42. Which of the following statement about tramadol is wrong?
(A) Oral tramadol has high bioavailability in the range of 80~90%.
(B) Tramadol has good efficacy for neuropathic pain and fibromyalgia.
(C) The risk for respiratory depression is lower than morphine at equianalgisic doses.
(D) Nausea and vomiting seldom occur in patients with tramadol.
(E) The tramadol is affected by cytochrome P450 2D6 activity.

38. For Chronic pain patients (CPPs), which of the following description is wrong: (A) In tertiary treatment facilities, depression has been reported in 10-100% of CPPs (B) Successful treatment of depression reduce the effect of pain interference. (C) Anxiety disorders are common in CPPs (D) The incidence of de novo opioid addiction is increased in CPPs (E) CPPs should be offered smoking cessation treatment.

39. Coxibs cause less adverse effect than NSAIDs except which of the following one? (A)Upper GI bleeding (B) Anemia (C) Asthma (D) Congestive heart failure (E) Lower GI bleeding

40. Which of the following commonly used opioids has the highest oral bioavailability? (A) hydromorphone (B) morphine . (C) pethidine (D) codeine (E) methadone

41. Which of the following statement about post-herpetic neuralgia (PHN) is wrong? (A) The most common sites for PHN are the mid-thoracic dermatomes and ophthalmic division of the trigeminal nerve. (B) Men are more often affected than women. (C) The pain is usually described as burning or electric shock-like. (D) The risk for PHN increase with age. (E) Carbamazepine may not be appropriate in PHN.

43. Which of the following statement concerning “joint pain” is least likely? (A) In a normal joint, only intense pressure on the joint and movements exceeding the working range elicit pain. (B) Under pathological conditions such as joint inflammation, hypersensitivity of the nociceptive system occurs frequently and leads to pain on palpation. (C) Mechanical sensitization of joint nociceptors is generated by numerous inflammatory mediators, including prostaglandins and cytokines. (D) Spinal sensitization involves excitatory amino acids, neuropeptides, and spinal prostaglandins. (E) Better understanding of pain mechanisms can't improve pain therapy.

44. Which one of the following statement is most appropriate? (A) Gabapentin is an anticonvulsant and analgesic. (B) Minocycline is not an antibiotic. (C) Nifedipine (adalat) is a T-type Na+ channel opener. (D) ∧-Conotoxins are derived from snakes..

45. Indications for lumbar epidural steroid injections include all of the following, EXCEPT? (A) Radicular pain with corresponding sensory change (B) Radiculopathy due to herniated disc with failed conservative treatment (C) Acute herpes zoster in the lumbar dermatomes (D) Posterlaminectomy (failed back) syndrome without radiculopathy

46. 下列有關慢性疼痛的流行病學調查, 何者正確? (A) regional pain syndrome 中最常見的是下肢疼痛 (Lower limb pain) I. (B) widespread body pain(例如 fibromyalgia) 男性的發生率高於女性 (C) cohort study 與 case-control study 是慢性疼痛流行病學研究適當的研究方法 (D)慢性疼痛議題容易進行 population based 的流行病學調查. (E)以上皆不正確

47. Which one of the following statement is most appropriate? (A)Glutamate can act on AMPA and NMDA receptors. (B) Minocycline can inhibit astrocyte activation. (C) Glial activation has nothing to do with nerve injury-induced neuropathic pain. (D) Astrocyte is not a glial cell.

48. All if the following are red flags in patients with low back pain, EXCEPT: (A) History of prolonged corticosteroid use (B) Saddle anesthesia (C) Age of 36 years (D) Urine retention (E) Bowel incontinence