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September 2017

  • a) Define persistent postoperative pain. (Also known as chronic or persistent post-surgical pain) (3 marks)
    b) Which surgical procedures are most commonly associated with persistent postoperative pain? (5 marks)
    c) What are the risk factors for development of persistent postoperative pain? (8 marks)
    d) What pathophysiological changes occur at spinal cord level during the transition from acute to
    persistent postoperative pain? (4 marks)

Pass rate 37.4%

This was adjudged to be a hard question and did indeed have a relatively low pass rate. In general global knowledge of this syndrome was poor, but specifically the last section on pathophysiology was particularly badly answered.
September 2015

  • a)  How should you manage the perioperative opioid requirements of a patient who is having elective
    surgery and who takes regular opioids for non-malignant pain? (8 marks)
  • b)  Give the conversion factors for oral tramadol, codeine and oxycodone to the equianalgesic oral
    morphine dose. (3 marks)
  • c)  What are the perioperative implications of an existing spinal cord stimulator? (6 marks)
  • d)  What additional perioperative precautions should be taken if the patient has an intrathecal drug
    delivery system fitted? (3 marks)
Chronic opioid use and analgesia conversion Pass rate 25.0% It was anticipated that candidates would find this question difficult and this proved to be the case. Some candidates lost marks because they wrote exclusively about the drugs they would use to manage opioid requirements for this patient but did not mention more general measures such as involvement of the pain team. Very few candidates gave any information about management of transdermal pain patches in the peri-operative period. There are differing opinions as to whether patches should be continued, particularly in the case of buprenorphine, but candidates were able to gain marks for either opinion provided they showed that they were aware of the potential problems of altered absorption and partial antagonism.
March 2015

  • You are called to see a 25 year-old man who suffered a traumatic below knee amputation 24 hours ago. He is using Patient Controlled Analgesia (PCA) with intravenous morphine and was comfortable until two hours ago when he started to experience severe pain.
    a) Why might his pain control have become inadequate? (5 marks)
  • b) How would you re-establish optimal pain control? (6 marks)
    c) Which factors would suggest that this patient has phantom limb pain (PLP)? (3 marks) d) What further pharmacological options are available for managing PLP? (6 marks)
Phantom limb pain Pass Rate 53.6%, 10.0% of candidates received a poor fail
A strongly discriminatory question; weak candidates simply wrote “neuropathic pain” as the answer and did not describe what they meant by the term. The specifics of managing phantom limb pain were not addressed by failing candidates in section (d).
September 2014

  • You are called to the Emergency Department to assess a 63 year-old man with known chronic respiratory disease. He has sustained unilateral fractures to his 9th, 10th and 11th ribs but has no other injuries. Paracetamol and codeine phosphate have not provided adequate pain relief.
  • a)  What respiratory problems could result from inadequate pain relief in this patient? (5 marks)
  • b)  How can the effectiveness of his pain relief be assessed? (8 marks)
  • c)  What other methods are available to improve management of this patient’s pain? (7 marks)
  • Pass Rate 43.7%
    Examiners expressed the view at SSD that this question was too easy so it is likely that the poor pass rate reflects limited exposure of candidates to the clinical scenario. Many candidates were unable to suggest how the effectiveness of analgesic interventions could be assessed and few offered regional techniques in their answer. It was surprising that a number suggested codeine / paracetamol compounds in their answer despite the question indicating that these agents had been unhelpful. This emphasises the need to read the question thoroughly.
March 2014

A 68-year-old patient attends the Pain Management Clinic with a history of intractable low back pain.

a) What symptoms and signs would alert you to the need for urgent investigation and referral? (50%)

b) List recommended treatment options that may be considered (with examples) if a magnetic resonance imaging (MRI) scan has excluded significant pathology. (50%)
Question 1 Pass Rate 68.9%

Generally well answered. Most candidates understood the importance of “red flags” in this clinical scenario. Some candidates ignored the result of the MRI scan and gave treatment options which referred to abnormal imaging (e.g. surgical approaches) and consequently detracted from their score. Reference to psychological and alternate / complementary therapies contributed to a high scoring answer.
September 2013

a) What are the complications of continuous epidural analgesia (CEA) in the ward setting? (40%)

b) How should patients be monitored throughout the period of CEA? (25%)

c) Outline the safety features that relate to equipment used for CEA. (35%)
70.4% Pass rate.

The question was based on the Best Practice in the management of epidural analgesia in the hospital setting. (November 2010), published by the Faculty of Pain Medicine of the Royal College of Anaesthetists. Section a) was divided into: complications of local anaesthetic, complications of opioids, human and organization factors (inadequate analgesia; drug administration errors; post dural puncture headache) and siting issues (infection). The safety features relating to equipment included both the pump and giving set. Some candidates focused on the giving set only. The pump should be configured specifically for epidural infusion and should be standardised as per MRHA, have alarms and be tamperproof.
September 2011

A 68-year-old woman attends the Pain Management Clinic with a two year history of pain in her back and legs.

a) Describe the pharmacological (30%) and other treatment options (40%), with examples, available for this lady.

b) What factors would alert you to the need for further investigation or referral? (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
March 2010

a) Describe the sensory distribution of the trigeminal nerve and outline the course of afferent fibres. (40%)

b) List the typical clinical features of trigeminal neuralgia. (20%)

c) How can trigeminal neuralgia be managed? (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
September 2009

a) Define pain. (15%)

b) Distinguish between acute and chronic pain. (15%)

c) What symptoms and signs suggest a diagnosis of neuropathic pain? (40%)

d) What are the possible mechanisms of action of amitriptyline in treating neuropathic pain? (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2009

You are called to see a 25 year-old male who had a traumatic below knee amputation 24 hours ago. He is using Patient Controlled Analgesia (PCA) with intravenous morphine and was comfortable until two hours ago when he started experiencing severe pain.

a) Why might his pain control have become inadequate and how would you re-establish optimal pain control? (45%)

b) What are the characteristic features of phantom limb pain? (20%)

c) What management options are available for phantom limb pain? (25%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2008

a) Describe the symptoms and signs of Complex Regional Pain Syndrome. (50%)

b) How many symptoms and signs are required to make the diagnosis? (20%)

c) What are the other pre-requisites for the diagnosis? (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2006

a) Define pain. (15%)

b) Distinguish between acute and chronic pain. (15%)

c) What symptoms and signs suggest a diagnosis of neuropathic pain? (40%)

d) What are the possible mechanisms of action of amitriptyline in treating neuropathic pain? (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2005

A 75 year old man has terminal prostate cancer with multiple metastases. A metastatic lesion at L5 is causing severe back pain but no neurological symptoms or signs. Modified release Morphine 60mg twice daily has marginally reduced the pain but caused nausea and sedation.
Discuss a care plan for this patient’s current symptoms.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2005

Describe two assessment tools used for the measurement of acute pain in adults. (30%) Describe the McGill pain questionnaire used to assess chronic pain. (20%) Include the strengths and weaknesses of each of the above. (30%) Why do assessment tools used in acute and chronic pain differ? (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2004

List the indications and contraindications for Transcutaneous Electrical Nerve Stimulation
(TENS) ?
What does the patient need to know when using a TENS machine ?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2003

A patient presents to the pain clinic with low back pain. List the indicators (‘red flags’) that would alert you to the possibility of serious pathology? In their absence what is the early management of simple mechanical low back pain?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2002

What are the principles of pain relief after surgery in a drug abuser dependent on opioids?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2002

What aims and strategies are emphasised in a "Pain Management Programme"?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2001

Describe the features and management of phantom limb pain.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question