Back Pain Chronic Back Pain Management 2 — Questions and Answers
Question 1: Mindfulness-based stress reduction (MBSR) helps chronic back pain patients primarily by:
- Strengthening core muscles directly
- Reducing pain catastrophizing and improving pain acceptance (Correct answer)
- Delivering analgesic medications
- Decompressing spinal nerves
Correct answer: Reducing pain catastrophizing and improving pain acceptance
MBSR teaches non-judgmental awareness of pain, which reduces catastrophizing, fear, and emotional reactivity to chronic pain.
Question 2: Which medication class carries the highest risk of physical dependence when used long-term for chronic back pain?
- NSAIDs
- SNRIs
- Opioids (Correct answer)
- Gabapentinoids
Correct answer: Opioids
Opioids carry the highest risk of physical dependence, tolerance, and opioid use disorder when used long-term for chronic pain.
Question 3: Which exercise type has the most evidence for reducing chronic low back pain intensity and improving function?
- High-intensity interval training only
- Mind-body exercises (yoga, tai chi) and strengthening/stabilization exercises (Correct answer)
- Competitive weightlifting
- Swimming exclusively
Correct answer: Mind-body exercises (yoga, tai chi) and strengthening/stabilization exercises
Stabilization exercises, yoga, and tai chi have strong evidence for reducing chronic LBP and improving functional outcomes.
Question 4: Sleep disturbance in chronic back pain patients is important to address because:
- It is unrelated to pain intensity
- Poor sleep increases central sensitization and lowers pain thresholds (Correct answer)
- Sleep loss reduces opioid requirements
- It only affects mood but not pain
Correct answer: Poor sleep increases central sensitization and lowers pain thresholds
Sleep deprivation increases central sensitization, lowers pain thresholds, and amplifies the experience of chronic pain.
Question 5: Work-related psychosocial factors ('yellow flags') that predict chronicity of back pain include:
- Positive SLR test
- Job dissatisfaction, fear of re-injury, and low social support at work (Correct answer)
- High disc hydration on MRI
- Absence of prior back surgery
Correct answer: Job dissatisfaction, fear of re-injury, and low social support at work
Yellow flags are psychosocial risk factors — including job dissatisfaction and fear — that predict poor recovery and chronic disability.
Question 6: Implantable intrathecal drug delivery systems are used for chronic back pain to deliver opioids:
- Intravenously
- Directly into the cerebrospinal fluid at much lower doses (Correct answer)
- Transdermally
- Via epidural space only
Correct answer: Directly into the cerebrospinal fluid at much lower doses
Intrathecal pumps deliver opioids directly into the CSF, achieving analgesia at doses 300x lower than oral equivalents.
Back Pain Chronic Back Pain Management 2
Mindfulness-based stress reduction (MBSR) helps chronic back pain patients primarily by: