Pain Management in Neurology Flashcards

A patient with trigeminal neuralgia fails carbamazepine. Which second-line medication is most appropriate?

Answer: Oxcarbazepine

Oxcarbazepine has similar sodium channel blocking efficacy to carbamazepine with a more favorable side-effect profile, making it the preferred second-line agent.

Which quantitative sensory testing (QST) finding is most characteristic of small-fiber neuropathy causing neuropathic pain?

Answer: Elevated cold detection threshold and impaired heat pain threshold

Small-fiber neuropathy impairs Aδ and C fibers, elevating cold detection thresholds and altering heat pain thresholds on QST.

A 55-year-old develops post-herpetic neuralgia. Which topical agent is FDA-approved as first-line for localized neuropathic pain?

Answer: Lidocaine 5% patch

The lidocaine 5% patch is FDA-approved for post-herpetic neuralgia and provides targeted sodium channel blockade with minimal systemic absorption.

The pain of central post-stroke syndrome (CPSP) most commonly follows infarction involving which brain region?

Answer: Thalamus (especially VPL nucleus)

Thalamic infarction, particularly of the ventroposterolateral nucleus, is the most common lesion site in CPSP due to disruption of spinothalamic input processing.

Which intervention is considered when spinal cord stimulation (SCS) is indicated for failed back surgery syndrome?

Answer: Electrode placement covering the thoracic cord at T8-T10

For failed back surgery syndrome with leg pain, SCS electrodes are typically placed at T8-T10 to cover the lower extremity dermatomes.

Which pain assessment tool is most validated for use in patients with moderate-to-severe cognitive impairment who cannot self-report?

Answer: Pain Assessment in Advanced Dementia (PAINAD)

PAINAD uses observable behaviors (breathing, vocalization, facial expression, body language, consolability) to assess pain in cognitively impaired patients.

A patient with fibromyalgia has failed multiple pharmacological treatments. Which non-pharmacological intervention has the strongest evidence base for fibromyalgia?

Answer: Aerobic exercise

Graded aerobic exercise is supported by strong evidence and EULAR guidelines as a cornerstone treatment for fibromyalgia pain and fatigue.