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

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

38. Which of the following is Wrong? (A) Opioids activate central μ opioid receptor which causing decreased peristalsis, decreased intestinal secretions, and increased sphincter tone. (B) Pain act as a physiologic antagonist to respiratory depression. (C) Up to two-thirds of patients experience nausea or vomiting during initiation of opioid therapy. (D) Antihistamines, opioid antagonists, propofol and ondansetron have been used for the treatment of pruritus.

39. 此超音波顯像圖示中，針尖位置於何處是最合適於星狀神經節注射？ (A) 1 (B) 2 (C) 3 (D) 4 (E) 5

40. Based on published monotherapy clinical trials, which one has negative results for treating postherpetic neuralgia? (A) Amitriptyline (B) Gabapentin (C) Oxycodone (D) Carbamezepine (E) Topical lidocaine patch

41. The major problems in using NSAIDs in acute use did not include: (A) allergic reaction (B) renal failure (C) coagulation problems (D) impact on healing processes, particularly of bone (E) all of the above were concerns with NSAIDs

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