Neuropathic Pain Quiz 3

Question 1

In class we discussed that all of the evaluable trials for treatment of neuropathic pain were short term (approx. 14 days); and placebo controlled. Adverse effects of treatment included balance and gait disturbances. Identify the correct statement.

A) Patients with neuropathic pain already have impaired balance and gait so this side effect is irrelevant
B) As the studies are placebo controlled we should infer that study patients had mild or no pain at enrollment
C) Using a placebo control in a study of acute pain helps to keep the placebo patients focused
D) Short term trials are the preferred study design when investigating chronic illness

Answer 1

B

Question 2

The main takeaway point from all of the presented studies of neuropathic is:

A) Use of one of the recommended treatments is likely to provide a small to moderate benefit to patients reporting mild pain. Clinicians should expect a very high percentage of patients to discontinue therapy due to side effects
B) Most patients will stick with the treatment protocol, and experience a great deal of pain relief from any of the recommended treatments
C) You should start treatment with an anticonvulsant, or antiarrhythmic agent since your patients will still be healthy enough to tolerate side effects
D) Patients having severe pain are likely to see a dramatic improvement upon treatment

Answer 2

A

Question 3

TCA MOA

Answer 3

Inhibits neuronal reuptake NE, serotonin, antihistamine, and acetylcholine

Question 4

SNRIs MOA

Answer 4

Inhibits neuronal reuptake NE and serotonin

Question 5

Gabapentin MOA

Answer 5

Unknown mechanism

Question 6

Tramadol MOA

Answer 6

Weak mu agonist, active metabolite is a strong mu agonist, weakly inhibits reuptake of NE and serotonin

Question 7

Pregabalin MOA

Answer 7

Blocks calcium channels in the CNS

Question 8

Which statement is not correct?

A) Opioids and similar medications such as tramadol should be reserved for patients refractory to other treatments and should be prescribed for the short term whenever possible
B) Glucose control has no effect on the progression of diabetic neuropathic pain
C) Although all treatment options have limitations an SNRI like duloxetine, or a medication such as pregabalin are worth consideration as the first treatment choice in patients having neuropathic pain
D) Future research in this area should include patients having moderate and or severe pain, have an active recognized comparator, and should be conducted over the long term

Answer 8

B