40. 認知行為療法(Cognitive-behavioral therapy CBT)為全方位疼痛治療的必要模式之一，下列何項是 CBT 的重要組成要素?
(A) 教育病患有關疼痛及其相關症候群的內容
(B) 協助病患專注於增加自身活動及功能提升而非止痛
(C) 教育訓練病患有關 biofeedback, relaxation 及 stress management 的技巧
(D) 協助病患進行未來目標的設定 (goal setting for the future)
(E) 以上皆是

36. 下列何項診斷為最常見的遺傳性神經病變(hereditary neuropathy) ? (A) Fabry’s disease (B) Inherited erythromelalgia (C) Charcot-Marie-Tooth disease (CMT) (D) Familial amyloid polyneuropahty (E) Guillain-Barre Syndrome (GBS)

37. 下列有關 complex regional pain syndrome (CRPS)的 interventional therapies 敘述何者正確? (A) Sympathetic block 目前被認為是 CRPS 第一線的標準介入性治療 (B) 由於 CRPS 皆有 sympthetically maintained pain (SMP), 因此 systemic infusion of sympatholytic agent (例如 phentolamine)具有很好的療效 (C) 目前實證醫學證據顯示針對下肢的 CRPS, spinal cord stimulation 比 dorsal root ganglion stimulation 的療效更佳 (D) 相較於 conservative treatment, spinal cord stimulation 於 CRPS 的療效目前已有 prospective randomized controlled trial 證實 (E) 以上皆正確

38. 針對免疫正常的病患, 下列何節段最常出現 herpes zoster? (A) Cranial (B) Cervical (C) Thoracic (D) Lumbar (E) Sacral

39. 下列何項藥物不屬於 central neuropathic pain 的 first line therapy ? (A) Tramadol (B) Amitriptyline (C) Gabapentin (D) Duloxetine (E) Pregabalin

41. Which one of the following statement is correct? (A) Functional imaging techniques applied for the study of pain are positron emission tomography (PET), functional magnetic resonance imaging (fMRI), near-infrared spectroscopy (NIRS), multi-channel electroencephalography (EEG) and magnetoencephalography (MEG), and intracranial recordings. (B) NIRS is an optical approach that also analyses changes in hemoglobin oxygenation levels by using light in the near infrared range (650 to 950 nm). (C) EEG and MEG are noninvasive neurophysiologic techniques that measure the respective electrical potentials and magnetic fields generated by neuronal activity of the brain and propagated to the surface of the skull where they are picked up with EEG electrodes or, in the case of its magnetic counterpart, received by supra conducting quantum interference device (SQUID) sensors located outside the skull. (D) (D.) Invasive recordings, which are assessed during neurosurgical interventions in patients ongoing epileptic surgery, or deep brain stimulation (DBS) procedures (most common in Parkinson disease), are extremely helpful to directly measure supraspinal pain signals. (E) All of the above are correct.

42. Which one of the following statement is wrong? (A) The person who has a chronic pain condition resides in a complex and costly world that is populated not only by themselves but also by their significant others, including health care providers, employers, and third-party payers. (B) People with chronic pain may feel that their health care providers, employers, and even family members are blaming them when their condition fails to respond to treatment as expected. (C) In the absence of cure or even substantial relief, individuals experiencing chronic pain may withdraw from contacts； lose their sources of income； alienate family, friends, and coworkers； and become more and more isolated, despondent, depressed, and, in general, demoralized. (D) Psychosocial and behavioral factors play an insignificant role in the experience, maintenance, and exacerbation of pain and potentially even the cause. (E) Because some level of pain persists in the majority of people with chronic pain regardless of treatment, self-management is an important complement to biomedical approaches.

43. 下列對於肌筋膜疼痛及纖維肌痛的比較，何者錯誤：

44. During peripheral sensitization of nociceptors, which of the coupling is wrong? (A) prostaglandin E2 (PGE2) --- EP receptor (B) bradykinin --- B2 receptor (C) heat --- TRPV1 receptor (D) ATP --- P2Y receptor (E) all of the above are right

45. Arrange the pain intensity of the following conditions from the strongest to the least according to long form McGill Pain Questionnaire. 1 Labor pain, 2 Amputation of digit, 3 Male low abdominal surgery, 4 Fracture: (A) 1＞2＞3＞4 (B) 2＞1＞4＞3 (C) 2＞1＞3＞4 (D) 1＞2＞4＞3 (E) None of above is right

46. Regarding the actions of spinal and supraspinal analgesia for opioids, which of the following statement is most likely: (A) Opioid receptors are mostly located at a predominantly 70% postsynaptic location on the central terminals of only small diameter nociceptive primary afferents. (B) The contribution of kappa, delta and mu receptors to the total opiate binding throughout the spinal cord is estimated to be delta ＞ mu ＞kappa. (C) Opioids inhibit OFF cells via GABA neurons and activate ON cells in the rostromedial medulla (RVM) leading to changes in spinal descending controls. (D) Nitric oxide (NO) is required for the 5-HT-mediated inhibition of PAG output and reversal of antinociception. (E) Fibers descending from the PAG to the dorsal horn of the spinal cord are mostly enkephalinergic, glycinergic and GABAergic.