6. The effect of placebo will be enhanced by the followings except
(A) conditioning by treatment context
(B) suggestion by verbal
(C) expectation of response
(D) desire of pain relief
(E) attention to pain

2. Which of the following statement concerning the treatment of cancer pain is least likely? (A) Obeying the principles of the analgesic ladder approach, 71% of patients will achieve good in relief without further intervention. (B) Oral morphine remains the drug of choice according to the analgesic ladder of the WHO. (C) The most common use of radiotherapy is for metastases abdominal pain. (D) The patient with advanced cancer is in the dynamic state with changing pathology. (E) About 60% of patients who receive radiotherapy will achieve at least 50% pain relief.

3. 有關 hyperalgesia 的描述何者為非？ (A) 組織受傷會導致許多促進發炎反應的化學物質的釋放，包括 bradykinin， prostaglandins，leukotrienes，serotonin，histamine，substance P，thromboxanes， platelet-activating factor，adenosine，ATP， protons 以及 free radicals 等等 (B) Hyperalgesia 不僅發生在受傷的區域，也會發生在周圍未受傷的區域。 (C) 在周圍未受傷害的區域產生的 hyperalgesia 稱之為 primary hyperalgesia (D) 在發炎反應的時候，marcophages 會釋放 cytokines 來調節發炎反應。 (E) 促進發炎反應之因子，如 cytokine 會促進神經生長因子之產生，再直接或間接地加強 疼痛現象。

4. Which of the following statement concerning “animal models of pain” is least likely? (A) When applying Von Frey filaments for identifying mechanical hyperalgesia, one of the drawbacks is that different application speed may generate different forces. (B) The writhing test is frequently referred to as a somatic pain model. (C) The injection of capsaicin is thought to activate TRPV1-expression nociceptors. (D) The injection of Freund’s complete adjuvant (FCA, or CFA) is a model for inflammatory pain. (E) The chronic constriction injury (CCI) model is a partial nerve lesion model.

5. 關於鴉片 類藥物的敘述，以下何者最為正確？ (A) 嗎啡可能使肥胖細胞(mast cell)釋放組織胺(histamine) (B) Methadone 具有 NMDA 受體拮抗劑的特性，且不會被 naloxone 拮抗 (C) 鴉片類藥物作用在腦幹會降低呼吸中樞對缺氧(low PO2)的敏感性 (D) 使用鴉片類藥物造成便秘是屬於中樞性副作用(central side effect) (E) 嗎啡的代謝產物 M3G 與 M6G 均有微弱的止痛效力

7. 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.

8. Which of the following drug is not suggested to be prescribed to prevent migraine? (A) beta blocker (B) anticonvulsant such as gabapentin (C) tricyclic antidepressant such as amitriptyline (D) SSRI (Selective serotonin re-uptake inhibitors), such as Fluoxetine (prozac) (E) all of the above can be prescribed as preventive medications

9. 關於疼痛臨床研究與止痛方式的統計，下列何者正確？ (A) 一般而言，某種止痛方式的 number need to treat 介於 8-12 之間，表示該方式是有效的 (B) 統計結果 Number need to treat 數值愈大，表示該止痛方式效果越好 (C) 統計結果 Number need to harm 不適合用以表達副作用或併發症的的發生率 (D) 比較不同止痛方式的效果時，病人自控式止痛的嗎啡用量是很好的指標，比 pain score 更為客觀 (E) 以上皆不正確

10. About image-guided lumbar sympathetic block, which the following indication is not proper? (A) Sympathetically maintained pain (B) Reflex sympathetic dystrophy (C) Phantom low limb pain (D) Raynaud’s disease (E) Chronic pancreatitis

11.關於嗎啡類藥物成癮的機轉敘述，下列何者錯誤： (A) 大腦中 ventral tegmental area (VTA) 及 nucleus accumbens (NA)為最重要影響腦區 (B) 此兩個腦區藉由系統中的 mesolimbic pathway 連接 (C) 與神經傳遞物血清素(serotonin)的分泌有關 (D) 此中樞神經網路代表了動物行為的「獎懲系統」(reward system) (E) 與酒精成癮的機制是同一套神經興奮系統

12. A 61-year-old woman presents to the pain clinic with a chief complaint of left shoulder and arm pain 3 years after undergoing radiation therapy for breast cancer. Physical examination reveals lymphedema of the left axilla with noticeable skin changes. Examination of the left supraclavicular area precipitates a sharp pain that radiates down her left arm. Which of the following is her likely diagnosis? (A) Tumor metastasis (B) Cervical radiculopathy (C) Reflex sympathetic dystrophy (D) Thrombangiitis obliterans (E) Radiation-induced plexopathy