Pre-Questionnaire

– Step 1 of 5

Dear ECHO Community Partner,

We are asking you to complete this questionnaire because you are participating in ECHO Pain Canada [insert hub site name ex.McGill University]. This Pre-ECHO questionnaire is 4 sections long and takes on average 20 min or less to complete. It will cover the following:

1. Self-efficacy
2. Attitudes and behaviours about chronic pain
3. Knowledge test
4. Adherence to guidelines (to be completed only by physicians, nurse practitioners, physician assistants, dentists, residents, fellows)

We ask you to complete all sections before you begin attending weekly ECHO sessions. By completing this questionnaire, you are consenting to participate in this program evaluation study. If you have any question regarding your rights as a program evaluation participant, please contact our Study Manager, Yalnee Shantharam at yalnee.shantharam@uhn.ca or the Quality Improvement Review Committee (QIRC) at QI@uhn.ca.

The aggregate data collected here will be used as part of an evaluation of this project funded by Health Canada. There is no industry or commercial involvement with any research conducted by ECHO Pain Canada.

Completion of this survey is voluntary and your participation, or choice not to participate, will not affect your current or future affiliation with ECHO Pain Canada. ECHO Pain Canada will not share your data with any external institution. Your responses are confidential.

Thank you for your time and support,
ECHO Pain Canada

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Self-Efficacy: Please answer the following *

	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Not Applicable
1) I am confident in my ability to identify patients who need pharmacological management of chronic pain	Strongly Disagree1) I am confident in my ability to identify patients who need pharmacological management of chronic pain Strongly Disagree	Disagree1) I am confident in my ability to identify patients who need pharmacological management of chronic pain Disagree	Somewhat Disagree1) I am confident in my ability to identify patients who need pharmacological management of chronic pain Somewhat Disagree	Neither Agree nor Disagree1) I am confident in my ability to identify patients who need pharmacological management of chronic pain Neither Agree nor Disagree	Somewhat Agree1) I am confident in my ability to identify patients who need pharmacological management of chronic pain Somewhat Agree	Agree1) I am confident in my ability to identify patients who need pharmacological management of chronic pain Agree	Strongly Agree1) I am confident in my ability to identify patients who need pharmacological management of chronic pain Strongly Agree	Not Applicable1) I am confident in my ability to identify patients who need pharmacological management of chronic pain Not Applicable
2) I am confident in my ability to identify patients who may need a comprehensive approach (rehabilitation, psychological service) to pain treatment	Strongly Disagree2) I am confident in my ability to identify patients who may need a comprehensive approach (rehabilitation, psychological service) to pain treatment Strongly Disagree	Disagree2) I am confident in my ability to identify patients who may need a comprehensive approach (rehabilitation, psychological service) to pain treatment Disagree	Somewhat Disagree2) I am confident in my ability to identify patients who may need a comprehensive approach (rehabilitation, psychological service) to pain treatment Somewhat Disagree	Neither Agree nor Disagree2) I am confident in my ability to identify patients who may need a comprehensive approach (rehabilitation, psychological service) to pain treatment Neither Agree nor Disagree	Somewhat Agree2) I am confident in my ability to identify patients who may need a comprehensive approach (rehabilitation, psychological service) to pain treatment Somewhat Agree	Agree2) I am confident in my ability to identify patients who may need a comprehensive approach (rehabilitation, psychological service) to pain treatment Agree	Strongly Agree2) I am confident in my ability to identify patients who may need a comprehensive approach (rehabilitation, psychological service) to pain treatment Strongly Agree	Not Applicable2) I am confident in my ability to identify patients who may need a comprehensive approach (rehabilitation, psychological service) to pain treatment Not Applicable
3) I am confident in my ability to assess patients for responsible opioid analgesic treatment	Strongly Disagree3) I am confident in my ability to assess patients for responsible opioid analgesic treatment Strongly Disagree	Disagree3) I am confident in my ability to assess patients for responsible opioid analgesic treatment Disagree	Somewhat Disagree3) I am confident in my ability to assess patients for responsible opioid analgesic treatment Somewhat Disagree	Neither Agree nor Disagree3) I am confident in my ability to assess patients for responsible opioid analgesic treatment Neither Agree nor Disagree	Somewhat Agree3) I am confident in my ability to assess patients for responsible opioid analgesic treatment Somewhat Agree	Agree3) I am confident in my ability to assess patients for responsible opioid analgesic treatment Agree	Strongly Agree3) I am confident in my ability to assess patients for responsible opioid analgesic treatment Strongly Agree	Not Applicable3) I am confident in my ability to assess patients for responsible opioid analgesic treatment Not Applicable
4) I am confident in my ability to understand possible side-effects of most pharmacological medications used for pain	Strongly Disagree4) I am confident in my ability to understand possible side-effects of most pharmacological medications used for pain Strongly Disagree	Disagree4) I am confident in my ability to understand possible side-effects of most pharmacological medications used for pain Disagree	Somewhat Disagree4) I am confident in my ability to understand possible side-effects of most pharmacological medications used for pain Somewhat Disagree	Neither Agree nor Disagree4) I am confident in my ability to understand possible side-effects of most pharmacological medications used for pain Neither Agree nor Disagree	Somewhat Agree4) I am confident in my ability to understand possible side-effects of most pharmacological medications used for pain Somewhat Agree	Agree4) I am confident in my ability to understand possible side-effects of most pharmacological medications used for pain Agree	Strongly Agree4) I am confident in my ability to understand possible side-effects of most pharmacological medications used for pain Strongly Agree	Not Applicable4) I am confident in my ability to understand possible side-effects of most pharmacological medications used for pain Not Applicable
5) I am confident in my ability to educate my clinic staff about chronic pain patients	Strongly Disagree5) I am confident in my ability to educate my clinic staff about chronic pain patients Strongly Disagree	Disagree5) I am confident in my ability to educate my clinic staff about chronic pain patients Disagree	Somewhat Disagree5) I am confident in my ability to educate my clinic staff about chronic pain patients Somewhat Disagree	Neither Agree nor Disagree5) I am confident in my ability to educate my clinic staff about chronic pain patients Neither Agree nor Disagree	Somewhat Agree5) I am confident in my ability to educate my clinic staff about chronic pain patients Somewhat Agree	Agree5) I am confident in my ability to educate my clinic staff about chronic pain patients Agree	Strongly Agree5) I am confident in my ability to educate my clinic staff about chronic pain patients Strongly Agree	Not Applicable5) I am confident in my ability to educate my clinic staff about chronic pain patients Not Applicable
6) I am confident in my ability to assess and manage psychiatric co-morbidities in patients with chronic pain	Strongly Disagree6) I am confident in my ability to assess and manage psychiatric co-morbidities in patients with chronic pain Strongly Disagree	Disagree6) I am confident in my ability to assess and manage psychiatric co-morbidities in patients with chronic pain Disagree	Somewhat Disagree6) I am confident in my ability to assess and manage psychiatric co-morbidities in patients with chronic pain Somewhat Disagree	Neither Agree nor Disagree6) I am confident in my ability to assess and manage psychiatric co-morbidities in patients with chronic pain Neither Agree nor Disagree	Somewhat Agree6) I am confident in my ability to assess and manage psychiatric co-morbidities in patients with chronic pain Somewhat Agree	Agree6) I am confident in my ability to assess and manage psychiatric co-morbidities in patients with chronic pain Agree	Strongly Agree6) I am confident in my ability to assess and manage psychiatric co-morbidities in patients with chronic pain Strongly Agree	Not Applicable6) I am confident in my ability to assess and manage psychiatric co-morbidities in patients with chronic pain Not Applicable
7) I am confident in my ability to assess and manage substance abuse co-morbidities in patients with chronic pain	Strongly Disagree7) I am confident in my ability to assess and manage substance abuse co-morbidities in patients with chronic pain Strongly Disagree	Disagree7) I am confident in my ability to assess and manage substance abuse co-morbidities in patients with chronic pain Disagree	Somewhat Disagree7) I am confident in my ability to assess and manage substance abuse co-morbidities in patients with chronic pain Somewhat Disagree	Neither Agree nor Disagree7) I am confident in my ability to assess and manage substance abuse co-morbidities in patients with chronic pain Neither Agree nor Disagree	Somewhat Agree7) I am confident in my ability to assess and manage substance abuse co-morbidities in patients with chronic pain Somewhat Agree	Agree7) I am confident in my ability to assess and manage substance abuse co-morbidities in patients with chronic pain Agree	Strongly Agree7) I am confident in my ability to assess and manage substance abuse co-morbidities in patients with chronic pain Strongly Agree	Not Applicable7) I am confident in my ability to assess and manage substance abuse co-morbidities in patients with chronic pain Not Applicable
8) I am confident in my ability to be identified as a "special interest" within my clinic and in my locality for chronic pain questions/issues	Strongly Disagree8) I am confident in my ability to be identified as a "special interest" within my clinic and in my locality for chronic pain questions/issues Strongly Disagree	Disagree8) I am confident in my ability to be identified as a "special interest" within my clinic and in my locality for chronic pain questions/issues Disagree	Somewhat Disagree8) I am confident in my ability to be identified as a "special interest" within my clinic and in my locality for chronic pain questions/issues Somewhat Disagree	Neither Agree nor Disagree8) I am confident in my ability to be identified as a "special interest" within my clinic and in my locality for chronic pain questions/issues Neither Agree nor Disagree	Somewhat Agree8) I am confident in my ability to be identified as a "special interest" within my clinic and in my locality for chronic pain questions/issues Somewhat Agree	Agree8) I am confident in my ability to be identified as a "special interest" within my clinic and in my locality for chronic pain questions/issues Agree	Strongly Agree8) I am confident in my ability to be identified as a "special interest" within my clinic and in my locality for chronic pain questions/issues Strongly Agree	Not Applicable8) I am confident in my ability to be identified as a "special interest" within my clinic and in my locality for chronic pain questions/issues Not Applicable
9) I am confident in my ability to explain the risks and benefits of common interventional pain procedures	Strongly Disagree9) I am confident in my ability to explain the risks and benefits of common interventional pain procedures Strongly Disagree	Disagree9) I am confident in my ability to explain the risks and benefits of common interventional pain procedures Disagree	Somewhat Disagree9) I am confident in my ability to explain the risks and benefits of common interventional pain procedures Somewhat Disagree	Neither Agree nor Disagree9) I am confident in my ability to explain the risks and benefits of common interventional pain procedures Neither Agree nor Disagree	Somewhat Agree9) I am confident in my ability to explain the risks and benefits of common interventional pain procedures Somewhat Agree	Agree9) I am confident in my ability to explain the risks and benefits of common interventional pain procedures Agree	Strongly Agree9) I am confident in my ability to explain the risks and benefits of common interventional pain procedures Strongly Agree	Not Applicable9) I am confident in my ability to explain the risks and benefits of common interventional pain procedures Not Applicable
10) I am confident in my ability to determine whether a patient is appropriate for opioid analgesic treatment	Strongly Disagree10) I am confident in my ability to determine whether a patient is appropriate for opioid analgesic treatment Strongly Disagree	Disagree10) I am confident in my ability to determine whether a patient is appropriate for opioid analgesic treatment Disagree	Somewhat Disagree10) I am confident in my ability to determine whether a patient is appropriate for opioid analgesic treatment Somewhat Disagree	Neither Agree nor Disagree10) I am confident in my ability to determine whether a patient is appropriate for opioid analgesic treatment Neither Agree nor Disagree	Somewhat Agree10) I am confident in my ability to determine whether a patient is appropriate for opioid analgesic treatment Somewhat Agree	Agree10) I am confident in my ability to determine whether a patient is appropriate for opioid analgesic treatment Agree	Strongly Agree10) I am confident in my ability to determine whether a patient is appropriate for opioid analgesic treatment Strongly Agree	Not Applicable10) I am confident in my ability to determine whether a patient is appropriate for opioid analgesic treatment Not Applicable
11) I am confident in my ability to determine if a patient may benefit from cognitive behavioural treatment (psychology or psychiatry)	Strongly Disagree11) I am confident in my ability to determine if a patient may benefit from cognitive behavioural treatment (psychology or psychiatry) Strongly Disagree	Disagree11) I am confident in my ability to determine if a patient may benefit from cognitive behavioural treatment (psychology or psychiatry) Disagree	Somewhat Disagree11) I am confident in my ability to determine if a patient may benefit from cognitive behavioural treatment (psychology or psychiatry) Somewhat Disagree	Neither Agree nor Disagree11) I am confident in my ability to determine if a patient may benefit from cognitive behavioural treatment (psychology or psychiatry) Neither Agree nor Disagree	Somewhat Agree11) I am confident in my ability to determine if a patient may benefit from cognitive behavioural treatment (psychology or psychiatry) Somewhat Agree	Agree11) I am confident in my ability to determine if a patient may benefit from cognitive behavioural treatment (psychology or psychiatry) Agree	Strongly Agree11) I am confident in my ability to determine if a patient may benefit from cognitive behavioural treatment (psychology or psychiatry) Strongly Agree	Not Applicable11) I am confident in my ability to determine if a patient may benefit from cognitive behavioural treatment (psychology or psychiatry) Not Applicable
12) I am confident in my ability to work with patients who suffer from chronic pain	Strongly Disagree12) I am confident in my ability to work with patients who suffer from chronic pain Strongly Disagree	Disagree12) I am confident in my ability to work with patients who suffer from chronic pain Disagree	Somewhat Disagree12) I am confident in my ability to work with patients who suffer from chronic pain Somewhat Disagree	Neither Agree nor Disagree12) I am confident in my ability to work with patients who suffer from chronic pain Neither Agree nor Disagree	Somewhat Agree12) I am confident in my ability to work with patients who suffer from chronic pain Somewhat Agree	Agree12) I am confident in my ability to work with patients who suffer from chronic pain Agree	Strongly Agree12) I am confident in my ability to work with patients who suffer from chronic pain Strongly Agree	Not Applicable12) I am confident in my ability to work with patients who suffer from chronic pain Not Applicable
13) I am confident in my ability to talk with a patient about chronic pain	Strongly Disagree13) I am confident in my ability to talk with a patient about chronic pain Strongly Disagree	Disagree13) I am confident in my ability to talk with a patient about chronic pain Disagree	Somewhat Disagree13) I am confident in my ability to talk with a patient about chronic pain Somewhat Disagree	Neither Agree nor Disagree13) I am confident in my ability to talk with a patient about chronic pain Neither Agree nor Disagree	Somewhat Agree13) I am confident in my ability to talk with a patient about chronic pain Somewhat Agree	Agree13) I am confident in my ability to talk with a patient about chronic pain Agree	Strongly Agree13) I am confident in my ability to talk with a patient about chronic pain Strongly Agree	Not Applicable13) I am confident in my ability to talk with a patient about chronic pain Not Applicable
14) I am confident in my ability to educate other staff members in our clinic about the complexities of issues associated with chronic pain treatment	Strongly Disagree14) I am confident in my ability to educate other staff members in our clinic about the complexities of issues associated with chronic pain treatment Strongly Disagree	Disagree14) I am confident in my ability to educate other staff members in our clinic about the complexities of issues associated with chronic pain treatment Disagree	Somewhat Disagree14) I am confident in my ability to educate other staff members in our clinic about the complexities of issues associated with chronic pain treatment Somewhat Disagree	Neither Agree nor Disagree14) I am confident in my ability to educate other staff members in our clinic about the complexities of issues associated with chronic pain treatment Neither Agree nor Disagree	Somewhat Agree14) I am confident in my ability to educate other staff members in our clinic about the complexities of issues associated with chronic pain treatment Somewhat Agree	Agree14) I am confident in my ability to educate other staff members in our clinic about the complexities of issues associated with chronic pain treatment Agree	Strongly Agree14) I am confident in my ability to educate other staff members in our clinic about the complexities of issues associated with chronic pain treatment Strongly Agree	Not Applicable14) I am confident in my ability to educate other staff members in our clinic about the complexities of issues associated with chronic pain treatment Not Applicable
15) I am confident in my ability to formulate a differential diagnosis for headaches	Strongly Disagree15) I am confident in my ability to formulate a differential diagnosis for headaches Strongly Disagree	Disagree15) I am confident in my ability to formulate a differential diagnosis for headaches Disagree	Somewhat Disagree15) I am confident in my ability to formulate a differential diagnosis for headaches Somewhat Disagree	Neither Agree nor Disagree15) I am confident in my ability to formulate a differential diagnosis for headaches Neither Agree nor Disagree	Somewhat Agree15) I am confident in my ability to formulate a differential diagnosis for headaches Somewhat Agree	Agree15) I am confident in my ability to formulate a differential diagnosis for headaches Agree	Strongly Agree15) I am confident in my ability to formulate a differential diagnosis for headaches Strongly Agree	Not Applicable15) I am confident in my ability to formulate a differential diagnosis for headaches Not Applicable
16) I am confident in my ability to treat chronic pain patients with adjunctive medications	Strongly Disagree16) I am confident in my ability to treat chronic pain patients with adjunctive medications Strongly Disagree	Disagree16) I am confident in my ability to treat chronic pain patients with adjunctive medications Disagree	Somewhat Disagree16) I am confident in my ability to treat chronic pain patients with adjunctive medications Somewhat Disagree	Neither Agree nor Disagree16) I am confident in my ability to treat chronic pain patients with adjunctive medications Neither Agree nor Disagree	Somewhat Agree16) I am confident in my ability to treat chronic pain patients with adjunctive medications Somewhat Agree	Agree16) I am confident in my ability to treat chronic pain patients with adjunctive medications Agree	Strongly Agree16) I am confident in my ability to treat chronic pain patients with adjunctive medications Strongly Agree	Not Applicable16) I am confident in my ability to treat chronic pain patients with adjunctive medications Not Applicable
17) I am confident in my ability to formulate a differential diagnosis for neck pain	Strongly Disagree17) I am confident in my ability to formulate a differential diagnosis for neck pain Strongly Disagree	Disagree17) I am confident in my ability to formulate a differential diagnosis for neck pain Disagree	Somewhat Disagree17) I am confident in my ability to formulate a differential diagnosis for neck pain Somewhat Disagree	Neither Agree nor Disagree17) I am confident in my ability to formulate a differential diagnosis for neck pain Neither Agree nor Disagree	Somewhat Agree17) I am confident in my ability to formulate a differential diagnosis for neck pain Somewhat Agree	Agree17) I am confident in my ability to formulate a differential diagnosis for neck pain Agree	Strongly Agree17) I am confident in my ability to formulate a differential diagnosis for neck pain Strongly Agree	Not Applicable17) I am confident in my ability to formulate a differential diagnosis for neck pain Not Applicable
18) I am confident in my ability to formulate a differential diagnosis for low back pain	Strongly Disagree18) I am confident in my ability to formulate a differential diagnosis for low back pain Strongly Disagree	Disagree18) I am confident in my ability to formulate a differential diagnosis for low back pain Disagree	Somewhat Disagree18) I am confident in my ability to formulate a differential diagnosis for low back pain Somewhat Disagree	Neither Agree nor Disagree18) I am confident in my ability to formulate a differential diagnosis for low back pain Neither Agree nor Disagree	Somewhat Agree18) I am confident in my ability to formulate a differential diagnosis for low back pain Somewhat Agree	Agree18) I am confident in my ability to formulate a differential diagnosis for low back pain Agree	Strongly Agree18) I am confident in my ability to formulate a differential diagnosis for low back pain Strongly Agree	Not Applicable18) I am confident in my ability to formulate a differential diagnosis for low back pain Not Applicable
19) I am confident in my ability to communicate effectively with patients and community members about chronic pain	Strongly Disagree19) I am confident in my ability to communicate effectively with patients and community members about chronic pain Strongly Disagree	Disagree19) I am confident in my ability to communicate effectively with patients and community members about chronic pain Disagree	Somewhat Disagree19) I am confident in my ability to communicate effectively with patients and community members about chronic pain Somewhat Disagree	Neither Agree nor Disagree19) I am confident in my ability to communicate effectively with patients and community members about chronic pain Neither Agree nor Disagree	Somewhat Agree19) I am confident in my ability to communicate effectively with patients and community members about chronic pain Somewhat Agree	Agree19) I am confident in my ability to communicate effectively with patients and community members about chronic pain Agree	Strongly Agree19) I am confident in my ability to communicate effectively with patients and community members about chronic pain Strongly Agree	Not Applicable19) I am confident in my ability to communicate effectively with patients and community members about chronic pain Not Applicable

Section 2) Attitudes and behaviours about chronic pain *

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
1. When I see consistently high scores on pain rating scales in the face of minimal or moderate pathology, this means that the patient is exaggerating his/her pain	Strongly Disagree1. When I see consistently high scores on pain rating scales in the face of minimal or moderate pathology, this means that the patient is exaggerating his/her pain Strongly Disagree	Disagree1. When I see consistently high scores on pain rating scales in the face of minimal or moderate pathology, this means that the patient is exaggerating his/her pain Disagree	Neutral1. When I see consistently high scores on pain rating scales in the face of minimal or moderate pathology, this means that the patient is exaggerating his/her pain Neutral	Agree1. When I see consistently high scores on pain rating scales in the face of minimal or moderate pathology, this means that the patient is exaggerating his/her pain Agree	Strongly Agree1. When I see consistently high scores on pain rating scales in the face of minimal or moderate pathology, this means that the patient is exaggerating his/her pain Strongly Agree
2. In chronic pain, the assessment should include measurement of the pain intensity, emotional distress, and functional status	Strongly Disagree2. In chronic pain, the assessment should include measurement of the pain intensity, emotional distress, and functional status Strongly Disagree	Disagree2. In chronic pain, the assessment should include measurement of the pain intensity, emotional distress, and functional status Disagree	Neutral2. In chronic pain, the assessment should include measurement of the pain intensity, emotional distress, and functional status Neutral	Agree2. In chronic pain, the assessment should include measurement of the pain intensity, emotional distress, and functional status Agree	Strongly Agree2. In chronic pain, the assessment should include measurement of the pain intensity, emotional distress, and functional status Strongly Agree
3. Early return to activities is one of my primary goals when treating a patient with recent onset back pain	Strongly Disagree3. Early return to activities is one of my primary goals when treating a patient with recent onset back pain Strongly Disagree	Disagree3. Early return to activities is one of my primary goals when treating a patient with recent onset back pain Disagree	Neutral3. Early return to activities is one of my primary goals when treating a patient with recent onset back pain Neutral	Agree3. Early return to activities is one of my primary goals when treating a patient with recent onset back pain Agree	Strongly Agree3. Early return to activities is one of my primary goals when treating a patient with recent onset back pain Strongly Agree
4. There is good evidence that psychosocial factors predict outcomes from back surgery better than the patient’s physical characteristics	Strongly Disagree4. There is good evidence that psychosocial factors predict outcomes from back surgery better than the patient’s physical characteristics Strongly Disagree	Disagree4. There is good evidence that psychosocial factors predict outcomes from back surgery better than the patient’s physical characteristics Disagree	Neutral4. There is good evidence that psychosocial factors predict outcomes from back surgery better than the patient’s physical characteristics Neutral	Agree4. There is good evidence that psychosocial factors predict outcomes from back surgery better than the patient’s physical characteristics Agree	Strongly Agree4. There is good evidence that psychosocial factors predict outcomes from back surgery better than the patient’s physical characteristics Strongly Agree
5. Antidepressants usually do not improve symptoms and function in chronic pain patients	Strongly Disagree5. Antidepressants usually do not improve symptoms and function in chronic pain patients Strongly Disagree	Disagree5. Antidepressants usually do not improve symptoms and function in chronic pain patients Disagree	Neutral5. Antidepressants usually do not improve symptoms and function in chronic pain patients Neutral	Agree5. Antidepressants usually do not improve symptoms and function in chronic pain patients Agree	Strongly Agree5. Antidepressants usually do not improve symptoms and function in chronic pain patients Strongly Agree
6. Cognitive behavioral therapy is very effective in chronic pain management and should be applied as early as possible in the treatment plan for most chronic pain patients	Strongly Disagree6. Cognitive behavioral therapy is very effective in chronic pain management and should be applied as early as possible in the treatment plan for most chronic pain patients Strongly Disagree	Disagree6. Cognitive behavioral therapy is very effective in chronic pain management and should be applied as early as possible in the treatment plan for most chronic pain patients Disagree	Neutral6. Cognitive behavioral therapy is very effective in chronic pain management and should be applied as early as possible in the treatment plan for most chronic pain patients Neutral	Agree6. Cognitive behavioral therapy is very effective in chronic pain management and should be applied as early as possible in the treatment plan for most chronic pain patients Agree	Strongly Agree6. Cognitive behavioral therapy is very effective in chronic pain management and should be applied as early as possible in the treatment plan for most chronic pain patients Strongly Agree
7. I feel comfortable calculating conversion doses of commonly used opioids	Strongly Disagree7. I feel comfortable calculating conversion doses of commonly used opioids Strongly Disagree	Disagree7. I feel comfortable calculating conversion doses of commonly used opioids Disagree	Neutral7. I feel comfortable calculating conversion doses of commonly used opioids Neutral	Agree7. I feel comfortable calculating conversion doses of commonly used opioids Agree	Strongly Agree7. I feel comfortable calculating conversion doses of commonly used opioids Strongly Agree
8. Long-term use of NSAIDs in the management of chronic pain has higher risk for tissue damage, morbidity, and mortality than long-term use of opioids	Strongly Disagree8. Long-term use of NSAIDs in the management of chronic pain has higher risk for tissue damage, morbidity, and mortality than long-term use of opioids Strongly Disagree	Disagree8. Long-term use of NSAIDs in the management of chronic pain has higher risk for tissue damage, morbidity, and mortality than long-term use of opioids Disagree	Neutral8. Long-term use of NSAIDs in the management of chronic pain has higher risk for tissue damage, morbidity, and mortality than long-term use of opioids Neutral	Agree8. Long-term use of NSAIDs in the management of chronic pain has higher risk for tissue damage, morbidity, and mortality than long-term use of opioids Agree	Strongly Agree8. Long-term use of NSAIDs in the management of chronic pain has higher risk for tissue damage, morbidity, and mortality than long-term use of opioids Strongly Agree
9. There is good medical evidence that interdisciplinary treatment of back pain is effective in reducing disability, pain levels, and in returning patients to work	Strongly Disagree9. There is good medical evidence that interdisciplinary treatment of back pain is effective in reducing disability, pain levels, and in returning patients to work Strongly Disagree	Disagree9. There is good medical evidence that interdisciplinary treatment of back pain is effective in reducing disability, pain levels, and in returning patients to work Disagree	Neutral9. There is good medical evidence that interdisciplinary treatment of back pain is effective in reducing disability, pain levels, and in returning patients to work Neutral	Agree9. There is good medical evidence that interdisciplinary treatment of back pain is effective in reducing disability, pain levels, and in returning patients to work Agree	Strongly Agree9. There is good medical evidence that interdisciplinary treatment of back pain is effective in reducing disability, pain levels, and in returning patients to work Strongly Agree
10. I believe that chronic pain of unknown cause should not be treated with opioids even if this is the only way to obtain pain relief	Strongly Disagree10. I believe that chronic pain of unknown cause should not be treated with opioids even if this is the only way to obtain pain relief Strongly Disagree	Disagree10. I believe that chronic pain of unknown cause should not be treated with opioids even if this is the only way to obtain pain relief Disagree	Neutral10. I believe that chronic pain of unknown cause should not be treated with opioids even if this is the only way to obtain pain relief Neutral	Agree10. I believe that chronic pain of unknown cause should not be treated with opioids even if this is the only way to obtain pain relief Agree	Strongly Agree10. I believe that chronic pain of unknown cause should not be treated with opioids even if this is the only way to obtain pain relief Strongly Agree
11. Under Canadian federal regulations, it is not lawful to prescribe an opioid to treat pain in a patient with a diagnosed substance use disorder	Strongly Disagree11. Under Canadian federal regulations, it is not lawful to prescribe an opioid to treat pain in a patient with a diagnosed substance use disorder Strongly Disagree	Disagree11. Under Canadian federal regulations, it is not lawful to prescribe an opioid to treat pain in a patient with a diagnosed substance use disorder Disagree	Neutral11. Under Canadian federal regulations, it is not lawful to prescribe an opioid to treat pain in a patient with a diagnosed substance use disorder Neutral	Agree11. Under Canadian federal regulations, it is not lawful to prescribe an opioid to treat pain in a patient with a diagnosed substance use disorder Agree	Strongly Agree11. Under Canadian federal regulations, it is not lawful to prescribe an opioid to treat pain in a patient with a diagnosed substance use disorder Strongly Agree
12. I know how to obtain information about both provincial and federal requirements for prescribing opioids	Strongly Disagree12. I know how to obtain information about both provincial and federal requirements for prescribing opioids Strongly Disagree	Disagree12. I know how to obtain information about both provincial and federal requirements for prescribing opioids Disagree	Neutral12. I know how to obtain information about both provincial and federal requirements for prescribing opioids Neutral	Agree12. I know how to obtain information about both provincial and federal requirements for prescribing opioids Agree	Strongly Agree12. I know how to obtain information about both provincial and federal requirements for prescribing opioids Strongly Agree

From the validated KnowPain-12 Questionnaire:
Gordon DB, Loeser JD, Tauben D, Rue T, Stogicza A, Doorenbos A. Development of the KnowPain-12 Pain Management Knowledge Survey. Clin J Pain. Oct 16.2013

A 57-year-old female presents with whole body muscle and joint pain. She was an athletic gymnast through her teens, despite recurrent shoulder and knee dislocations. She also complains of endometriosis, temporomandibular joint dysfunction, and gastroesophageal reflux. On sensory exam, there is pain to light touch in her upper, mid-, and lower back. Which one of the following is the most likely primary diagnosis? *

a) Fibromyalgia
b) Hypothyroidism
c) Osteoarthritis
d) Myofascial pain syndrome

A 45-year-old male presents for assistance with his “sciatica”. It began 15 years ago and radiated down his right leg, but is now focused to his lower back area, with no radiation, and “is only better if I never move…” so he doesn’t. Which one of the following medications is the most appropriate for this patient’s chronic mechanical low back pain? *

a) Baclofen
b) Acetaminophen
c) Nabilone
d) Duloxetine

A 43-year-old male twisted his left ankle playing basketball. Four weeks later, he continued having excruciating pain on the whole left foot with swelling, redness, and extreme tenderness to light touch. Which one of the following is the most likely explanation for his pain? *

a) Gout
b) Complex Regional Pain Syndrome
c) Plantar fasciitis
d) Deep vein thrombosis

Along with Psychological, what are the other two Ps of chronic pain management? (Select 2) *

a) Pathophysiological
b) Pharmacological
c) Physical
d) Prevention
e) Prolotherapy

A 68-year-old woman has headaches, neuropathic pain, anxiety, and sleep disorder. She currently uses sumatriptan for her migraines, escitalopram and buspirone to manage her mood, and trazodone to improve her sleep. She has optimized her non-pharmacological strategies but her pain is still limiting her function. The clinician would like to start a medication for her chronic pain. Which one of the following medications is a good option for her as add-on therapy? *

a) Duloxetine
b) Nortriptyline
c) Pregabalin
d) Venlafaxine

A 64-year-old man has chronic low back pain and diabetic neuropathic pain. He has a private drug plan and has been on oxycodone with acetaminophen for 15 years. His medical history includes insomnia, diabetes, benign prosthetic hypertrophy, renal dysfunction, and hypertension. The combination oxycodone with acetaminophen is no longer providing him with functional benefit or pain relief. Which one of the following is an appropriate medication he could try instead of the oxycodone with acetaminophen? *

a) Amitriptyline
b) Naproxen
c) Codeine
d) Buprenorphine patch

A 70-year-old male complains of a 2-year gradual onset of right buttock and radiating leg pain, numbness, and weakness. The symptoms are worse when standing and walking. After walking for 10 -15 min he needs to sit down and feels immediately better. Physical examination revealed full lumbar flexion and negative straight leg raising with mild weakness of the dorsiflexors of the right foot. Which one of the following is the most likely diagnosis? *

a) Neurogenic claudication
b) Lumbar disc herniation
c) Facet syndrome
d) Degenerative back pain

A 50-year-old female was involved in a car collision and injured her back 2 years ago. A lumbar MRI was negative at that time. She has been off work for over 1 year but her goal is to return to work. She has gained weight, and now suffers from headaches, depression, and insomnia. She stopped exercising 6 months ago because of the pain and is afraid to start again. Medication no longer seems to help. Which one of the following is the best management plan to recommend to her? *

a) Increase the dose of the pain medication
b) Address pain avoidance behaviours
c) Start a weight loss program
d) Repeat the MRI of the lumbar spine

A 39-year-old male is overwhelmed as he is waking up with severe, headache, neck, and low back pain. The pain is most intense when he wakes up in the morning. Sleep medications help him to fall asleep but have had no impact on his waking pain. Which one of the following is the BEST NEXT step? *

a) Provide him with education about sleep hygiene
b) Refer him back to the family doctor to order a sleep study
c) Recommend he use pillows to support his posture during sleep
d) Recommend he change his sleeping aid medication

A 60-year-old female is experiencing significant chronic shoulder and elbow pain. It has worsened with the pandemic and social distancing restrictions. She works for a tech company and now works long hours from home. Which one of the following should be advised FIRST to alleviate her pain? *

a) Refer to a Registered Massage Therapist
b) Home workplace ergonomics assessment
c) Re-assess pain medications
d) Advise her to buy a shoulder brace

A 42-year-old female, otherwise healthy, works from home full-time and is currently breastfeeding her 15-month old child. She has had pain according to the pattern in the diagram for the past six months. Which one of the following is the most likely diagnosis? *

a) C7 Radiculopathy
b) Rotator cuff tear
c) Rhomboids and scalenes myofascial trigger points
d) Fibromyalgia

Is the following statement true or false, regarding patients with chronic pain? A screening for psychological risk factors and psychiatric comorbidities is indicated only in high risk groups of patients such as those with a history of past or current psychiatric illness. *

True
False

A patient with chronic pain has a positive screen for depression. Which one of the following is the most appropriate next step? *

a. Start an antidepressant that also has analgesic effects and refer to psychiatry
b. Start an antidepressant that also has analgesic effects and refer for CBT for depression
c. Do a thorough evaluation of mood and safety assessment
d. Discuss the positive screen with the patient and send them to the emergency department

A 35-year-old male says that he is convinced that his back pain is from a slipped disc and that he needs back surgery. The clinician has completed a full history and physical exam and does not see a surgical indication. Which one of the following should the clinician do next? *

a) Refer to a back surgeon so that the patient can hear from them that he doesn’t need surgery
b) Refer the patient to a physiotherapist for back pain education and exercises
c) Explain to the patient that many patients with the exact same problems that get better without surgery
d) Learn more about why he feels that he needs surgery

A patient with chronic pain is taking 40mg oral (PO) oxycodone long-acting q.12.h. The physician will switch this patient to hydromorphone oral long-acting. Which one of the following is the most appropriate first prescription of hydromorphone? *

a) Hydromorphone 3 mg PO q.12.h
b) Hydromorphone 6 mg PO q.12.h
c) Hydromorphone 12 mg PO q.12.h
d) Hydromorphone 24 mg PO q.12.h

A 39-year-old female has fibromyalgia and depression. She has been on opioids, benzodiazepines, smoking THC, and using CBD oils. She comes to a physiotherapy session and falls asleep in the middle of the exercise. The physiotherapist tries to wake her but she is breathing very slowly and unable to wake up. Which one of the following is the BEST next step? *

a) Let her take a nap for a few minutes
b) Check if she has naloxone kit and administer to her
c) Use the on-site defibrillator (AED)
d) Call her doctor and obtain more information

Which one of the following statements describes the use of the term pseudo-addiction in the differential diagnosis? *

a) It is a term currently accepted as part of a differential diagnosis for problematic opioid use
b) It is a term currently accepted in the differential diagnosis of opioid-induced hyperalgesia
c) It is a term previously accepted as part of a differential diagnosis for problematic opioid use
d) It is a term previously accepted as part of a differential diagnosis for opioid- induced hyperalgesia

Which one of the following is the current situation related to approval and use of sublingual buprenorphine/naloxone in Canada? *

a) It is not approved
b) It is approved for the treatment of moderate-to-severe chronic non-cancer pain
c) It is approved for the treatment of moderate-to-severe chronic non-cancer pain and for substitution treatment in adults with problematic opioid drug dependence
d) It is approved for substitution treatment in adults with problematic opioid drug dependence

A 52-year-old female patient with neck pain has been prescribed short-acting oxycodone with acetaminophen for the past 3 years. In the past year she was involved in two motor vehicle accidents, as the driver, because she was too drowsy. Whenever she tries to cut down the oxycodone, the neck pain gets worse and she has diarrhea. Occasionally, when she is having a stressful experience, she will have cravings for the oxycocet. As per DSM-V, which one of the following describes her situation with respect to the criteria for opioid use disorder? *

a) She fits the criteria of mild opioid use disorder
b) She fits the criteria of moderate opioid use disorder
c) She fits the criteria of severe opioid use disorder
d) She does not fit the criteria of opioid use disorder

A patient diagnosed with opioid use disorder is on a stable dose of 24mg sublingual buprenorphine/naloxone daily. She has undergone a dental extraction. Which one of the following is the most appropriate management of the post-procedure dental pain? *

a) Add another 4 mg of sublingual buprenorphine/naloxone
b) Add 5 mg short-acting oxycodone as needed, up to 3 tablets per day q8h up to 7 days
c) Add ice application several times a day for 10-15 min and ibuprofen
d) Order a urine drug screen before prescribing any opioid medications

Before Starting Opioid Therapy, in what percentage of your patients with Chronic Non-Cancer Pain do you do the following?: *

	Never	Less than 25%	25-75%	More than 75%	Always
Explain potential harms of long-term opioid therapy	NeverExplain potential harms of long-term opioid therapy Never	Less than 25%Explain potential harms of long-term opioid therapy Less than 25%	25-75%Explain potential harms of long-term opioid therapy 25-75%	More than 75%Explain potential harms of long-term opioid therapy More than 75%	AlwaysExplain potential harms of long-term opioid therapy Always
Be sure to prescribe a dose less than 50mg morphine equivalents daily	NeverBe sure to prescribe a dose less than 50mg morphine equivalents daily Never	Less than 25%Be sure to prescribe a dose less than 50mg morphine equivalents daily Less than 25%	25-75%Be sure to prescribe a dose less than 50mg morphine equivalents daily 25-75%	More than 75%Be sure to prescribe a dose less than 50mg morphine equivalents daily More than 75%	AlwaysBe sure to prescribe a dose less than 50mg morphine equivalents daily Always
Assess for past/current substance use disorders as well as active psychiatric disorders	NeverAssess for past/current substance use disorders as well as active psychiatric disorders Never	Less than 25%Assess for past/current substance use disorders as well as active psychiatric disorders Less than 25%	25-75%Assess for past/current substance use disorders as well as active psychiatric disorders 25-75%	More than 75%Assess for past/current substance use disorders as well as active psychiatric disorders More than 75%	AlwaysAssess for past/current substance use disorders as well as active psychiatric disorders Always
Assess patient’s level of function (eg. social, recreational, occupational)	NeverAssess patient’s level of function (eg. social, recreational, occupational) Never	Less than 25%Assess patient’s level of function (eg. social, recreational, occupational) Less than 25%	25-75%Assess patient’s level of function (eg. social, recreational, occupational) 25-75%	More than 75%Assess patient’s level of function (eg. social, recreational, occupational) More than 75%	AlwaysAssess patient’s level of function (eg. social, recreational, occupational) Always
Explain potential benefits of long-term opioid therapy	NeverExplain potential benefits of long-term opioid therapy Never	Less than 25%Explain potential benefits of long-term opioid therapy Less than 25%	25-75%Explain potential benefits of long-term opioid therapy 25-75%	More than 75%Explain potential benefits of long-term opioid therapy More than 75%	AlwaysExplain potential benefits of long-term opioid therapy Always
Confirm that the patient has a condition that has been shown to benefit from opioids	NeverConfirm that the patient has a condition that has been shown to benefit from opioids Never	Less than 25%Confirm that the patient has a condition that has been shown to benefit from opioids Less than 25%	25-75%Confirm that the patient has a condition that has been shown to benefit from opioids 25-75%	More than 75%Confirm that the patient has a condition that has been shown to benefit from opioids More than 75%	AlwaysConfirm that the patient has a condition that has been shown to benefit from opioids Always
Have patient sign a treatment agreement	NeverHave patient sign a treatment agreement Never	Less than 25%Have patient sign a treatment agreement Less than 25%	25-75%Have patient sign a treatment agreement 25-75%	More than 75%Have patient sign a treatment agreement More than 75%	AlwaysHave patient sign a treatment agreement Always
Assess patient’s level of pain intensity using a scale	NeverAssess patient’s level of pain intensity using a scale Never	Less than 25%Assess patient’s level of pain intensity using a scale Less than 25%	25-75%Assess patient’s level of pain intensity using a scale 25-75%	More than 75%Assess patient’s level of pain intensity using a scale More than 75%	AlwaysAssess patient’s level of pain intensity using a scale Always
If patient is on benzodiazepine, try to taper them off	NeverIf patient is on benzodiazepine, try to taper them off Never	Less than 25%If patient is on benzodiazepine, try to taper them off Less than 25%	25-75%If patient is on benzodiazepine, try to taper them off 25-75%	More than 75%If patient is on benzodiazepine, try to taper them off More than 75%	AlwaysIf patient is on benzodiazepine, try to taper them off Always
Assess risk of addiction using screening tool	NeverAssess risk of addiction using screening tool Never	Less than 25%Assess risk of addiction using screening tool Less than 25%	25-75%Assess risk of addiction using screening tool 25-75%	More than 75%Assess risk of addiction using screening tool More than 75%	AlwaysAssess risk of addiction using screening tool Always
Perform urine drug screening	NeverPerform urine drug screening Never	Less than 25%Perform urine drug screening Less than 25%	25-75%Perform urine drug screening 25-75%	More than 75%Perform urine drug screening More than 75%	AlwaysPerform urine drug screening Always
Give the patient written information about opioid therapy	NeverGive the patient written information about opioid therapy Never	Less than 25%Give the patient written information about opioid therapy Less than 25%	25-75%Give the patient written information about opioid therapy 25-75%	More than 75%Give the patient written information about opioid therapy More than 75%	AlwaysGive the patient written information about opioid therapy Always
Refer to colleague for assessment	NeverRefer to colleague for assessment Never	Less than 25%Refer to colleague for assessment Less than 25%	25-75%Refer to colleague for assessment 25-75%	More than 75%Refer to colleague for assessment More than 75%	AlwaysRefer to colleague for assessment Always
Conduct formal psychological screening	NeverConduct formal psychological screening Never	Less than 25%Conduct formal psychological screening Less than 25%	25-75%Conduct formal psychological screening 25-75%	More than 75%Conduct formal psychological screening More than 75%	AlwaysConduct formal psychological screening Always