Pain Management Flashcards

A patient with postherpetic neuralgia has failed a trial of amitriptyline. What is the most appropriate next step?

Answer: Gabapentin or pregabalin

Gabapentin and pregabalin are NICE-recommended alternatives for neuropathic pain when first-line agents fail.

Duloxetine is most appropriate for which pain condition?

Answer: Diabetic peripheral neuropathic pain

Duloxetine, an SNRI, is licensed and NICE-recommended for diabetic peripheral neuropathic pain.

A cancer patient on regular modified-release morphine reports breakthrough pain. How should PRN morphine be administered?

Answer: As needed, up to every 4 hours

Breakthrough (PRN) morphine can be administered as needed, typically up to every 4 hours, in addition to the background modified-release dose.

Which topical agent is licensed for localized peripheral neuropathic pain such as postherpetic neuralgia?

Answer: Lidocaine 5% medicated plaster

Lidocaine 5% medicated plasters are licensed for localized neuropathic pain, particularly postherpetic neuralgia.

A patient with metastatic bone pain from prostate cancer remains in pain despite regular paracetamol. Which adjuvant is most appropriate to add?

Answer: Dexamethasone 4 mg OD

Corticosteroids such as dexamethasone reduce peri-tumoral oedema and inflammation, providing effective adjuvant analgesia for bone metastases.

A 30-year-old woman with chronic widespread pain is prescribed amitriptyline 10 mg at night. What is the primary analgesic rationale?

Answer: As a low-dose adjuvant analgesic for central sensitization

Low-dose amitriptyline is used as an adjuvant analgesic, modulating descending pain pathways independently of its antidepressant effect.

A patient with multiple sclerosis has spasticity causing significant pain. Which medication directly targets this mechanism?

Answer: Baclofen 10 mg TDS

Baclofen is a GABA-B agonist that reduces spinal cord excitability, directly reducing spasticity and associated pain.