MS – Neuropathic Pain Management — SCE Neurology MCQ

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EasyMultiple Sclerosis & CNS InflammationMS – Neuropathic Pain ManagementSCE Neurology

A 55-year-old man with MS develops progressive spasticity-related neuropathic pain in both legs despite gabapentin 900 mg three times daily. He has already tried amitriptyline with intolerable anticholinergic side effects. What is the next pharmacological option per NICE guidance for neuropathic pain?

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Correct answer: C — Pregabalin

NICE CG173 recommends pregabalin as an alternative to gabapentin for neuropathic pain if the initial agent is insufficient or not tolerated. Other options include duloxetine. Tramadol is a short-term rescue option but not first-line. Amitriptyline has already been tried. A: Pregabalin is the appropriate next step. B: Carbamazepine is first-line for trigeminal neuralgia, not general neuropathic pain. C: NSAIDs are ineffective for neuropathic pain. D: Opioids are not first-line and have significant risks. E: Cannabidiol is not recommended by NICE for neuropathic pain in MS (Sativex/nabiximols may be considered for spasticity via NHS England, but that is different).

Reference: NICE CG173 Neuropathic Pain (2013, updated 2020); NICE NG100 MS (2022)