1.

Clinical pain is pain that:

A) requires some form of medical treatment.
B) is chronic.
C) is recurrent.
D) All of the answers are correct.

2. Chronic pain is experienced by about __________ of the population in the United

States.
A) one-fourth
B) one-third
C) one-half
D) two-thirds

3. The most common reason that people seek medical treatment is for:
A) heart disease.
B) cancer.
C) diabetes.
D) pain.

4. Acute pain is to _______________ pain as chronic pain is to _______________

pain.
A) dull; sharp
B) sharp; dull
C) recurrent; intermittent
D) intermittent; recurrent

5. Recurrent pain:
A) involves episodes of discomfort interspersed with periods in which the individual is
relatively pain free.
B) is a sharp, stinging pain that is localized in an injured area of the body.
C) is a dull, burning pain that is long lasting.
D) is a condition in which the pain sufferer becomes more sensitive to pain over time.

6. Jerry has a nagging lower backache that is always present and is moderate in
intensity. Jerry's pain would probably be classified as:
A) acute pain.
B) referred pain.
C) chronic pain.
D) prechronic pain.

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 7. When Carla had the flu, every part of her body seemed to hurt, and she felt
compelled to get extra rest. Carla's condition is an example of:
A) prechronic pain.
B) acute recurrent pain.
C) psychophysiological pain.
D) hyperalgesia.

8. Researchers believe that opioid-induced _________ occurs because of

________________ among nerve cells in the spinal cord.
A) hyperalgesia; long-term potentiation
B) hyperalgesia; inhibition
C) acute pain; damage
D) chronic pain; desensitization

9. Because of pain's nature, researchers have had to rely on each of the following
EXCEPT:
A) behavioral measures.
B) pain diaries.
C) rating scales.
D) objective measures.

10. Which of the following is NOT true regarding the measurement of pain?
A) There are many objective measures of pain.
B) The most frequently used measures are based on the patient's verbal or written
report.
C) Chronic pain is what patients report fearing most about illness.
D) People suffering from headaches tend to choose the same pattern of words to
describe their pain.

11. One way to asses pain is by recording changes in _________, and other
indicators of _____________ arousal.
A) heart rate; autonomic
B) blood pressure; CNS
C) skin temperature; endocrine
D) skin conductance; cortical

12. To assess patients' pain experiences, nurses and other health care professionals
often use:
A) a pain rating scale.
B) the Pain Behavior Scale.
C) electromyography (EMG).

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D) simple measures of autonomic arousal.

13. Which of the following is NOT one of Ronald Melzack's dimensions for
categorizing pain?
A) sensory quality
B) affective quality
C) intrusive quality
D) evaluative quality

14. The most widely used pain questionnaire is the:

A) Melzack Pain Questionnaire.
B) McGill Pain Questionnaire.
C) Minnesota Multiphasic Pain Inventory.
D) Nociception Survey.

15. There are no specialized receptor cells devoted solely to the sense of:
A) touch.
B) vision.
C) hearing.
D) pain.

16. The simplest sensory receptors for pain are called:

A) fast nerve fibers.
B) slow nerve fibers.
C) free nerve endings.
D) nocebos.

17. What are nociceptors?

A) Sensory receptors in the skin that respond to painful stimuli
B) Motor nerves in the spinal cord that relay pain signals from the periphery of the
body to the central nervous system
C) Thalamic cells that route pain messages to the appropriate areas of the cortex
D) Cortical cells that block pain messages from the spinal cord

18. The slow pain system services:

A) the skin.
B) mucus membranes.
C) all body tissues except the brain.
D) the brain.

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 19. The fast pain system carries pain that is perceived as:
A) coming from the skin.
B) stinging and generalized throughout the body.
C) dull and localized in one area.
D) stinging and localized in one area.

20. Fast nerve fibers are _______________ and conduct neural impulses at about
_______________ meters per second.
A) myelinated; 15 to 30
B) large; 0.5 to 2
C) unmyelinated; 0.5 to 2
D) small; 15 to 30

21. Slow nerve fibers are _______________ and conduct neural impulses at about
_______________ meters per second.
A) myelinated; 15 to 30
B) large; 0.5 to 2
C) unmyelinated; 0.5 to 2
D) small; 15 to 30

22. Acute, stinging pain is transmitted in which type of nerve fibers?

A) slow
B) fast
C) periacqueductal
D) substantia gelatinosa

23. The substantia gelatinosa is the area of the spinal cord where:
A) fast fibers synapse with sensory nerves.
B) slow fibers synapse with sensory nerves.
C) fast and slow fibers synapse with sensory nerves.
D) free nerve endings synapse with sensory nerves.

24. Which of the following is NOT involved in the pathway of pain from the skin to
the brain?
A) the pituitary gland
B) the amygdala
C) the thalamus
D) the cortex

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 25. On its way to the _______, the fast pain pathway triggers neural activity in the
_____________, which is the brain's mechanism for arousing the cortex in
response to important messages.
A) medulla; thalamus
B) thalamus; medulla
C) thalamus; reticular formation
D) somatosensory cortex; midbrain

26. Incoming messages to the cerebral cortex from the skin senses are ultimately
routed to the:
A) somatosensory cortex.
B) reticular formation.
C) medulla.
D) ventrobasal complex.

27. The pain in the shoulder that accompanies advanced heart disease is an example
of:
A) acute pain.
B) chronic pain.
C) referred pain.
D) chronic intractable benign pain.

28. Before his coronary bypass surgery, Bill used to experience a deep, burning pain
in his left shoulder. Bill's pain was an example of _______________ pain.
A) referred
B) phantom limb
C) psychophysiological
D) dysfunctional

29. The neurotransmitter secreted by pain fibers in the spinal cord that increases pain
messages is:
A) substance P.
B) encephalin.
C) endorphin.
D) naloxone.

30. Through their synapses with slow fibers, neurons containing _______________
are believed to regulate how much of the slow pain system's message reaches the
brain.
A) substance P
B) enkephalins

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C) glutamate
D) serotonin

31. The area of the brain that, when electrically stimulated, causes an immediate
reduction in pain is the:
A) periaqueductal gray region.
B) pituitary gland.
C) substantia gelatinosa.
D) hypothalamus.

32. Which neurotransmitter is activated during the phenomenon of stress-induced

analgesia?
A) naloxone
B) substance P
C) glutamate
D) endorphin

33. Chronic pain patients are often deficient in self-regulatory skills, which are partly
regulated by the area of the brain known as the:
A) periaqueductal gray.
B) anterior cingulate cortex.
C) reticular formation.
D) substantia gelatinosa.

34. An opioid antagonist that binds to opioid receptors in the body and blocks the
effects of natural opiates is:
A) substance P.
B) enkephalin.
C) naloxone.
D) prostaglandin.

35. In one study, dental patients who were given a placebo reported increased pain
when they were also injected with:
A) substance P.
B) enkephalins.
C) endorphin.
D) naloxone.

36. One study of patients suffering from __________ found that those with one
variation of the COMT gene displayed the most several psychological and

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 functional impact pain scores.
A) chronic fatigue syndrome
B) restless leg syndrome
C) referred pain
D) fibromyalgia

37. The gate control theory attempts to explain how:

A) certain nerve cells in the brain respond to specific features of sensory stimuli.
B) the perception of touch is related to the specific nerve endings that are activated.
C) the nervous system blocks or allows pain signals to pass to the brain.
D) None of these are explanations.

38. The so-called pain gate is believed to exist in the:

A) spinal cord.
B) brainstem.
C) thalamus.
D) cerebral cortex.

39. According to the gate control theory, the central control mechanism refers to
signals from:
A) fast pain fibers that close the gate.
B) slow pain fibers that open the gate.
C) fast or slow pain fibers that open the gate.
D) the brain that can shut the gate.

40. Which of the following is an example of phantom limb pain?

A) A patient continues to feel a deep, burning sensation in a wound that has healed.
B) After an accidental fall, Brad can no longer feel any sensations in his left arm.
C) An amputee reports feeling pain in a missing leg.
D) After bruising her shoulder, Sheila's arm has gone numb.

41. Which of the following is NOT true regarding gender differences in the
experience of pain?
A) Women report more frequent episodes of pain than men do.
B) Women suffer more than men from migraines and tension headaches.
C) Men receive 5 to 10 percent more prescription drugs for common pain complaints
than do women.
D) Certain analgesics provide longer-lasting relief for women than they do for men.

42. Cultural differences in pain reactions are most likely related to differences in:

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A) pain threshold.
B) pain tolerance.
C) health behaviors.
D) All of the answers are correct.

43. Which of the following personality traits has NOT been linked with chronic pain
patients?
A) hysteria
B) hypochondriasis
C) depression
D) emotional dependence

44. Pain sufferers may experience _____________ from the social reinforcement
they receive in response to pain behaviors.
A) long-term potentiation
B) deferred imitation
C) primary gains
D) secondary gains

45. Brad's psychologist believes that he is not progressing in his treatment because
adhering to the role of a pain patient brings him a lot of attention from others.
Because she wants to reshape Brad's pain behavior, the therapist is advocating:
A) cognitive therapy.
B) guided imagery.
C) distraction.
D) an intervention based on a conditioning model.

46. _______________ is an opioid analgesic, whereas _______________ is a

nonopioid acting analgesic.
A) Morphine; aspirin
B) Ibuprophen; morphine
C) Acetaminophen; naproxin
D) Aspirin; acetaminophen

47. Aspirin, acetaminophen, and ibuprofen are classified as:

A) nonsteroidal anti-inflammatory drugs.
B) prostaglandins.
C) COX-2 inhibitors.
D) opioids.

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 48. The chemical substance responsible for localized pain and inflammation, such as
the pain of sunburn, is:
A) substance P.
B) glutamate.
C) prostaglandin.
D) NSAID.

49. Generally speaking, surgery to relieve pain:

A) yields excellent local pain relief, but only for certain types of injuries.
B) has unpredictable results.
C) is the most effective biomedical treatment for pain.
D) yields excellent central pain relief.

50. Which of the following is NOT true of transcutaneous electrical nerve

stimulation?
A) It is a form of counterirritation.
B) It involves applying impulses of electricity to nerve endings under the skin near the
painful area.
C) It yields excellent local pain relief for some chronic pain patients.
D) It is a form of behavior therapy.

51. Analgesia created by triggering another, mildly painful stimulus is called:

A) counterirritation.
B) referred pain.
C) phantom pain.
D) stress-induced analgesia.

52. The dominant model for treating chronic pain is:

A) behavior modification.
B) dissociation training.
C) cognitive-behavioral therapy.
D) rational-emotive therapy.

53. After being injured in a football game, David is certain that his hoped-for career
as a professional athlete is doomed to fail and that the rest of his life will be
miserable. A health psychologist would probably characterize David's pattern of
thinking as an example of:
A) catastrophizing.
B) victimization.
C) self-blame.
D) dwelling on the pain.

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 54. Which form of therapy vigorously challenges clients' illogical and self-defeating
beliefs?
A) psychoanalysis
B) systematic desensitization
C) aversive conditioning
D) cognitive restructuring

55. One research study of catastrophizing among rheumatoid arthritis patients found
that ____________ was associated with elevated levels of ________________.
A) poor emotional regulation; substance P
B) helplessness; C-reactive protein
C) rumination; prostaglandin
D) cognitive distraction; inflammation

56. Like _______________, imagery is based on the concept that our attention and
awareness have _______________.
A) relaxation training; unlimited capacity
B) cognitive distraction; a limited capacity
C) Lamaze training; an optimal level of arousal
D) visualization; multiple dimensions

57. Which of the following is an example of cognitive distraction?

A) While rescuing an unconscious victim from a burning building, a seriously injured
firefighter was able to ignore her own pain.
B) By mentally rehearsing a difficult medical treatment, a patient is able to keep his
emotions under control.
C) By ignoring a chronic pain sufferer's excessive complaining, dependence, and
request for painkillers, the staff at a pain clinic aim to increase more positive ways
of coping.
D) A chronic pain patient wears a battery-powered device that emits an audible tone
whenever his muscle tension increases.

58. A key component of cognitive behavioral therapy is _______, which focuses on

helping individuals reinterpret and restructure pain-related sensations.
A) aversive conditioning
B) stimulus control training
C) cognitive restructuring
D) negative reinforcement

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 59. Which approach to pain control works best?
A) physical therapy
B) behavioral therapy
C) biomedical therapy
D) It depends on the patient and the nature of the pain.

60. The most effective pain-management programs:

A) focus only on controlling a patient's pain.
B) combine cognitive-behavioral therapy with the judicious use of analgesic drugs.
C) are based on operant conditioning.
D) are based on classical conditioning.

61. In one study comparing the effectiveness of different treatments in relieving the
pain of tension headaches, the greatest relief occurred with:
A) biofeedback.
B) relaxation training.
C) a combination of biofeedback and relaxation.
D) a placebo.

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Answer Key

1. A
2. B
3. D
4. B
5. A
6. C
7. D
8. A
9. D
10. A
11. A
12. B
13. C
14. B
15. D
16. C
17. A
18. C
19. D
20. A
21. C
22. B
23. C
24. A
25. C
26. A
27. C
28. A
29. A
30. B
31. A
32. D
33. B
34. C
35. D
36. D
37. C
38. A
39. D
40. C
41. C
42. B
43. D
44. D

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45. D
46. A
47. A
48. C
49. B
50. D
51. A
52. C
53. A
54. D
55. B
56. B
57. A
58. C
59. D
60. B
61. C

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