NCS Pain Management in Neurology 2

Question 1

A patient with central sensitization presents with allodynia. Which neuroplastic mechanism best explains this phenomenon?

Accepted Answer

Wind-up and long-term potentiation in dorsal horn neurons

Answer

Peripheral nociceptor fatigue

Answer

Reduced substance P release at the synapse

Answer

Increased GABAergic inhibition in the spinal cord

Question 2

Which opioid receptor subtype is primarily responsible for supraspinal analgesia?

Accepted Answer

Mu (μ)

Answer

Kappa (κ)

Answer

Delta (δ)

Answer

Nociceptin/orphanin FQ (NOP)

Question 3

A patient on long-term opioids requires escalating doses for the same pain relief. Which pharmacological process best describes this?

Accepted Answer

Pharmacodynamic tolerance

Answer

Opioid-induced hyperalgesia

Answer

Serotonin syndrome

Answer

Physical dependence

Question 4

The 'gate control theory' of pain proposes that pain transmission is modulated at the level of the:

Accepted Answer

Spinal cord dorsal horn

Answer

Thalamus

Answer

Periaqueductal gray

Answer

Primary somatosensory cortex

Question 5

Which descending pain modulation pathway utilizes serotonin and norepinephrine as primary neurotransmitters?

Accepted Answer

Dorsolateral funiculus (PAG-RVM system)

Answer

Spinothalamic tract

Answer

Dorsal column-medial lemniscal pathway

Answer

Anterolateral system

Question 6

A neurologist prescribes duloxetine for a patient with diabetic peripheral neuropathy. What is the primary mechanism of analgesic action?

Accepted Answer

Serotonin-norepinephrine reuptake inhibition enhancing descending pain modulation

Answer

Sodium channel blockade in peripheral nerves

Answer

NMDA receptor antagonism

Answer

COX-2 inhibition reducing prostaglandin synthesis

Question 7

In complex regional pain syndrome (CRPS), which finding differentiates Type I from Type II?

Accepted Answer

Documented nerve injury in Type II

Answer

Presence of allodynia

Answer

Sympathetically maintained pain in Type I only

Answer

Skin temperature changes in Type II only