ache headache that waxes and wanes for days, is not aggravated by activity, and is accompanied by tension or fatigue. What type of headache is the likely diagnosis?

• Migraine without aura
• Tension type headache
• Sinus headache
• Chronic daily headache
• Migraine with aura (classic migraine)

Q4. Which of the following is the most common factor that can trigger or bring on a migraine headache?

• Poor sleep or sleeping late into the morning
• Clenching the teeth together
• Stress
• Specific foods including too much sugar
• Excessive noise, bright lights, and fumes

Q5. Which of the following statements about the relationship between headache and temporomandibular disorders is correct?

• Temporomandibular disorders are a common cause of headache in the temples and forehead.
• Temporomandibular disorders causes jaw pain but rarely trigger headaches
• Migraine headaches can be due to an underlying temporomandibular disorder
• Clicking or locking in the temporomandibular joints (jaw joint) often causes headache

Q6. Transformational headaches have what main characteristic:

• Progression from episodic headaches occurring occasionally to chronic daily headache
• Profession from temple or forehead headaches to one that involves the whole head and neck.
• Progression from tension-type headache in the temples to headaches involving the whole head
• Progression from functional headaches to disabling headaches.

Q7. What are factors that predict the development of transformational headaches?

• Medication and caffeine overuse
• Stressful life events with depression and anxiety
• Sleep disorders including snoring, sleep apnea, and insomnia
• Muscle pain and dysfunction
• All of the above.

Q8. A patient presents with chronic daily headaches. A number of contributing factors are identified in the assessment that need to be addressed to enhance medication effectiveness. The factors range from easier [level I] to more complex [level II] to most complex [level III]. Which set of contributing factors is listed in according to their intervention complexity?

• Level I: habits and behavioral factors, II: stress and emotional factors, III. social factors and the meaning of pain
• Level I: social factors and the meaning of pain, II: stress and emotional factors, III. habits and behavioral factors
• Level I: stressors and emotional factors, II: habits and behavioral factors, III. social factors and the meaning of pain
• Level I: habits and behavioral factors, II: social factors and the meaning of pain, III. stressors and emotional factors,

Quiz 02: Module Quiz: Fibromyalgia

Q1. Most people with fibromyalgia are:

• Affected by autoimmune disorders
• School-age children
• Disabled
• Adult females

Q2. Which of the following is a common feature of fibromyalgia?

• Chronic widespread pain involving the head, neck, back, and extremities
• Stiffness that is perceived as a dull aching pain
• Difficulty sleeping, waking frequently, having difficulty returning to sleep, and feeling unrefreshed in the morning
• Feeling fatigue, tired, exhausted, and dragging with little energy
• All of the above

Q3. Which of the following statements best characterizes the diagnosis of the fibromyalgia syndrome?

• Fibromyalgia syndrome is a wastebasket diagnosis made only after exclusion of all other medical conditions with a recognized potential to cause physical pain.
• The diagnosis of fibromyalgia requires the presence of a psychological or personality disorder and usually results from childhood abuse by a parent or sibling.
• People who have had widespread discomfort for at least three months and exhibit a diffuse low pain threshold can be characterized as having fibromyalgia even if another painful disorder is known to be present.
• Patients with major depression who also have chronic widespread pain automatically meet the diagnostic criteria for fibromyalgia syndrome.

Q4. The natural course of the fibromyalgia syndrome over time is best described by which of the following statements?

• Fibromyalgia consistently becomes worse with dramatic changes in the weather.
• Fibromyalgia maintains about the same severity over a period of many years.
• Fibromyalgia clinically typically converts into a rheumatic disease within two years of its symptomatic onset.
• Fibromyalgia will resolve after settlement of a disability or personal injury claim.

Q5. Patients with fibromyalgia typically suffer from poor sleep and which other characteristics:

• Obstructive sleep apnea.
• Bad dreams and waking in a panic
• Frequent bed wetting
• Waking in the morning feeling unrefreshed and exhausted

Q6. Patients with fibromyalgia often have cognitive difficulties including what characteristics

• Aggressive thoughts from anger and frustration
• Poor focus and/or concentration, like being in a fog
• Losing touch with reality with frequent fantasy thoughts
• Lost memories of past events

Q7. Fibromyalgia is often misdiagnosed as another medical condition, including rheumatoid arthritis, osteoarthritis, lupus, hypothyroidism, vitamin D deficiency, Lyme disease, multiple sclerosis, and polymyalgia rheumatica. What approach would be the most helpful to rule in or out these disorders?

• A biopsy of affected tissue
• A magnetic resonance scan of the muscles and joints
• Evaluation by a rheumatologist
• A urine test

Q8. The pathogenesis of the fibromyalgia syndrome is best described by which of the following statements

• The presence of another painful condition fully negates any objective findings associated with the fibromyalgia syndrome.
• All patients with fibromyalgia are depressed, and it is known that depression lowers the pain threshold.
• There are no abnormal objective findings in people with fibromyalgia, so the clinician must simply believe the patient’s claim of widespread body pain.
• Dysfunctional nociception is present in fibromyalgia with objective evidence from clinical assessment, sleep physiology, neurophysiology, neuroimaging, and chemical testing of spinal fluid.

Preventing Chronic Pain: A Human Systems Approach Week 05 Quiz Answers

Q1. Biomechanical factors that may contribute to the development of osteoarthritis include:

• Cycles of loading and unloading cartilage.
• Short bouts of repetitive loading.
• Carrying a load while moving the joint, such as walking or running.
• Sudden, fast loading of the joint.

Q2. Some sporting activities may contribute to the development of osteoarthritis (OA) because they:

• have a high risk of acute joint injury
• require strength and sustained muscle tension
• require aerobic conditioning
• require flexibility to perform at a high level

Q3. Which person is most likely to develop knee OA?

• A healthy 22 year old male who is a recreational runner
• A 40 year woman with a normal weight and BMI who does yoga
• The 60 year old twin sister of a woman with knee OA

Q4. Which of the following is true of normal cartilage?

• It has many cells that attract water
• Once developed it does not change
• It has a good blood supply in the early adult years
• The surface is smooth and lubricated with synovial fluid

Q5. In knee osteoarthritis, which is true of management strategies?

• Aerobic activity should be high-impact
• Even modest muscle strength gains are helpful
• Strength training is better than aerobic training
• Strength training should be performed twice per week

Quiz 01: Module Quiz: Arthritis

Q1. Biomechanical factors that may contribute to the development of osteoarthritis include:

• Cycles of loading and unloading cartilage.
• Short bouts of repetitive loading.
• Carrying a load while moving the joint, such as walking or running.
• Sudden, fast loading of the joint.

Q2. Some sporting activities may contribute to the development of osteoarthritis (OA) because they:

• have a high risk of acute joint injury
• require strength and sustained muscle tension
• require aerobic conditioning
• require flexibility to perform at a high level

Q3. Which person is most likely to develop knee OA?

• A healthy 22 year old male who is a recreational runner
• A 40 year woman with a normal weight and BMI who does yoga
• The 60 year old twin sister of a woman with knee OA

Q4. Which of the following is true of normal cartilage

• It has many cells that attract water
• Once developed it does not change
• It has a good blood supply in the early adult years
• The surface is smooth and lubricated with synovial fluid

Q5. In knee osteoarthritis, which is true of management strategies?

• Aerobic activity should be high-impact
• Even modest muscle strength gains are helpful
• Strength training is better than aerobic training
• Strength training should be performed twice per week

Quiz 02: Module Quiz: Chronic Pain Mechanisms

Q1. Which of these statements is correct about pain in our society?

• The societal cost of treating chronic pain is greater than cancer, heart disease, and diabetes combined
• Chronic pain affects less than 10 million Americans
• Few people seek medical attention for chronic pain
• Chronic pain is not considered a disease, but instead is only a symptom associated with other diseases.
• None of the above

Q2. Which of the following statements are true?

• Pain is an emotion-arousing experience that can impact all aspects of our lives.
• The perception of acute pain is adaptive, and can help with immediate survival
• The perception of chronic pain can be maladaptive and does not often appear to serve an useful survival function
• Genetic and environmental factors influence the perception of both acute and chronic pain
• All of the above

Q3. Which statement is false?

• Central nervous system networks integrate sensory information to produce both the perception of pain and modulate the body’s reaction to tissue injury
• The stimulation of nociceptors (pain fibers) produces the perception of pain without influencing the general physiology of the body
• Substances released from cells of the immune system modulate nociceptor activity
• None of the abov

Q4. What factors contribute to the production of neurogenic inflammation?

• A. Physical exercise
• B. Psychological stress
• C. Cytokines such as IL8
• A and C
• B and C

Q5. Which of these statements about central sensitization is correct?

• It is associated with enhanced pain perception to touch
• It is associated with time dependent changes in the excitability of spinal cord neurons that convey the sense of pain
• Sustained activity in primary afferent C-fibers can produces time-dependent cellular events in spinal neurons and higher levels of the central nervous system.
• All of the above

Q6. Which of the following is correct regarding the role of spinal glia and pain transmission?

• These cells mediate peripheral sensitization
• When activated these cells secrete a vast array of pro-pain producing substances
• Activation of these cells inhibit central sensitization7.

Q7. Which of the statements about common chronic pain conditions is correct?

• A. There is very little overlap in the mechanisms that mediate most common chronic pain conditions like temporomandibular joint disorders and irritable bowel syndrome.
• B. Common to many chronic pain conditions are stressful life events with depression and anxiety
• C. There is substantial overlap in the mechanisms that mediate most common chronic pain conditions
• B and C
• None of the above

Q8. Which of the following conditions have been associated with central sensitization?

• Temporomandibular disorders
• Migraine headache
• Fibromyalgia
• Irritable bowel syndrome
• All of the abov

Q9. Which of the following statements is incorrect?

• Genetic factors contribute to common chronic pain conditions
• Many genes influence pain perception
• Genetic factors can influence the response to analgesics
• Only environmental factors contribute to the development of chronic pain conditions
• All of the above

Q10. Which of the following statements are incorrect?

• Environmental events such as injury can cause changes in gene expression that lead to chronic pain conditions
• Psychological stress can cause changes in gene expression that lead to chronic pain conditions
• Dynamic change in the signs and symptoms associated with chronic pain conditions is influenced by changes in gene expression
• Patients with a condition like fibromyalgia all have the same signs and symptoms and genetic factors that mediate the clinical presentation.
• None of the above

Quiz 01: Module Quiz: Body

Q1. What are the 2 types of muscle afferent sensory nerves that are involved in pain?

• Type III and Type IV sensory receptors
• Type II stretch receptor and Type IV sensory receptor
• Type III sensory receptor and Type II stretch receptor
• Type I muscle spindle and Type II stretch receptor

Q2. What pain mechanisms are typical of chronic musculoskeletal pain

• All of the above
• Peripheral sensitization is the primary mechanism with increased synaptic efficiency due to repeated firing of the nociceptive (pain) neurons within the muscle.
• Central sensitization is the primary mechanism with hypersensitivity of nociceptive (pain) neurons in the central nervous system (spinal cord and brain).
• Primary and secondary hyperalgesia with decreased threshold for pain in an injured tissue and surrounding tissues

Q3. Wind-up is the mechanism that increases muscle pain with increase strain over time. What does it involve?

• Both the tenderness and the pain fluctuate with increasing strain to alert the central nervous system.
• First, the pain increases within the muscle, followed by muscle and joint tenderness.
• A painful stimulus to muscles is delivered repeatedly above a critical rate.
• The muscle tissues have increased pain severity through peripheral sensitization.

Q4. There are many physical risk factors for chronic pain. Which of these is NOT a risk factor:

• Protecting acute musculoskeletal injuries with rest and immobility
• Sustained or eccentric posture and repetitive strain
• Weak and poorly conditioned muscles
• Loss of flexibility and range of motion in the musculoskeletal system

Q5. Which of these is NOT a repetitive strain injury (RSI) to the muscles and joints;

• Sustained postures at work.
• Mechanical compression from a shoulder bag
• A single strong exertion from lifting a heavy weight
• Sustained muscle tensing habits such as bracing phone between the head and shoulders
• Continuous vibration from equipment in the proximity6

Q6. Muscle fiber type I, also termed red slow twitch fibers, is characterized by all of the following EXCEPT

• High oxidative phosphorylation with high oxygenation, ATP production, mitochondria, and increased vascularity
• Sustaining postural muscle tone
• Facilitating long distance running and sustained work during the day
• Designed for large forces over short periods of time

Q7. Short term and long term positive feedback cycles often occur with muscle pain. Which cycle is the most common?

• Muscle weakness leads to over-exercise, which compensate for weakness, and the cycle continues.
• High stress leads to poor muscle posture, which leads to more pain, causing more stress, and the cycle continues.
• Muscle tension leads to pain, which leads to inactivity and resultant poor posture to protect from pain. This leads to eventual weakness and more tensing, and the cycle continues.
• Poor posture leads to obesity, increased weight on the muscles, more muscle pain, and the cycle continues.

Q8. The 5 general types of exercise most helpful to prevent chronic pain include:

• Physiological, structural, postural, mobilization, and ergonomic
• Isometric, isotonic, isomobilic, exoskeletal, and ergonomic
• Yoga, tai chi, flexibility, anaerobic, and aerobic
• Range of motion, strengthening, endurance, posture, and relaxation

Q9. What is post-exercise muscle soreness:

• Post-exercise muscle pain is a normal response to unusual exertion.
• A process that leads to muscles building more strength and bulk after rest.
• A form of repetitive strain of the muscles.
• Mal-adaptive process that leads to greater pain and stiffness.

Q10. Strategies that can help prevent chronic pain from sports injuries include;

• All of the above.
• Dynamic warm-up exercises that include a gentle walk or jog, then static stretching to increase the range of motion of commonly injured joints.
• Avoiding high risks from extreme sports
• Use R.I.C.E. (Rest, Ice, Compression and Elevate) for severe injuries
• Use M.E.A.T. (Movement, Exercise, Analgesics and Treatment) for post-exercise muscle soreness

Quiz 02: Module Quiz: The Mind: The Cognitive Dimension

. Q1. The functions of the brain include sensory processing, motor function, emotion regulation and which of the following?

• Atitude-processes
• Information-processing
• Decision-making
• Behavior modification

Q2. Personal relevance, or how we choose to attend to things in our environment at any given point in time, is based on what factors?

• Threat, immediate needs, and personal goals.
• Decisions about the value of what is in the environment
• What others deem as important to attend to
• All of the above

Q3. Thoughts about pain are influenced by:

• Learning
• The context in which pain is experienced
• Imagination
• All of the above

Q4. Chronic pain is experienced in our:

• Body
• Emotions
• Thoughts
• All of the above

Q5. Our bodies have a hard time distinguishing what is _______________ from what is _______________________

• Difficult, intense
• Strength, tension
• Imagined, real
• Impulsive, goal-directed

Q6. Self efficacy is defined as;

• The belief that one is a good and worthwhile person
• The belief that one is capable of acting in a certain way
• The belief that one can control one’s feelings
• All of the above

Q7. If you think “I can’t do it,” you are most likely to feel what?

• Angry and frustrated
• Hopeless and helpless
• Fearful and intimidated
• All of the above

Q8. Every choice one makes, including those that require some thought, affects what?

• Our experience of pain
• Our health and well-being
• Our perspectives on the world
• All of the above

Q9. Self-efficacy requires preparation, acceptance, coping, and

• Positivity
• Problem-solving
• Catastrophizing
• Purpose

Q10. Which of the following responses to life challenges are within our control?

• Perspectives
• Emotional responses
• Habits and behaviors
• All of the above

Q11. The capacity of a system or person to absorb disturbance and re-organize, even while undergoing change, is called what

• Mindfulness
• Self-efficacy
• Resilience
• Purpose

Q12. Factors closely associated with resilience are:

• Meditation skills; good body image; physical support
• Optimism; a sense of connection; problem-solving ability.
• Healthy work environment; good health care team; compliance with health recommendations
• Good nutrition; exercise; education

Q13. Coping with change, preserving emotional balance, preparing for an uncertain future, and altering views about health are some of the goals of what?

• Resiliency training
• Health care education
• Mindfulness training
• Medication withdrawal

Q14. Some of the specific cognitive skills associated with resiliency include:

• Increasing acceptance
• Decreasing all or nothing and catastrophizing thinking
• Increasing a cognitive sense of control
• All of the above

Q15. The domains of wellbeing discussed in this module include physical, emotional, life purpose, relationship and what else?

• Safety and security
• Behavior
• Nutrition
• Cognition

Q16. Darwin states that those of a species who survive are what?

• Strongest
• Most intelligent
• Emotionally most expressive
• Most responsive to change

Q17. The environment supplies the stressors, and we as individuals are challenged to supply the:

• Behavior change
• Optimism
• Emotional response
• Coping

Q18. The best choice for adding resiliency and coping to your life is:

• Whatever helps you
• Meditation training
• Biofeedback
• Medication

Q19. Nothing erases unpleasant or negative thoughts better than concentrating on what?

• Music or meditation
• Someone else’s bad luck
• TV or (using) other kinds of distractions
• Pleasant ones

Quiz 01: Module Quiz: Society

Q1. Which of the following statements best describes “neuroplasticity”:

• The brain produces more variation and morphological changes with age.
• Neuroplasticity occurs with broad changes of the brain that occur with dementia and Alzheimer’s.
• The brain is constantly changing its structure, synapses, and efficiency due to environmental, social, and lifestyle factors.
• We are born with a certain number of brain cells and as we live and age, our brain cells are lost and not replaced.

Q2. Factors that increase negative neuroplasticity and the risk of chronic pain include all of the following EXCEPT:

• Emotional states such as depression, anxiety, and anger
• Lifestyle factors such as poor sleep, substance abuse including alcohol, nicotine, opiates, methamphetamine, and cocaine use
• Creative factors such as doing art, cooking, music, gardens, literature, businesses, or other projects.
• Social factors such as chronic social stressors, abuse, violence, and socioeconomic status

Q3. Which of the following statements is NOT true about verbal abuse

• It contributes to chronic pain, migraine, daily headaches, stammering, ulcers, indigestion, diarrhea, constipation, and heart conditions.
• It contributes to cognitive factors such as intrusive memories, memory gaps, hyper-vigilance and exaggerated startle response.
• It contributes to no real physical or psychological harm since most people are able to ignore verbal abuse.
• It contributes to lifestyle issues such as alcohol and drug abuse, suicide, self-mutilation, and assaultive behaviors.
• It contributes to emotional factors such as fear, anxiety, depression, stress, PTSD, irritability, and anger issues.

Q4. Why do people hurt others and cause pain? The research is evolving, but there are some risk factors including all of the following except:

• Genetic link between impulsivity and sensation-seeking behavior
• History of childhood abuse and defensive fear of getting hurt more
• Low empathy for others coupled with low self-esteem
• Alcoholism or drug abuse
• Low socio-economic status

Q5. An individual’s overuse of the Internet can lead to:

• Stronger posture muscles
• More happiness, excitement and delight.
• Carpal tunnel, jaw, neck and back pain
• Academic excellence due to increase exposure to knowledge
• More sharing of the Internet and better family relationships

Quiz 02: Module Quiz: Emotional Challenges

Q1. Which of the following statements about negative emotions and chronic pain are true?

• Negative emotions, such as anxiety and depression, are a common part of the chronic pain experience.
• As depression and anxiety decreases, the intensity of the chronic pain also decreases.
• As depression and anxiety get worse, the intensity of the chronic pain also gets worse.
• All of the above

Q2. What statement is true about the term “psychophysiological”?

• It refers to patients with illnesses that are primarily caused by psychiatric conditions
• Like “psychosomatic”, it suggests that most pain is not physical but rather a psychological problem
• Our emotions and physical body are separate and have little direct affect on each other.
• It reflects the idea that physiology, emotions, thoughts and behaviors all interact in health and illness.

Q3. Are emotions a risk factor or a protective factor in chronic pain?

• Emotions are only a protective factor in chronic pain since whether positive or negative, they can teach us how to control pain.
• It depends on what kind of emotion. Negative emotions can be a risk factor for chronic pain. Positive emotions can be a protective factor in chronic pain.
• Emotions are neither a risk nor protective factor since they are separate and distinct from the body and its pains.
• Emotions are only a risk factor for chronic pain since they cannot be well controlled and become worse with pain

Q4. What statement is correct about the overlap between positive psychology and integrative medicine?

• They both believe that chronic pain is primarily a psychological problem.
• They both believe that the body, mind, emotions, and spirit need to be addressed as separate realms.
• The both believe that chronic pain can be addressed by integrating psychiatric treatments such anti-depressant medications with a positive attitude to maximize placebo.
• They both support care that enhances an individual’s innate healing capacities.

Q5. Suppressed negative emotions can manifest in a number of ways, EXCEPT for which of the following:

• Muscle tension and increased pain
• Prioritizing a person’s own needs before anyone else’s
• Compulsively keeping over busy with shopping, exercising, or working
• Eating when not hungry or, alternatively, appetite loss
• Increased irritability and sadness
• Excessive use of alcohol, prescription or recreational drugs

Q6. Which of the following is and example of putting positive psychology principles into practice.

• Develop an appreciation of life challenges by making a list of the things you would never do again.
• Create a journal to write down all the negative emotions and activities you dislike.
• Know your weaknesses by making a list of your worst qualities.
• Explore dreams by making a list of what activities, people, and work you enjoy the most.
• Cultivate realism by making a list of 3 negative things that have happened to you.

Q7. What strategies can be used to train the brain and nervous system to turn off the “false alarm” of chronic pain?

• Practicing distraction using sensory stimulus from food
• Applying topical anesthetics over the area of pain to numb the skin
• Practicing sensation-focused or abdominal breathing with concentration meditation
• Creating acute pain in other areas of the body

Quiz 01: Module Quiz: The Lifestyle Realm

1. Negative feedback cycles are common between lifestyle factors and chronic pain. Which of the following is NOT a common feedback cycle involving lifestyle and chronic pain?

• Caffeine and pain.
• Risky behavior and pain.
• Playing musical instruments and pain.
• Poor sleep and pain.
• Disrupted routines, activities of daily living, and pain.

Q2. While good sleep is a protective factor for chronic pain, poor sleep is a risk factor for chronic pain. There are many causes of poor sleep including all of the following except;

• Consuming too much caffeine
• Sleep apnea and snoring
• Exercising right before bed to tire you out
• Stress, worry, and depression
• Bed bugs that bite at night

Q3. It is recommended to obtain a sleep study to determine if you have sleep apnea. Which of the following is NOT a reason to obtain a sleep study:

• If someone has told you that you snore loudly or gasp for breath while sleep.
• You are tired when you wake up in the morning with fatigue that lasts for more than two to three weeks.
• If you wake up with bad dreams.
• You have difficulty getting to sleep or staying asleep at night.
• If you legs are “active” or have itching, aching, or cramping during sleep.

Q4. Which statement is true about inflammation?

• Dietary factors such as high levels of fat and sugar improves inflammation.
• Environmental toxins from free-radical damage from sun, radiation, pollution, and cigarette smoke rarely cause inflammation.
• It’s the body’s response to infection, toxins, irritation, or injury
• It is not a leading cause of chronic pain from arthritis and breakdown of the joints.
• Injury and repetitive strain can injure but not cause inflammation of the joints

Q5. Which of the following statements is true about sugar dietary intake and its association with chronic pain;

• When sugar is absorbed, it contributes directly to the breakdown of joint tissue.
• After being ingested, sugar is metabolized directly to convert into neurotransmitters involved in pain.
• Sugar makes a person more prone to opioid pain analgesic addiction.
• Sugar is rapidly absorbed and causes a spike in blood glucose (sugar) level, which promotes inflammation and chronic pain

Q6. Which of the following nutrients help protect against inflammation;

• Omega-3 fatty acids found in fish, anchovies, bluefish, herring, mackerel, salmon, sardines, sturgeon, lake trout, tuna, nuts and oils.
• Vitamin E found in vegetable oils, nuts and sunflower seeds, is most abundant fat-soluble antioxidant in the body.
• Vitamin C is found in fresh colorful fruits and vegetable, is most abundant water-soluble antioxidant in the body, combats pollution and smoke-induced free-radicals
• Magnesium found in nuts, seeds, beans, kelp, halibut, mackerel, cocoa, wheat germ, brown rice, and leafy green vegetables.
• All of the above.

Q7. What statement best describes the use alcohol for chronic pain

• People rarely mix alcohol and pain medications.

• Despite that alcohol has only transient analgesic effects, it is still often used to self-medicate for chronic pain.

• Most people in pain maintain safe levels of alcohol use.
• Withdrawal from chronic alcohol use does not amplify pain.

Q8. People with chronic pain often use controlled substances, other medications, and illicit drugs or alcohol inappropriately. Guidelines for use of controlled substances such as opioids with patients with chronic pain include;

• Sign an agreement with patients regarding goals, expectations, consequences, benefits, and risks and discontinue use if agreement is broken or goals not achieved.
• Use opioids only as an adjunct treatment for intractable pain, in coordination with a comprehensive care program.
• Review state pharmacy on-line prescription registry to ensure that only one prescriber and one pharmacy is providing the medications.
• Make sure all controlled substance medications are stored in a locked cabinet.
• All of the above.

Q9. People with acute lifestyle stress;

• Take on too many activities that need their attention.
• Cannot organize all of the demands, so life becomes disordered, chaotic and crisis-oriented.
• Are in a rush, late, with things often going wrong.
• Often feel anxious, over-aroused, tense, short-tempered, and hostile with interpersonal relationships that can deteriorate.
• All of the above

Q10. Many bad habits including diet, sleep, repetitive strain, inactivity, and over-working contribute to chronic pain. Reversing bad habits can be done with the following steps;

• Identify what habits are present, understand the need for change, punish yourself every time you stop the habit by verbal self-abuse
• Identify what habits are present, understand the need for change, monitor the habits using reminder methods and correct with a positive habit
• Identify what habits are present, understand the need for change, reward yourself with chocolate every time you stop the habit.
• Identify what habits are present, understand the need for change, call a friend and complain about lack of controlling the habit.

Quiz 01:Module Quiz: The Environment

Q1. Environmental protective factors that can prevent chronic pain include;

• Being careful and organized to minimize accidents
• Clean and infection-free environment and practices
• Pre-emptive care to prevent chronic pain after surgery
• Breathing clean indoor and outdoor air
• Maintain a quiet and peaceful setting for home and work
• All of the above

Q2. Environmental risk factors that increase potential for chronic pain include;

• Being accident prone and being in injury-prone situations
• Chaotic, disorganized, unclean and infection-prone environment
• Adverse events from medical treatment
• Air quality, inhalants, and tobacco
• Noise, vibration, and weather changes
• All of the above

Q3. Which of the following is NOT a risk factor that can occur while driving:

• Texting, talking on a mobile phone, listening to music, tending to children.
• Being unaware or inexperienced about cars that are loading and unloading people
• Keeping up with the speed of the traffic around you.
• Driving at excessive speed for current road conditions
• Feeling drowsy and not wearing a seat belt

Q4. Children and teenagers most often develop traumatic brain injury (TBI) after;

• Assaults
• Blow to head by an adult
• Falls
• Sport injuries
• Motor vehicle accidents

Q5. Risk factors for personal accidents are common and include all of the following EXCEPT;

• Leaving clutter around the floor
• Pursuing extreme risks such as steep mountain skiing and climbing
• Being careless and lazy
• Wearing the most fashionable clothing
• Being distracted by cell phones and other activities

Q6. Medical and dental treatment risk that lead to chronic pain are surprisingly common. Risk factors for prolonged pain after surgery include all of the following except;

• Severity of acute postoperative pain
• Concomitant radiation or chemotherapy.
• Length of time in surgery and under anesthesia
• Intraoperative factors such as nerve damage during surgery
• Preoperative factors such as prior persistent pain

Q7. What is the most common onset factor for temporomandibular (TMJ) jaw pain?

• Dental treatment
• Oral sexual activities
• Heavy chewing
• Sports injury
• Blow to the jaw in an assault

Q8. Candidiasis is a persistent yeast infection (thrush) that can cause chronic pain in the mouth, tongue, skin, genital area, and other areas. It can lead to neural hyper-sensitivity and hyper-innervation even after the resolution of infection and inflammation. Risk factors include all of the following except:

• Drinking contaminated water
• Poor oral hygiene and high sugar diet
• Poor immune system (e.g. AIDS, chemotherapy, cancer, seriously ill)
• Overuse of antibiotic drugs

Q9. Indoor pollution occurs in 33% of the population, and leads to respiratory problems, headaches, and other health concerns. Indoor air contaminants include all of the following except:

• Pesticides, solvents, and asbestos.
• Dust mites, allergens, and molds.
• Biomass fuel smoke from burning organic material such as wood, dung or charcoal.
• Aroma from cooking foods such as bakery products and stews.
• Carbon monoxide from improper functioning furnaces.

Q10. Improving home safety is important to prevent accidents and the development of chronic pain. In improving home safety, all of the following are important EXCEPT;

• Keeping water off the bathroom floor and away from sources of electricity
• Keeping kitchen clean, dishes and sharp objects put away, hot surfaces protected from the high traffic areas.
• Keeping stairs free of clutter and well lit at night with firm railings
• Keep smoke and carbon monoxide detectors and two fire extinguishers in the house.
• Avoid purchasing tall entertainment centers that can tip and cause injury

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