NCS Pain Management in Neurology 4

Question 1

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

Accepted Answer

NMDA receptor activation and dynorphin upregulation

Answer

Increased mu-opioid receptor density

Answer

Reduced prostaglandin synthesis

Answer

Enhanced GABAergic inhibition

Question 2

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

Accepted Answer

Continuous opioid infusion as primary treatment

Answer

Acetazolamide for CSF pressure reduction

Answer

Repeated lumbar puncture

Answer

High-dose corticosteroids for idiopathic intracranial hypertension

Question 3

Which characteristic distinguishes nociceptive from neuropathic pain in clinical assessment?

Accepted Answer

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

Answer

Neuropathic pain always involves burning or electric shock quality

Answer

Nociceptive pain responds to NSAIDs while neuropathic pain never does

Answer

Nociceptive pain is always acute and neuropathic pain is always chronic

Question 4

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

Accepted Answer

Cervical epidural steroid injection

Answer

Intravenous ketamine infusion

Answer

Transcutaneous electrical nerve stimulation (TENS)

Answer

Oral baclofen

Question 5

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

Accepted Answer

Pain predominantly of neuropathic origin

Answer

Moderate nociceptive pain requiring opioids

Answer

Severe fibromyalgia activity

Answer

High risk for opioid misuse

Question 6

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

Accepted Answer

α2δ subunit of voltage-gated calcium channels

Answer

GABA-B receptors

Answer

Voltage-gated sodium channels

Answer

NMDA receptor glycine site

Question 7

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

Accepted Answer

Lhermitte's sign — electric shock sensation with neck flexion

Answer

Constant burning in all four extremities

Answer

Thalamic pain unresponsive to all medications

Answer

Allodynia restricted to the face