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Chemotherapy-induced neuropathic pain — FRCA Final MCQ

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ModeratePain MedicineChemotherapy-induced neuropathic painFRCA Final

A 48-year-old woman has burning foot pain, allodynia and poor sleep six months after chemotherapy. She has tried amitriptyline but stopped because of urinary retention and confusion. Renal function and liver function are normal. What is the most appropriate pain management?

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Correct answer: D — Switch to duloxetine with functional goals and review

Duloxetine is a reasonable first-line or alternative agent for neuropathic pain when amitriptyline is not tolerated. Escalating an anticholinergic drug that caused confusion and urinary retention is inappropriate. Strong opioids are not first-line for chronic non-cancer neuropathic pain. Treatment should include education, sleep, mood and function rather than pain score alone.

Reference: NICE CG173 neuropathic pain; Faculty of Pain Medicine Core Standards