Which of the following is true about the use of antidepressants and their analgesic effects

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A. Analgesic effects are only seen in patients who suffer from depression

B. Depressed patients require higher doses for analgesic effect

C. Antidepressants do not relieve pain if the patient suffers from depression

D. Depressed patients respond faster to analgesic effects of antidepressants

4. Fluoxetine may be contraindicated if the patient is suffering from

A. Fibromyalgia

B. Diabetic neuropathy

C. Restless leg syndrome

D. IBS (irritable bowel syndrome)

5. A 32-year-old man is in the emergency room with a fracture of his right forearm. He is in pain and anxious because he is worried about loosing his job. He tells you that he had undergone treatment for depression in the past. Your emergency room treatment should include

A. Analgesics only

B. Anlagesics and anxiolytics

C. Analgesics and antidepressants

D. Analgesics, axiolytics, and antidepressants

Answers

1. The answer is D. Chronic negative affective states can increase the response of the amygdala to pain, leading to increased pain perception. Increased production of cytokines can lead to the "over shooting" of immune response. Heightened glucocorticoid activity, stress, and pain culminate in downregulation of BDNF.

2. The answer is C. With cognitive restructuring and coping skills training patients may experience less physiological arousal and less intense pain, which is consistent with the Neuromatrix Theory of pain.

3. The answer is D. Antidepressants relieve pain in patients irrespective of the fact whether they suffer from endogenous depression or not. In both these situation the dose required to produce a reduction in pain is far less than the dose needed to produce the anti depressant effect.

4. The answer is C. Exacerbation of restless legs syndrome is a possibility with fluoxetine.

5. The answer is A. This is an acute pain phase of pain, and treatment is centered on pain relief, identification and, if possible, remediation of the underlying medical condition.

Chapter 13: Interventional Pain Management

1. Which is true of the trigeminal neurolysis procedure

A. All three divisions of the trigeminal nerve (ophthalmic, mandibular, and maxillary can be individually blocked

B. The Gasserian ganglion block will block all the three divisions of the fifth cranial nerve

C. It can be used to treat chronic headache

D. Facial numbness is not a complication of this procedure

2. Mary is a 35-year-old female who has been suffering from a headache following whiplash injury. She says that her pain starts from the back of her head and radiates to the forehead and into both of her eyes. On examination, she has tenderness over the posterior occiput. The following statement is not correct:

A. She could be suffering from occipital neuralgia

B. Occipital nerve block is one of the treatment options

C. Depot steroid injection can prolong the duration of occipital nerve block

D. Peripheral nerve stimulation is not a treatment option for Mary

3. A 75-year-old man is referred to you by the orthopedic surgeon. He has been suffering from low back pain radiating to lateral side of his right calf. MRI of lumbar spine shows a herniated disc impinging right L5 nerve root. The indicated pain intervention is

A. Right L5 nerve root block

B. A caudal epidural

C. Interlaminar epidural injection

D. All of the above

4. When performing radiofrequency ablation the following does NOT occur

A. Heating up of the tissues

B. Nerves are stimulated first to avoid complication

C. Temperature ranges from 42° to 80°

D. None of the above

5. Which of the following statements is not true regarding SCS (Spinal Cord Stimulator)?

A. The electrodes are placed in the epidural space, stimulating the dorsal column of the spinal cord

B. SCS is effective for pain due to ischemia

C. Infection is a possible complication

D. SCS uses radiofrequency waves for stimulation

Answers

1. The answer is D. Only mandibular and maxillary divisions are blocked individually. Trigeminal nerve sub serves facial sensation so the neurolysis is not useful for treating chronic headache and it can lead on to unpleasant facial numbness.

2. The answer is D. Occipital nerve stimulation can be used to treat resistant cases of occipital neuralgia.

3. The answer is D. All these interventions can produce pain relief, though a right L5 nerve root injection has the advantage of targeting directly the affected nerve root with minimal volume of the injectate.

5. The answer is D. SCS uses lower frequencies for producing pain relief. It has been used successfully for treating angina and ischemic limb pain.

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