Chronic Pain 101: Pop Quiz

Explain all of your answers clearly and thoroughly. Once you have completed your quiz, hand it to the judgmental doctor at the front of the class.

Multiple Choice

1. A patient presents to the ER for six weeks of persistent abdominal pain. When questioned as to why she delayed coming in for so long she:

   1. Remains silent in hopes the nurse will draw her own conclusion.

   2. Attempts to make excuses regarding a hectic work schedule, familial obligations, and overwhelming extracurricular activities precluding her from seeking medical attention in a more reasonable time.

   3. Waits until the doctor mentions her previous five ER visits—complete with inconclusive diagnoses—to justify her desire to “endure the pain” as long as humanly possible, earning herself a frown and a lecture on rational human behavior. (After which he will proceed to add another inconclusive diagnosis to her record)

   4. All of the above.

2. You are a medical professional. A female patient confesses that she is experiencing physical discomfort. Her symptom is likely due to: (Choose the MOST correct answer)

   1. Hormones

   2. Menstrual cramps

   3. Depression

   4. Anxiety

3. You are a chronic pain patient seeing a new doctor for the first time. Within 5 minutes, you become aware of their ignorance regarding your conditions. They interrupt and talk over every attempt you make to educate them. (You briefly consider screaming at the top of your lungs to gain their attention) The treatment plan they put forth as a suggestion is laughable. You respond by:

   1. Executing that scream you’ve been holding in for the past 20 minutes.

   2. Patiently explaining why they’re a colossal idiot and asking what cereal box they fished their medical degree out of.

   3. Throwing chairs around the room a’la She-Hulk until they agree to listen to you.

   4. Briefly entertain options a-c before resigning yourself to the reality that you are a patient and devoid of any authority. Quietly agree to the idiotic treatment plan that will accomplish nothing. Consider searching for ANOTHER doctor while acknowledging the six-plus month wait you will need to endure for an appointment slot to open.

4. A chronic pain patient informs you they are experiencing a pain equivalent to “10” on the Wong-Baker visual pain scale. This means:

   1. Nothing. You ask the question because it appears on the intake form, and you are programmed to fill in every blank on the screen. Associating the number with the actual amount of agony a person might be experiencing requires more effort than you’re willing to give.

   2. The patient is a drug addict. The only people who can genuinely report a pain score of “10” have severed limbs, third-degree burns, or are in the company of small children. As this patient walked into the ER under their own power, they are clearly exaggerating to obtain narcotics for a fix.

   3. The patient is hoping to jump ahead in the line. They failed to warrant any attention when they reported chest pains—their ECG was perfectly normal—so now they are trying a different tactic. There is no limit to the underhanded tactics they will attempt to get ahead of patients who genuinely need medical attention.

   4. The patient needs acting lessons. They have not studied the Wong-Baker scale in enough detail. While their face is creased in an approximation of pain, and they ARE hunched over in the chair, no tears are falling down their face. If they hoped to elicit a sympathetic response, they would have done more to convince you they were in excruciating pain. (Perhaps dropping a limb as they hobbled to the chair)

5. A patient in pain will:

   1. Cry

   2. Scream

   3. Thrash on the bed

   4. Sit quietly, swallowing every evidence of misery in a twisted need to preserve her dignity, particularly after watching doctors and nurses raise skeptical eyebrows.

Short Answer

1. What is the most appropriate way to describe pain to a medical professional without getting labeled hysterical, depressed, insane, delusional, dramatic, hyperbolic, or having your record marked as a raging hypochondriac? (Provide separate answers for male and female practitioners)

2. You are a female patient. It feels like your pelvic organs are twisting into a Gordion Knot. You know something is wrong. (The same way it’s been wrong for the past two months) A doctor—with a medical degree you DON’T possess—exhibits sympathy throughout your testing. He promises to get to the bottom of your agony. Until the imaging and lab work turn up normal results. Then he suggests you seek psychological evaluation. (Your “female crazies” are showing again) How do you respond?

3. You are an anesthesiologist. During your pre-surgical interview, a patient informs you they have fibromyalgia. In under 500 words, describe why you would choose to ignore that diagnosis and move forward with a standard analgesic plan, leaving the patient to wake in excruciating pain. (Pay particular attention to your advanced knowledge of chronic pain states and nerve inflammation in your answer)

4. Outline the proper way to respond to a chronic pain patient’s response to the question, “How’s your pain now?” Take into account that you have already administered two doses of low-dose narcotics and reported your suspicions to the doctor that the patient is a hypochondriac—blatantly ignoring their reported symptoms.

5. There are two patients awaiting attention. One is a young child screaming at the top of his lungs. The mother is equally hysterical, demanding immediate medical care—there is evidence of a mild contusion on the elbow. The other is a middle-aged female reporting excessive abdominal pain preventing her from sitting, standing, or lying down. She has a mild fever and is obviously struggling to get comfortable. Explain why you provide emergent care to the child and label the female as “anxious.”

Essay

1. Describe pain.

2. You are a medical professional. Detail ONE way you could treat your patients as human beings—rational, thinking, coherent human beings, capable of identifying that there is something fundamentally WRONG with their bodies—when they present to your office or clinic when their only symptom is PAIN.