d, Morphine, intravenous: Existing published clinical evidence cited by Goldstein et al has shown that morphine was one of the most frequently used opioids for a successful preemptive analgesia outcome. The most effective route was shown to be intravenous.

b, Ten minutes before: Previously published data indicate that opioids best reduce pain in the postoperative period when they are present in the biological system 10 minutes before the initial incision, allowing sufficient time for morphine to enter areas of the nervous system (eg, dorsal horn), block incoming nociceptive stimuli, and reduce central sensitization.

d, Sacral myofascial release: Achieving viscerosomatic and somatovisceral reflexing may be the most important consideration when determining the osteopathic manipulative (OM) techniques for use in this population because patients present with these reflexes stimulated for one of two reasons: (1) the patient has a documented pathological history that presumably produces a heightened response in that afferent input to the spinal cord and higher centers, and muscle tension presumably increases in these areas along with pain and other tissue texture changes, or (2) the surgical procedure causes more adverse events such as pain, spasm, and edema than would be expected by the pathological condition or surgical intervention alone. By reducing or eliminating altered somatic/efferent reflexing and nociceptor stimulation using osteopathic manipulative treatment (OMT) such as sacral myofascial release, patients would have less somatic reactivity (muscle spasm) and pain, and would use less morphine.

a, Anandamide: Anandamide is an endocannabinoid ligand, a fatty acid amide. Beta-endorphin (β-endorphin) and enkephalin are endorphin ligands, short-chain peptides, as noted in the June 2005 original contribution by McPartland et al.

b, Anxiolysis, sedation, and analgesia: Experimental studies and clinical anecdotes suggest that both OMT and endocannabinoid ligands have been associated with anxiolysis, sedation, and analgesia—as well as euphoria.

b, The definition of addiction in the use of an opioid is “the compulsive behavior, even with adverse consequences, to use opioids.”

e, All of the above.

b, False: Patients who are transitioning from sustained-release morphine to buprenorphine should undergo induction using buprenorphine and later be switched to the buprenorphinenaloxone hydrochloride combination, not vice versa as stated.

b, False: Pharmacologic therapy alone is rarely sufficient for treatment of patients with drug addiction. Comprehensive addiction care for most patients requires drug abuse counseling (individual or group) and participation in self-help programs.

d, None of the above: Buprenorphine is available only in two sublingual formulations, either alone or in combination with naloxone.

c, Patients with chronic pain who have an active history of drug abuse must be carefully monitored for signs of abuse or diversion.

d, Todd and colleagues' research documented distinct differences in the treatment of pain from long bone fractures among ethnic populations.

b, Comprehensive evaluation and treatment of patients with chronic pain needs to incorporate the individual's and the family's concerns.

a, True: Treatment of patients with substance abuse disorders (SUDs) can be as effective as for patients with other chronic medical illnesses.

a, Only 1% of patient visits to physicians' offices are associated with substance use problems.

a, True: Although it may seem obvious to the reader that physicians should have the skills to understand clinical, legal, and ethical considerations involved in prescribing medications with abuse potential, this is truly a question of “do no harm” that is grossly disregarded in many physicians' offices around the United States. This disregard contributes dramatically to the growing problem of pharmaceutical opiate abuse.

e, Marijuana is the most abused illicit drug in the United States today. ♦