Déjerine-Roussy – First-Line Treatment — SCE Neurology MCQ

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HardCerebrovascular DiseaseDéjerine-Roussy – First-Line TreatmentSCE Neurology

A 69-year-old develops severe central post-stroke burning pain after a thalamic infarct. He has postural hypotension, urinary retention, prolonged PR interval and oedematous heart failure; renal function is normal. Which NICE first-line neuropathic-pain option is the best fit to his comorbidity profile?

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Correct answer: A — Duloxetine

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · B = shown as D

A can worsen orthostasis, urinary retention and cardiac conduction. B is a NICE initial option but dizziness and peripheral oedema make it less attractive with this patient’s falls and heart-failure profile. C is principally first line for trigeminal neuralgia and carries interaction and hyponatraemia burdens. D is correct: duloxetine is one of the NICE initial choices and avoids the antimuscarinic, conduction and oedema liabilities highlighted. E is not routine initial neuropathic-pain treatment.

Reference: NICE CG173: neuropathic pain in adults: https://www.nice.org.uk/guidance/cg173/chapter/Recommendations