Pain Procedures Flashcards
For unilateral pain in head, face, neck, and upper extremity, what is the pain procedure to be done?
● A. Cingulotomy
● B. Cordotomy
● C. Commisural myelotomy
● D. Stereotactic mesencephalotomy
● E. Dorsal rhizotomy
D. Stereotactic mesencephalotomy
The success of cordotomy is known by which of the following?
● A. Loss of pinprick sensation on the affected site
● B. Weakness of the affected side
● C. Ipsilateral Horner syndrome
● D. Muscle tetany on the affected side
● E. None of the above
C. Ipsilateral Horner syndrome
Which of following is considered to be a relative contraindication of spinal cord stimulation?
● A. Failed back syndrome
● B. Regional pain syndrome
● C. Cancer pain
● D. Diabetic neuropathy
● E. Postherpetic neuralgia
C. Cancer pain
For commissural myelotomy, where is laminectomy done?
● A. Single level above highest dermatome involved in pain
● B. Two levels above highest dermatome involved in pain
● C. Three levels above highest dermatome involved in pain
● D. Two levels below highest dermatome involved in pain
● E. Three levels below highest dermatome involved in pain
C. Three levels above highest dermatome involved in pain
Dorsal root entry lesions are indicated for all except?
● A. Phantom pain
● B. Cancer pain
● C. Spinal cord injuries
● D. Postherpetic neuralgia
● E. Deafferentation pain
B. Cancer pain
What is the most common complication of cordotomy?
● A. Ataxia
● B. Ipsilateral paresis
● C. Bladder dysfunction
● D. Postcordotomy dysesthesia
● E. Sleep-induced apnea
A. Ataxia
Which of the following are the types of pain procedures which are being used currently?
● A. Electrical stimulation (deep brain stimulation or spinal cord stimulation)
● B. Direct drug administration into the CNS (spinal, epidural, intrathecal, or intraventricular)
● C. Intracranial ablative procedures (cingulotomy, medial thalamotomy)
● D. Spinal ablative surgical procedures like cordotomy or cordectomy or commissural myelotomy
● E. Sympathectomy or peripheral nerve procedures like nerve block
● F. All of the above
F. All of the above
Cordotomy is the procedure of choice for unilateral pain below C5 dermatomal level. Which of the following fibers are interrupted in this procedure?
● A. Lateral spinothalamic tract fibers
● B. Anterior spinothalamic tract fibers
● C. Posterior spinothalamic tract fibers
● D. Medial spinothalamic tract fibers
● E. All of the above
A. Lateral spinothalamic tract fibers
Following are the postcordotomy complications except?
● A. Ataxia
● B. Ipsilateral paresis
● C. Sleep-induced apnea never occurs with it
● D. Bladder dysfunction
● E. Postcordotomy dysfunction
C. Sleep-induced apnea never occurs with it
In experienced hands, 94% of patients will achieve at least significant pain relief at the time of hospital discharge. This level of analgesia falls with time. At 1 year, what percentage of patients will be pain free?
● A. 80%
● B. 70%
● C. 60%
● D. 50%
● E. 40%
C. 60%
Commissural myelotomy is performed for interruption of pain fibers crossing in the anterior commissure on their way to the lateral spinothalamic tract. It is done for bilateral or midline pain primarily below the thoracic levels. What percentage of patients have complete pain relief after the operation?
● A. 50%
● B. 60%
● C. 70%
● D. 80%
● E. 90%
B. 60%
Administration of narcotics can be done in epidural space or intrathecally for pain relief. Which of the following are the advantages of CSN administration of narcotics over systemic narcotics?
● A. It causes less sedation or confusion
● B. It causes less interference with GI motility
● C. It causes less nausea and vomiting
● D. All of the above
D. All of the above
Which of the following are the indications of spinal cord stimulation?
● A. Failed back surgery syndrome and complex regional pain syndrome are FDA-approved indications
● B. Diabetic neuropathy or refractory angina pectoris
● C. Postthoracotomy pain
● D. Postherpetic neuralgia or painful limb ischemia
● E. All of the above
E. All of the above
Dorsal root entry zone lesions appear to be most effective in treating all of the following except?
● A. Deafferentation pain resulting from nerve root evulsion
● B. Spinal cord injuries with pain around the lowest spared dermatome
● C. Postherpetic neuralgia
● D. Generally used for cancer pain
● E. Postamputation phantom limb pain
D. Generally used for cancer pain
Which of the following are the potential complications of spinal cord stimulation?
● A. Lead migration or lead breakage
● B. Infection
● C. Hardware malfunction or unwanted stimulation
● D. CSF leak, radicular pain, intermittent interference with cardiac pacemaker
● E. All of the above
E. All of the above
