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ABFM + KSA Pain Management (Latest Update 2025 / 2026) Questions & Answers | Grade A | 100% Correct (Verified Answers)

Question:

True statements regarding the management of chronic daily headaches include which of the following? (Mark all that are true.)

a) A small daily dose of prednisone (5-10 mg) helps decrease the frequency of

headaches

b) Amitriptyline can reduce headache frequency by up to 50%

c) Opioids are effective (50% improvement) in more than 60% of patients

d) NSAIDs are associated with a lower risk of medication-overuse

headaches compared to ergotamine

Rationale:

Chronic daily headache refers to the presence of a headache more than 15 days per month for longer than 3 months. Chronic daily headache is not a diagnosis but a category that contains many disorders representing primary and secondary headaches. Secondary causes must be ruled out before the diagnosis of a primary headache disorder is made. Approximately 3%-5% of the population worldwide and 70%-80% of patients presenting to headache clinics in the United States have daily or near-daily headaches. The disability associated with this disorder is substantial and includes a diminished quality 1 / 4

of life related to physical and mental health, as well as impaired physical, social, and occupational functioning.

The overuse of medications used for acute headache may lead to medication- overuse headache, a syndrome of daily headaches caused by the very medications used to relieve the pain. The prevalence in the population of chronic daily headache associated with overuse of these medications was recently estimated to be 1.4% overall, with a higher estimated occurrence among women (2.6%), especially those over the age of 50 (5%) (level of evidence 2).

Overuse of medications for acute headache is defined as any of the following:

• regular overuse of a headache medication for >3 months
• use of ergotamine, triptans, opioids, and combination analgesics >10

days/month

• use of simple analgesics 15 or more days/month
• use of any headache medications 15 or more days/month

NSAIDs and dihydroergotamine mesylate (unlike ergotamine tartrate) are generally associated with a low risk of medication overuse headache, and are often used to treat breakthrough headaches during the withdrawal period.

Randomized trials of the use of preventive medications in chronic daily headache are scarce. In a single trial involving amitriptyline,

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Question:

True statements regarding the management of fibromyalgia include which of the following? (Mark all that are true.)

a) Tricyclic antidepressants or cyclobenzaprine (Flexeril) at bedtime

would be an appropriate initial therapy

b) NSAIDs may be used effectively either as monotherapy or in combination

with other medications

c) Aerobic exercise two to three times per week may improve

conditioning and fibromyalgia symptoms

d) Sleep and antianxiety agents such as trazodone (Oleptro),

benzodiazepines, and nonbenzodiazepine sedatives are indicated if sleep disturbance is a prominent symptom

e) Multidisciplinary approaches that incorporate two or more

strategies help decrease pain and improve function

Rationale:

The following recommendations regarding the management of fibromyalgia are supported by the strongest evidence (SOR A).

Evaluation of the patient with fibromyalgia syndrome (FMS) begins with a complete history and physical examination, focusing on illnesses that may mimic or complicate FMS, such as hypothyroidism or ankylosing spondylitis, or that can occur concurrently with FMS, such as tendinitis, systemic lupus erythematosus, rheumatoid arthritis, or osteoarthritis.

The clinician should perform a complete joint examination, manual muscle strength testing, and a neurologic examination.The clinical diagnosis of FMS depends on the presence of widespread pain, defined as pain in all four body quadrants and axial pain, for at least 3 consecutive months. The only physical 3 / 4

examination criterion for the diagnosis of FMS is the presence of excess tenderness to manual palpation of at least 11 of 18 muscle-tendon sites.

Multiple strategies, including both pharmacologic and nonpharmacologic therapies, should be used in the management of FMS. For initial treatment of FMS, a tricyclic antidepressant, in particular 10-30 mg amitriptyline, or cyclobenzaprine can be given at bedtime to promote sleep. An SSRI such as fluoxetine, alone or in combination with a tricyclic, can be used for pain relief.NSAIDs should not be used as the primary pain medication. There is no evidence that NSAIDs are effective when used alone, although NSAIDs (including COX-2 selective agents) and acetaminophen may provide some analgesia when used with other medications.

Other potentially useful medications include sleep and antianxiety medications such as trazodone, benzodiazepines, nonbenzodiazepine sedatives, or levodopa and carbidopa, especially if sleep disturbances such as restless legs syndrome are prominent. Also, the FDA has approved t

Question:

True statements regarding the management of chronic pelvic pain in women include which of the following? (Mark all that are true.)

a) Addressing patients' social issues may be helpful in resolving

symptoms

b) Chronic pelvic pain patients should be managed by a gynecologist or pain

specialist

c) When chronic pelvic pain is cyclic, diagnostic laparoscopy is required

before starting hormonal therapy

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