Chronic Pain Medicine and Palliative/Cancer Pain MCQs

Anaesthesia · 18 free questions with answers & explanations.

1. A 55-year-old patient with inoperable pancreatic cancer has severe upper abdominal pain (NRS 9/10) unresponsive to oral morphine 200 mg/day. Which interventional procedure targets the coeliac plexus to provide sustained pain relief?
2. The WHO analgesic ladder for cancer pain management recommends a stepwise approach. A patient with cancer pain not controlled on non-opioids (Step 1) should be escalated to Step 2, which includes:
3. A patient with chronic neuropathic pain from diabetic peripheral neuropathy is being initiated on pharmacotherapy. Which drug class is recommended as FIRST-LINE by EFNS/NeuPSIG guidelines?
4. Opioid-induced hyperalgesia (OIH) is a paradoxical phenomenon seen with high-dose opioid therapy. Its proposed mechanisms include:
5. According to the WHO three-step analgesic ladder for cancer pain, which combination is the CORRECT step-2 recommendation for moderate cancer pain not controlled by step-1 drugs?
6. A 62-year-old with pancreatic cancer has severe epigastric pain rated 9/10 despite oral morphine 120 mg/day equivalent. What interventional pain procedure provides the most durable relief for visceral pancreatic cancer pain?
7. A patient on long-term oral morphine 60 mg/day (equianalgesic dose 60 mg/day) needs to be converted to transdermal fentanyl due to swallowing difficulties. What is the correct fentanyl patch dose?
8. Which of the following best describes the mechanism of action of gabapentinoids (gabapentin, pregabalin) in neuropathic pain?
9. A palliative care patient develops opioid-induced hyperalgesia (OIH). Which statement best characterises OIH and its management?
10. A 60-year-old man with pancreatic cancer has intractable abdominal pain despite oral morphine 120 mg/day. The MOST appropriate interventional procedure for visceral cancer pain from upper abdominal malignancy is:
11. In the WHO analgesic ladder for cancer pain, which statement about Step 3 (strong opioids) is MOST accurate?
12. A 45-year-old woman with complex regional pain syndrome (CRPS) type I of the right upper limb has allodynia, trophic changes, and vasomotor instability that has not responded to 6 months of oral medication. The MOST evidence-based interventional treatment at this stage is:
13. A patient with postherpetic neuralgia confined to the T4 dermatome scores 7/10 on NRS despite pregabalin 300 mg/day. Which adjuvant analgesic has the strongest evidence as a topical agent for localised neuropathic pain?
14. A patient on long-term strong opioids for cancer pain develops opioid-induced hyperalgesia (OIH). The mechanism of OIH is BEST described as:
15. A 55-year-old patient with pancreatic cancer has severe epigastric pain not controlled by oral morphine 120 mg/day. A coeliac plexus neurolytic block is planned. What is the mechanism of pain relief and the agent used for neurolysis?
16. According to the WHO analgesic ladder for cancer pain, what is the CORRECT sequence and principle of opioid escalation?
17. A patient with chronic low back pain due to lumbar facet joint arthropathy has temporary relief from diagnostic medial branch blocks. The MOST appropriate next interventional step for longer-term pain relief is:
18. A patient on long-term oral morphine for chronic cancer pain requires opioid rotation to transdermal fentanyl due to intolerable side effects. The oral morphine dose equivalent of transdermal fentanyl 25 mcg/h is approximately: