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

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

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

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

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

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

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

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

Question 5

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

Accepted Answer

Pain predominantly of neuropathic origin

Answer

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

(NCS) Neurologic Clinical Specialist Practice Test

(NCS) Neurologic Clinical Specialist Practice Test

NCS Pain Management in Neurology 4