16. Which one of the following intervention provides the worst therapeutic effect of pain relief for lumbar spinal radicular pain?
(A) transforminal epidural steroids injection
(B) radiofrequency denervation
(C) spinal cord stimulation
(D) lumbar sympathetic block
(E) caudal steroids injection

12. 抗癲癇藥物也是用於治療慢性神經病理性疼痛的主要藥物之一，下列有關於抗癲癇藥物之 敘述何者為非? (A) 所有抗癲癇藥物之作用機轉均為抑制離子通道，而抑制神經之病態性興奮。 (B) Carbamazepine 對於中風後之中樞性疼痛之止痛效果，優於 lamotrigine。 (C) NNT 是用於表示止痛效果的指標，而 NNH 則是用來表示止痛藥物副作用之指標。 (D) Gabapetin 的結構類似 GABA，但卻並不作用於 GABAA 或 GABAB 受體，其主要是作用 於鈣離子通道之次單元，而抑制鈣離子流及興奮性胺基酸之釋放。 (E)大部分的抗癲癇藥物是以‖use-dependent‖的方式作用於阻斷鈉離子通道，而產生抑制神 經過度興奮的神經病理性疼痛。

13. 一位末期肝癌疼痛的病患，因口服嗎啡已經造成嚴重的嘔吐，考慮改由脊髓腔內(intrathecal) 持續給藥，因其每天劑量達 600 mg，經換算後脊髓給藥劑量應為每天約： (A) 20 mg (B) 10 mg (C) 6 mg (D) 2 mg (E) 1 mg

14. 當病人一再來門診或急診要求注射成癮性止痛藥時，下列哪些現象暗示病患可能有「成癮」 現象? (A) 病人抱怨最近的處方的止痛時間不夠久，藥效變差。 (B) 病患抱怨最近疼痛加重厲害，發作頻繁，他把三天的藥一天吃完。 (C) 病患自述出現嗜睡、噁心、性慾降低、便秘，但是疼痛都沒有減輕。 (D) 病人自述沒吃止痛藥會睡不著，希望睡前加重劑量輔助睡眠。 (E) 病人最近反覆敘述藥物遺失，而且發生很多次。

15. 主導 prostaglandin 代謝之 COX-1 enzyme 存在於？ (A) most tissues (B) platelet (C) G.I. tract (D) kidney (E) all of above

17. Which opioid described below belong to ―full agonist‖? (A) buprenorphine (B) fentanyl (C) nalbuphine (D) butorphanol (E) naltrexone

18. Pain is a frequent consequence of spinal cord injury (SCI). Which of the following statement is least likely: (A) Below-level neuropathic pain is most likely described as severe or excruciating months or years following initial injury. (B) Damage to the spinothalamic tracts is an important ingredient in the development of neuropathic pain following SCI. (C) Chronic musculoskeletal pain is common in tetraplegic patients after SCI. (D) Patients with cervical SCI are at risk of developing CRPS affecting upper limbs. (E) Below-level neuropathic pain is also referred to deafferentation pain.

19. About diagnostic nerve blocks, which one of following statements is wrong? (A) May help in locating the origin of pain. (B) Pain originating from malfunctioning CNS pain modulation may also be relieved by a peripheral nerve block. (C) Repeated diagnostic blocks are mandatory before any attempted chemical or physical denervation. (D) Are reliable as prognostic aids for neurolytic procedures. (E) Pain relief from a saline block does not indicate a psychogenic pain or malingered pain.

20. Choice a right description about acute pain associated with chemotherapy toxicity. (A) Intraperitoneal chemotherapy seldom induces abdominal pain. (B) Vincristine treatment can induce peripheral neuropathy. (C) ntrathecal methotrexate produces an acute menigitic syndrome in 80% of patients (D) 5-fluorouracil (5-FU) produces peripheral neuropathy but no chest pain. (E) None of above is right.

21. About the failed back surgery syndrome (FBSS), which one of the following procedure may be the last to be considered due to possible poor response? (A) caudal steroids injection (B) epidural adhesive lysis (C) spinal cord stimulation (D) radiofrequency denervation (E) lumbar sympathetic block

22. Effects on postoperative morbidity of regional anaesthetic or analgesic techniques compared with those of general anaesthesia and systemic postoperative analgesics may reduce the following complications, except: (A) pulmonary embloism (B) myocardial complications (C) pulmonary infectious complications (D) cerebral complications (E) other thromboembloic complications