Pain Management in Neurology Flashcards

Opioid-induced hyperalgesia (OIH) is mechanistically linked to which receptor/pathway activity?

Answer: NMDA receptor activation and dynorphin upregulation

OIH involves NMDA receptor sensitization and spinal dynorphin upregulation that paradoxically increase pain sensitivity despite ongoing opioid use.

In a patient with headache attributed to intracranial hypertension, which pain management approach is contraindicated?

Answer: Continuous opioid infusion as primary treatment

Opioids are generally contraindicated as primary treatment for elevated ICP headache because they can worsen CO2 retention and further increase intracranial pressure.

Which characteristic distinguishes nociceptive from neuropathic pain in clinical assessment?

Answer: Neuropathic pain arises from lesion or disease of the somatosensory nervous system

The IASP defines neuropathic pain as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.

A patient with cervical radiculopathy has severe neuropathic pain unresponsive to conservative therapy. Which interventional option directly targets the pain generator?

Answer: Cervical epidural steroid injection

Cervical epidural steroid injection delivers anti-inflammatory medication directly to the affected nerve root, addressing the inflammatory pain generator.

The LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) score ≥ 12 indicates:

Answer: Pain predominantly of neuropathic origin

A LANSS score ≥ 12 suggests that pain mechanisms are predominantly neuropathic, guiding selection of neuropathic pain-specific therapies.

Pregabalin's analgesic mechanism in neuropathic pain involves binding to which target?

Answer: α2δ subunit of voltage-gated calcium channels

Pregabalin binds to the α2δ-1 subunit of voltage-gated calcium channels, reducing calcium influx and subsequent excitatory neurotransmitter release at synapses.

Which clinical feature best distinguishes pain from multiple sclerosis (MS) from other central pain syndromes?

Answer: Lhermitte's sign — electric shock sensation with neck flexion

Lhermitte's sign, an electric shock-like sensation radiating down the spine with neck flexion, is a hallmark of demyelination in the dorsal columns of the cervical cord in MS.