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WHO Ladder and Neuropathic Pain — FRCA Final MCQ

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EasyPain MedicineWHO Ladder and Neuropathic PainFRCA Final

A 42-year-old man (ASA I) presents to the pain clinic with a 3-month history of burning, shooting pain in the right T6 dermatome following shingles. On examination there is allodynia over the affected area. According to the WHO pain ladder, neuropathic pain is best managed by:

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Correct answer: E — Using disease-specific guidelines (NICE CG173) rather than the WHO ladder

The WHO analgesic ladder was designed for cancer pain and is not appropriate for neuropathic pain management. Neuropathic pain responds poorly to paracetamol and NSAIDs (steps 1-2 of the ladder). NICE CG173 provides disease-specific guidance recommending amitriptyline, duloxetine, gabapentin, or pregabalin as first-line treatments. The WHO ladder's step-wise escalation through conventional analgesics delays effective treatment for neuropathic pain.

Reference: NICE – 2020 – CG173 Neuropathic pain; Faculty of Pain Medicine – 2021 – Core curriculum