Back Pain Chronic Back Pain Management 1 — Questions and Answers
Question 1: Chronic low back pain is generally defined as pain lasting longer than how many weeks?
- 2 weeks
- 4 weeks
- 12 weeks (Correct answer)
- 6 months
Correct answer: 12 weeks
Chronic low back pain is conventionally defined as pain persisting for 12 weeks (3 months) or longer.
Question 2: Central sensitization in chronic back pain refers to which pathophysiological process?
- Structural disc collapse
- Amplification of neural signaling in the CNS leading to heightened pain perception (Correct answer)
- Peripheral nerve injury only
- Reduction in inflammatory mediators
Correct answer: Amplification of neural signaling in the CNS leading to heightened pain perception
Central sensitization involves neuroplastic changes in the central nervous system that amplify pain signals beyond normal tissue damage.
Question 3: The Fear-Avoidance Model of chronic back pain suggests that which behavior perpetuates disability?
- Overexercising despite pain
- Avoiding movement due to fear of re-injury (Correct answer)
- Seeking immediate surgical care
- Using NSAIDs long-term
Correct answer: Avoiding movement due to fear of re-injury
Fear-avoidance behaviors — avoiding physical activity for fear of causing harm — lead to deconditioning and increased disability.
Question 4: Which interdisciplinary program is most effective for patients with chronic back pain and significant psychosocial disability?
- Passive massage therapy only
- Interdisciplinary pain rehabilitation program (IPRP) (Correct answer)
- Immediate spinal surgery
- Rest and NSAID therapy
Correct answer: Interdisciplinary pain rehabilitation program (IPRP)
IPRPs combine physical, psychological, and occupational interventions and have the best outcomes for chronic pain with psychosocial involvement.
Question 5: Which validated questionnaire measures disability related to low back pain in clinical and research settings?
- PHQ-9
- Oswestry Disability Index (ODI) (Correct answer)
- AUDIT-C
- GAD-7
Correct answer: Oswestry Disability Index (ODI)
The Oswestry Disability Index measures functional impairment across 10 domains in patients with low back pain.
Question 6: Duloxetine (Cymbalta) is used in chronic back pain management primarily because of its mechanism as a:
- NSAID
- Serotonin-norepinephrine reuptake inhibitor (SNRI) with central pain modulation (Correct answer)
- Muscle relaxant
- Opioid receptor agonist
Correct answer: Serotonin-norepinephrine reuptake inhibitor (SNRI) with central pain modulation
Duloxetine is an SNRI that modulates descending pain inhibitory pathways, making it effective for chronic musculoskeletal pain.
Back Pain Chronic Back Pain Management 1
Chronic low back pain is generally defined as pain lasting longer than how many weeks?