OCS OCS Pharmacology & Pain Management 2 — Questions and Answers
Question 1: A patient is prescribed methotrexate for rheumatoid arthritis; which precaution should the OCS observe during treatment?
- Monitor for signs of immunosuppression and fatigue; avoid high-intensity exercise during flares (Correct answer)
- Encourage maximal loading regardless of disease activity
- Discontinue all modalities due to drug interactions
- Avoid any range of motion activities
Correct answer: Monitor for signs of immunosuppression and fatigue; avoid high-intensity exercise during flares
Methotrexate is an immunosuppressant and can cause fatigue and increased infection risk, requiring the OCS to monitor exercise tolerance and avoid vigorous exercise during disease flares.
Question 2: Topical diclofenac gel is used in orthopedic practice primarily for which purpose?
- Local NSAID delivery with reduced systemic side effects for superficial joint pain (Correct answer)
- Muscle relaxation via cutaneous absorption
- Antibiotic prophylaxis over wound sites
- Corticosteroid delivery to deep tendons
Correct answer: Local NSAID delivery with reduced systemic side effects for superficial joint pain
Topical diclofenac provides localized COX inhibition for superficial joints like the knee and hand, with significantly lower systemic absorption and GI side effects compared to oral NSAIDs.
Question 3: Which pain neuroscience education (PNE) concept helps patients understand why pain does not always equal tissue damage?
- The brain produces pain as a protective output based on perceived threat, not only tissue damage (Correct answer)
- Pain is a direct measure of structural damage severity
- Nerve conduction velocity determines pain intensity
- Pain signals travel from tissue to brain without CNS modulation
Correct answer: The brain produces pain as a protective output based on perceived threat, not only tissue damage
PNE teaches that the brain creates pain as a protective response based on perceived threat level, which explains why pain and tissue damage are often poorly correlated.
Question 4: A patient taking bisphosphonates (e.g., alendronate) for osteoporosis presents with thigh pain; which serious adverse effect must be considered?
- Atypical femoral fracture (Correct answer)
- Avascular necrosis of the femoral head
- Stress fracture of the tibia
- Pathological hip dislocation
Correct answer: Atypical femoral fracture
Long-term bisphosphonate use is associated with atypical femoral fractures, often presenting with prodromal thigh pain before complete fracture.
Question 5: The biopsychosocial model of pain assessment incorporates which three domains?
- Biological (tissue), psychological (thoughts/emotions), and social (environment/context) factors (Correct answer)
- Biomarkers, pharmacology, and surgery
- Anatomy, physiology, and pathology
- Diagnosis, prognosis, and treatment
Correct answer: Biological (tissue), psychological (thoughts/emotions), and social (environment/context) factors
The biopsychosocial model recognizes that pain is influenced by biological tissue factors, psychological factors such as fear-avoidance beliefs, and social factors including work and support systems.
Question 6: Which outcome measure is specifically designed to assess pain catastrophizing — a psychological factor strongly associated with poor outcomes in chronic musculoskeletal pain?
- Pain Catastrophizing Scale (PCS) (Correct answer)
- Oswestry Disability Index (ODI)
- Tampa Scale of Kinesiophobia (TSK)
- Fear-Avoidance Beliefs Questionnaire (FABQ)
Correct answer: Pain Catastrophizing Scale (PCS)
The Pain Catastrophizing Scale (PCS) measures rumination, magnification, and helplessness related to pain, which are strong predictors of disability and chronicity.
OCS OCS Pharmacology & Pain Management 2
A patient is prescribed methotrexate for rheumatoid arthritis; which precaution should the OCS observe during treatment?