DPT DPT Pharmacology & Pain Management 2 — Questions and Answers
Question 1: Gabapentin is frequently prescribed for neuropathic pain. What is its primary mechanism of action?
- Binds to voltage-gated calcium channels reducing excitatory neurotransmitter release (Correct answer)
- Blocks sodium channels in peripheral nerves
- Inhibits COX-2 enzymes
- Activates mu-opioid receptors
Correct answer: Binds to voltage-gated calcium channels reducing excitatory neurotransmitter release
Gabapentin binds to the alpha-2-delta subunit of voltage-gated calcium channels, reducing release of excitatory neurotransmitters in the dorsal horn.
Question 2: A patient using topical diclofenac gel reports decreased pain at the knee. What is the primary advantage of topical over oral NSAIDs?
- Reduced systemic GI and renal side effects (Correct answer)
- Faster onset of action
- Greater anti-inflammatory potency
- Longer duration of effect
Correct answer: Reduced systemic GI and renal side effects
Topical NSAIDs achieve local tissue concentrations with minimal systemic absorption, greatly reducing GI and renal adverse effects.
Question 3: Which measurement tool best captures a patient's self-reported pain intensity in a standardized, reproducible way during PT reassessment?
- Numeric Pain Rating Scale (NPRS) (Correct answer)
- McGill Pain Questionnaire
- Brief Pain Inventory
- Visual Analog Scale drawn on paper
Correct answer: Numeric Pain Rating Scale (NPRS)
The NPRS (0–10) is widely validated, quick to administer, and sensitive to change for tracking pain intensity across PT sessions.
Question 4: Serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine are used for chronic musculoskeletal pain primarily because they:
- Modulate descending pain inhibitory pathways (Correct answer)
- Reduce peripheral inflammation
- Block spinal NMDA receptors
- Inhibit prostaglandin synthesis
Correct answer: Modulate descending pain inhibitory pathways
SNRIs enhance descending noradrenergic and serotonergic inhibition of pain transmission from the brainstem to the spinal dorsal horn.
Question 5: A patient taking bisphosphonates for osteoporosis is beginning a resistance exercise program. What is the most important precaution?
- Screen for atypical femoral fractures before high-impact loading (Correct answer)
- Avoid all weight-bearing exercise
- Use only aquatic therapy
- Limit sessions to 10 minutes
Correct answer: Screen for atypical femoral fractures before high-impact loading
Long-term bisphosphonate use is associated with atypical femoral fractures, requiring screening before initiating high-impact or resistance loading.
Question 6: In multimodal pain management, the primary role of the physical therapist is to:
- Address physical impairments and functional limitations to reduce pain drivers (Correct answer)
- Adjust medication dosages based on pain scores
- Prescribe pharmacological agents
- Replace pharmacological management with exercise alone
Correct answer: Address physical impairments and functional limitations to reduce pain drivers
PTs address the biomechanical, neuromuscular, and psychological contributors to pain through active and passive interventions within their scope of practice.
DPT DPT Pharmacology & Pain Management 2
Gabapentin is frequently prescribed for neuropathic pain.
What is its primary mechanism of action?