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1. Which ONE of the following
statements is TRUE?
a) The most appropriate pain assessment
tool for all types of pain is the Visual
b) Abbey Pain Scale is recommended for
assessing pain in children.
c) When assessing pain in palliative care,
consideration should be given to the
patient’s pain history and cultural
aspects of pain beliefs.
d) Most of the pain assessment tools
available will address pain in palliative
2. Which ONE of the following
statements is TRUE?
a) Palliative care is only for patients
suffering from cancer.
b) Pain in palliative care should be
treated only when curative therapies
c) Patients with end-stage non-malignant
chronic disease do not have high levels
d) The experience of pain in palliative
care is emotional and will vary
3. Which ONE of the following
statements is FALSE?
a) Current techniques to treat pain can
relieve more than 90% of cancer pain.
b) Healthcare systems are largely
responsible for the under-treatment of
pain in palliative care in Australia.
c) It is not uncommon for a patient
suffering pain in palliative care to
present with several types of pain.
d) Wind up’ pain can occur if pain
management is not addressed early in
4. Which ONE of the following
statements is FALSE?
a) Non-steroidal anti-inflammatory drugs
are effective for metastatic bone pain.
b) Oral morphine, oxycodone and
hydromorphone all have similar
efficacy and toxicity in opioid naïve
c) Opioids can decrease the risk of central
nervous system adverse effects in the
elderly thus short-acting opioids are
most appropriate for managing pain in
palliative care in this setting.
d) Opioid equianalgesic dosing tables are
‘approximate’ and close monitoring
of the patient is necessary when
changing from one opioid to another.
5. Which ONE of the following
statements is TRUE?
a) Carbamazepine is the anticonvulsant
of choice for treating neuropathic pain
in cancer patients.
b) Constipation associated with opioids
is usually transient and will not require
any prescribed treatment.
c) Changing from one opioid to another
opioid may alter the adverse effect
d) As studies are limited in the area of non-
pharmacological treatments for pain
in palliative care, alternate therapies
such as transcutaneous electrical nerve
stimulation (TENS) should not be tried.
7. WHO Definition of Pain. World Health Organization. Retrieved
23rd February 2013
8. McCaffery M, Pasero C. Assessment: underlying complexities,
misconceptions and practical tools. In: McCaffery M,Pasero
CL, editors. Pain: clinical manual. 2nd ed. St. Louis: Mosby;
9. Breivik H. Postoperative pain management: why is it difficult
to show that it improves outcome? Eur J Anaesthesiol.
10. Caraceni A, Pigni A, Brunelli C. Is oral morphine still the
first choice opioid for moderate to severe cancer pain? A
Systematic review within the European Palliative Care Research
Collborative guidelines project. Palliat Med 2011;25:402-409
11. Van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG,
Schouten HC, van Kleef M, Patijn J, 2007. Prevalence of pain in
patients with cancer: a systematic review of the past 40 years.
Ann Oncol 18(9):1437-1449.
12. Heath JA, Clarke NE, Donath SM, McCarthy M, Anderson VA,
Wolfe J. Symptoms and suffering at the end of life in children
with cancer: an Australian perspective. Med J Aust. 2010
13. National Pain Strategy 2010
14. The Pharmacy Guild of Australia. Submission to the Senate
Inquiry into Palliative Care in Australia. Canberra. March 2012
15. Philip S, Whitecare MD, A Patrick J et al. Managing Pain in the
Dying Patient. Am Fam Physician 2000 Feb 1:61(3):755-764
16. Therapeutic Guidelines. Palliative Care 2010.Version 3
17. Holen JC, Hjermstad MJ, Loge JH, et al. Pain assessment tools:
is the content appropriate for use in palliative care? J Pain
Symptom Manage. 2006 Dec 32(6):567-80 .
18. Kanner RM, Foley KM. Patterns of narcotic drug use in a cancer
pain clinic. Ann N Y Acad Sci. 1981; 362:161-72
19. Davies, AN, A. Dickman, Reid C, Stevens A, Zeppetella G.
The management of cancer-related breakthrough pain:
recommendations of a task group of the Science Committee
of the Association for Palliative Medicine of Great Britain and
Ireland. Eur J Pain 2009;13(4):331-338
20. Tassinari D, Drudi F, Rosati M, Tombesi P, Sartori S, Maltoni M.
The second step of the analgesic ladder and oral tramadol in
the treatment of mild to moderate cancer pain: a systematic
review. Palliat Med. 2011 Jul;25(5):410-23.
21. Tassinari D, Sartori S, Tamburini E, Scarpi E, Tombesi P, Santelmo
C, et al. Transdermal fentanyl as a front-line approach to
moderate-severe pain: a meta-analysis of randomised clinical
trials. J Palliat Care. 2009 Autumn;25(3):172-80 .
22. Saarto T, Wiffen PJ. Antidepressants for neuropathic pain.
Cochrane Database of Systematic Reviews.[internet] 2007
[cited 2013 Feb 27] Available from: http://onlinelibrary.wiley.
23. The Pharmacy Guild of Australia. Guild Digest November 2011
24. Zech DF, Grond S, Lunch J et al. Validation of world Health
Organization guidelines for cancer pain relief. Pain. 1995;151-4
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