31. Which of the following examination is required to be certain of the degree of arachnoiditis?
(A) CT
(B) MRI
(C) Myelography
(D) NCV+EMG
(E) x-ray

27. A 25-year-old, obese man complains of a burning pain in the anterolateral thigh. Deep tendon reflexes and findings in a motor examination are normal. There is a slight sensory deficit in the lateral thigh that corresponds to the painful area. What is the most appropriate diagnostic block to perform on this patient? (A) Epidural local anesthetic and sterioid (B) Trigger point injection (C) Lateral femoral cutaneous nerve block (D) Illioinguinal nerve block (E) Lumbar sympathetic block

28. Which of the following treatment is NOT the indication for limbs pain induced by increased spasticity after C7 incomplete spinal cord injury? (A) Joint positioning and range-of-motion (ROM) exercises. (B) Treat underlying spasticity-triggering events (infection, pressure ulcer, etc). (C) Serial casting or dynamic splinting to relieve already-occurred contractures. (D) Oral narcotics, like codeine or tramadol. (E) Anti-spasticity blocks via Botulinum toxins, phenol, or ethanol.

29. Which of the following is the acceptable statement about pathogenesis of FMS? (A) There is evidence to suggest that FMS is a disorder of abnormal processing of sensory information within the central nervous system. (B) Several neurochemical mediators of pain, substance P, nerve growth factor, dynorphin A, glutamate, nitric oxide, serotonin and noradrenaline are viewed as pronociceptive because they carry or amplify afferent signals, leading to the brain perception of increased pain. (C) The elevation of cerebrospinal fluid substance P in FMS is due to lowered activity of cerebrospinal fluid substance P esterase because the rate of cleavage of libeled substance P by FMS cerebrospinal fluid was lower than normal. (D) In different subtypes of FMS, it is believed that nerve growth factor may be responsible for the elevated cerebrospinal fluid substance P through its effects on central sensitization and neuroplasticity. (E) A specific Gi-protein–coupled receptor in peripheral blood leukocytes was found to be dysfunctional in patients with FMS. This resulted in lower baseline, also depressed intracellular levels of cyclic AMP and proposed as a diagnostic test for FMS.

30. 下列關於 placebo analgesia 的敘述何者錯誤？ (A) 暗示、建議、期待、或制約(conditioning)都是增強 placebo analgesia 的重要因素。 (B) 與 placebo analgesia 有關的生理結構可能是 limbic system (包括 amygdala, ventral striatum，anterior cingulate，和 prefrontal cortex)。 (C) 在不同疼痛模型，出現 Placebo effect 比率的人數(responder)不同；在拔牙後疼痛實驗佔20% '在止血帶誘發疼痛低於 10%。 (D) 不同疼痛模型，placebo analgesia 在 VAS 的強度也不同；如拔牙後疼痛實驗 responder 與 non-responder 可以相差到 5 分。 (E) Nocebo 與 placebo 相反，是指經過治療(處理)後，結果反而無效或是疼痛加劇；例如利用暗示，使原本有效的 N20 拔牙止痛，變得更痛。

32. When the administration of opioids failed to manage pain or the dose of opioids are noted to escalate, the following differential diagnosis should be considered, except: (A) Limited absorption of oral preparations—vomiting or gastric stasis. (B) Pain poorly responsive to opioids alone- such as Neuropathic pain (C) Pharmacological factors: Opioid-induced hyperalgesia and allodynia (D) Psychological factors: Distress, Anxiety or Depression (E) All of the above should be considered

33. Which of the following statement concerning the complex regional pain syndromes (CRPS) is least likely: (A) CRPS is characterized by pain, abnormal regulation of blood flow and sweating, as well as tropic changes of skin and subcutaneous tissues. (B) Reflex sympathetic dystrophy (RSD) usually develops after injury to a major peripheral nerve. (C) RSD is also called CRPS type I. (D) In addition to positive sensory phenomena, up to 50% of patients with chronic CRPS type I develop hypoaesthesia and hypoalgesia on the entire half of the body. (E) Spontaneous pain or allodynia/hyperalgesia occurs, which is not limited to the territory of a single peripheral nerve in patients with CRPS type I.

34. Neuropathic pain may happen most frequently in which one of following therapeutic blocks? (A) glycerol or ethanol neurolytic block (B) cryoneurolysis (C) radiofrequency denervation (D) pulsed radiofrequency (E) none of above

35. Choice a right description about morphine treatment of cancer pain. (A) Nausea is a common mild side effect with strong opioid but no early prevention needed. (B) Sedation and mild confusion may happen and they are usually not self-limiting. (C) Respiratory depression should not be the reason for avoiding using morphine. (D) Morphine resistance seldom happens and no consideration was needed for clinical practice. (E) None of above is right.

36. 抗憂鬱劑常被用在治療慢性神經病理性疼痛緩解，以下有關於此類藥物之敘述何者為非? (A) 三環抗憂鬱劑是慢性疼痛治療的首選藥物。 (B) Amitriptyline 可同時抑制 Serotonin 和 Noradrenaline 兩神經傳遞物質之回收，效果較其他選擇性回收抑制劑之治療效果佳，其 NNT 為 14 左右。 (C) 三環抗憂鬱劑之止痛效果，主要並非來自於其鎮靜或是抗焦慮之作用。 (D) 近來之研究發現三環抗憂鬱劑也具有抑制鈉離子通道及 NMDA 受體之作用。 (E) 青光眼及攝護腺肥大是使用三環抗憂鬱劑的禁忌症。

37. 下列有關 spinal cord injury (SCI)之後引起之疼痛，下列敘述，何者較不正確？ (A) 慢性 SCI 疼痛，大約佔 SCI 之 65％ (B) 慢性 SCI 疼痛病人當中，大約有 1/3 病人具有嚴重疼痛 (C) 可區分為 musculoskeltal pain，visceral pain 以及 nreuropathic pain (above-level pain、 at-level、below-level) (D) 其中以 neuropathic pain 最常見，約佔慢性 SCI pain 之 58％ (E) 一般而言，眾多藥物及治療方式當中，較難有長時間而滿意的止痛療效