Back Pain Back Pain Medications and Therapies 1 — Questions and Answers
Question 1: Which NSAID is most commonly recommended for back pain due to its favorable GI safety profile when used with a proton pump inhibitor?
- Aspirin
- Indomethacin
- Celecoxib (COX-2 inhibitor) (Correct answer)
- Ketorolac
Correct answer: Celecoxib (COX-2 inhibitor)
Celecoxib selectively inhibits COX-2 with less GI mucosal damage than non-selective NSAIDs, making it preferable for patients at GI risk.
Question 2: Cyclobenzaprine, used as a muscle relaxant for back spasm, acts primarily on which structure?
- Peripheral neuromuscular junction
- Spinal cord interneurons and brainstem (Correct answer)
- Muscle fibers directly
- Dopamine receptors
Correct answer: Spinal cord interneurons and brainstem
Cyclobenzaprine acts centrally on the brainstem and spinal cord to reduce tonic somatic motor activity, relieving muscle spasm.
Question 3: Which opioid analgesic property is most relevant to its risk of causing physical dependence in back pain patients?
- Half-life duration
- Mu-receptor binding and tolerance development (Correct answer)
- Route of administration
- Protein binding percentage
Correct answer: Mu-receptor binding and tolerance development
Opioid binding to mu-receptors leads to neuroadaptation and tolerance, resulting in physical dependence with regular use.
Question 4: Duloxetine (Cymbalta) is FDA-approved for chronic low back pain and works by which mechanism?
- Blocking COX-1 and COX-2 enzymes
- Inhibiting serotonin and norepinephrine reuptake (SNRI) (Correct answer)
- Binding GABA receptors
- Blocking sodium channels
Correct answer: Inhibiting serotonin and norepinephrine reuptake (SNRI)
Duloxetine is an SNRI that enhances descending inhibitory pain pathways via norepinephrine and serotonin, reducing central sensitization in chronic pain.
Question 5: What is the primary risk of long-term systemic corticosteroid use for back pain management?
- Renal failure only
- Osteoporosis, adrenal suppression, and hyperglycemia (Correct answer)
- Hearing loss
- Peripheral neuropathy
Correct answer: Osteoporosis, adrenal suppression, and hyperglycemia
Long-term systemic steroids cause significant side effects including osteoporosis (worsening spinal health), adrenal suppression, and metabolic effects like hyperglycemia.
Question 6: Acupuncture for chronic low back pain is thought to work partly through release of which endogenous substances?
- Prostaglandins
- Endorphins and enkephalins (Correct answer)
- Substance P only
- Cortisol
Correct answer: Endorphins and enkephalins
Acupuncture stimulates release of endogenous opioids (endorphins, enkephalins) and serotonin, modulating pain perception through central and peripheral mechanisms.
Back Pain Back Pain Medications and Therapies 1
Which NSAID is most commonly recommended for back pain due to its favorable GI safety profile when used with a proton pump inhibitor?