National Physical Therapy Examination (NPTE) Quiz: Pain Characteristics Evaluation

A 28-year-old male with a new diagnosis of ankylosing spondylitis reports significant low back and buttock pain. He notes that his pain and stiffness are most severe upon waking in the morning, lasting for about 90 minutes. He finds that his symptoms are consistently eased by taking a hot shower and performing gentle exercises, and they tend to worsen with prolonged periods of rest.

Based on these classic characteristics of inflammatory back pain, what is the MOST accurate prognostic judgment regarding his response to physical therapy?

A patient with a 2-year history of patellofemoral pain syndrome describes their pain using words like "agonizing," "torturing," and "uncontrollable." They express a belief that the pain signifies ongoing damage to their knee and that they will inevitably end up in a wheelchair. They have ceased all recreational activities and report feeling hopeless.

According to the cognitive-affective dimensions of pain, these characteristics have what primary prognostic implication?

A 45-year-old patient with a 10-year history of low back pain describes their pain as widespread, migrating, and inconsistent. The physical examination reveals non-anatomic tenderness to light touch and pain provocation with tests that should not be painful, such as axial loading. The reported pain intensity seems disproportionate to the objective findings. Which of the following is the MOST likely primary pain mechanism?

A patient is being treated for a subacute whiplash-associated disorder. As part of the initial assessment, the patient completes several questionnaires. The results indicate a high score on the Pain Catastrophizing Scale (PCS).

This finding is MOST predictive of which of the following clinical outcomes?

A 62-year-old patient with a long-standing history of type 2 diabetes mellitus is referred for physical therapy due to bilateral foot pain that disrupts sleep. Which of the following pain descriptions would MOST strongly suggest a neuropathic origin?

A 58-year-old patient reports a 2-week history of left shoulder pain that began without injury. The physical therapist's examination reveals full and pain-free active and passive range of motion of the glenohumeral joint, and all special tests for the shoulder are negative. The patient notes the pain can occur at rest, is worse when lying flat, and is sometimes accompanied by a feeling of shortness of breath. The patient's presentation MOST warrants an immediate referral to rule out pathology in which system?

A patient with chronic Achilles tendinopathy performs a set of eccentric heel drops. Immediately after the exercise, the pain decreases from a 5/10 to a 3/10 on the Numeric Pain Rating Scale (NPRS). However, the next morning, the patient reports the pain is an 8/10 and it took two days to return to baseline. How should the therapist BEST interpret this pain response?

A patient presents 6 weeks after a distal radius fracture, for which they were casted. They now report severe, constant, burning pain in the entire hand, which is far greater than expected for this stage of healing. The examination reveals pitting edema, a shiny and taut appearance of the skin, and extreme sensitivity to light touch over the hand. These pain characteristics and objective findings are MOST consistent with a diagnosis of:

A physical therapist needs to assess for hip pain in a 78-year-old, non-verbal patient with severe dementia during a supine-to-sit transfer. Which of the following observations would be the MOST reliable and specific indicator of pain in this patient?

An older adult patient reports bilateral buttock and posterior thigh pain that begins after walking approximately 5 minutes. The patient notes that the pain is significantly relieved by sitting down or by leaning forward on a shopping cart while walking. Stopping and standing upright does not relieve the symptoms. These pain characteristics are MOST consistent with:

During an examination of a patient with right shoulder pain, the therapist applies firm pressure over the supraspinatus tendon, which the patient rates as 8/10 pain. The therapist then applies the same pressure to the contralateral, asymptomatic supraspinatus tendon, and the patient rates it as a 4/10 pain. Finally, light pressure on the skin over the tibialis anterior also elicits a 2/10 pain report. This constellation of findings is MOST indicative of:

A patient is evaluated 4 days after a motor vehicle accident with a diagnosis of whiplash-associated disorder (WAD). The initial examination reveals a Numeric Pain Rating Scale (NPRS) score of 8/10, severe limitations in cervical range of motion due to pain, and a high score on the Tampa Scale of Kinesiophobia (TSK). According to clinical practice guidelines for WAD, these initial findings suggest the patient has:

A 55-year-old patient reports bilateral knee pain. The patient states that the pain and stiffness are most severe upon waking and last for about 90 minutes. The symptoms improve with gentle activity but worsen significantly by the end of the day. The patient also reports intermittent episodes of warmth and swelling in both knees without a specific injury. This constellation of symptoms is MOST characteristic of which type of pain?

A patient reports the insidious onset of mid-thoracic back pain that is described as a deep, gnawing ache. The physical therapist notes that the pain is constant, is not altered by changes in posture or movement, and is reportedly worse approximately 1-2 hours after eating. Which of the following pain origins is MOST likely?

A physical therapist examines a patient with right-sided low back pain that radiates into the posterior thigh and calf. The straight leg raise test at 40 degrees reproduces this leg pain. The pain is described as a narrow, shooting band. A neurological screen reveals 5/5 strength in all myotomes, intact sensation to light touch, and 2+ reflexes. What is the MOST precise classification for this patient's leg symptoms?

A patient completing the McGill Pain Questionnaire (MPQ) to describe their chronic leg pain selects the words "throbbing," "pounding," and "pulsing" from the list of descriptors. These words are part of the sensory-discriminative component and are PRIMARILY associated with which class of pain?

During an examination of a patient with a diagnosis of fibromyalgia, the physical therapist notes that the patient reports severe pain in response to a light pinprick (hyperalgesia) and also reports pain when the therapist lightly strokes the skin with a cotton ball (allodynia). These sensory findings are MOST indicative of which underlying pain mechanism?

A patient with acute low back pain of 3 weeks duration has localized, mechanical symptoms that are eased with rest. Another patient has chronic low back pain of 3 years duration, with widespread, non-specific symptoms, poor sleep quality, and a high score on the Fear-Avoidance Beliefs Questionnaire (FABQ).

When evaluating the prognosis for significant improvement with standard physical therapy, which statement is MOST accurate?

A therapist wants to use a brief, self-report questionnaire to screen a new patient with chronic low back pain for multiple psychosocial risk factors (yellow flags) that may predict long-term disability and work loss. Which of the following tools is BEST suited for this purpose?

A patient who underwent a right transtibial amputation 4 months ago due to trauma is now in physical therapy for prosthetic training. The patient reports frequent, distressing episodes of a twisting and burning pain that feels as if it is located in the absent foot. Which pain mechanism is PRIMARILY responsible for these symptoms?