NCS Pain Management in Neurology 5

Question 1

A patient with refractory chronic migraine is being considered for occipital nerve stimulation (ONS). What is the theoretical basis for its analgesic effect?

Accepted Answer

Direct stimulation of the trigeminal nucleus caudalis via convergent pathways

Answer

Suppression of cortical spreading depression at the occipital cortex

Answer

Activation of the hypothalamic pain modulation center

Answer

Blockade of C2 afferents entering the cervical cord

Question 2

Which cognitive-behavioral therapy (CBT) technique is specifically evidence-based for catastrophizing in chronic pain patients?

Accepted Answer

Cognitive restructuring targeting pain-related helplessness and magnification

Answer

Systematic desensitization

Answer

Prolonged exposure therapy

Answer

EMDR for pain memories

Question 3

A 70-year-old patient with chronic pain requires analgesic therapy. Which analgesic is considered LEAST appropriate in elderly patients due to risk of anticholinergic effects and CNS toxicity?

Accepted Answer

Meperidine (pethidine)

Answer

Tramadol

Answer

Gabapentin at reduced dose

Answer

Acetaminophen

Question 4

Ketamine's analgesic mechanism in chronic pain states primarily involves:

Accepted Answer

NMDA receptor antagonism reducing central sensitization

Answer

Mu-opioid receptor agonism

Answer

Sodium channel blockade at peripheral nociceptors

Answer

COX-1 and COX-2 inhibition

Question 5

In evaluating a patient for chronic pain, the Waddell signs are used to identify:

Accepted Answer

Behavioral or psychosocial contributions to low back pain presentation

Answer

Severity of neuropathic component using dermatomal mapping

Answer

Degree of central sensitization using QST

Answer

Malingering confirmed by imaging discordance

Question 6

Which finding on skin punch biopsy would confirm a diagnosis of small-fiber neuropathy (SFN) as the cause of burning extremity pain?

Accepted Answer

Reduced intraepidermal nerve fiber density (IENFD) below the 5th percentile

Answer

Demyelination of large myelinated fibers

Answer

Presence of inflammatory infiltrate around epineurial vessels

Answer

Axonal swelling in large-caliber sensory fibers

Question 7

A patient with spinal cord injury at T6 develops pain below the level of injury. This is best classified as:

Accepted Answer

Central neuropathic pain at-level and below-level SCI pain

Answer

Nociceptive musculoskeletal pain from disuse

Answer

Peripheral neuropathic pain from nerve root avulsion

Answer

Visceral pain from neurogenic bladder