Neuropathic Cancer Pain — SCE Medical Oncology MCQ

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EasySupportive & Palliative OncologyNeuropathic Cancer PainSCE Medical Oncology

A 65-year-old man with cancer-related neuropathic pain (burning, shooting pain in a dermatomal distribution from tumour invasion of the brachial plexus) is not adequately controlled on morphine alone. What adjuvant analgesic should be added?

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Correct answer: D — Gabapentin or pregabalin

Neuropathic cancer pain (characterised by burning, shooting, lancinating quality ± allodynia) responds poorly to opioids alone and requires adjuvant analgesics. Gabapentinoids (gabapentin, pregabalin) are first-line adjuvants for neuropathic cancer pain per WHO and NICE guidelines. Antidepressants (amitriptyline, duloxetine) are alternatives. The combination of opioid + gabapentinoid addresses both nociceptive and neuropathic pain components.

Reference: NICE CG140 Opioids in palliative care; WHO Analgesic Ladder; ESMO 2024 Pain Guidelines; NICE NG193 Neuropathic pain