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Module 17 · Anaesthesia Blueprints

Pain medicine: exam notes and MCQs

Prepare pain medicine for postgraduate anaesthesia examinations with structured notes, exam-style questions and referenced explanations from standard textbooks and current guidelines.

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Exam notes in this module

Pain pathways and interventional pain
Nociception, modulation, neuropathic pain and common interventional blocks.
Acute postoperative pain and the acute pain service
Assessment, multimodal analgesia, PCA and epidurals, opioid safety, special groups and preventing chronic pain.
Chronic and cancer pain
Mechanisms, assessment, neuropathic pain drugs, CRPS, the WHO ladder, opioid rotation and interventional options.

Sample questions

Q1. Gabapentin and pregabalin produce analgesia mainly by binding to:

  1. GABA-A receptors
  2. The α2δ subunit of voltage-gated calcium channels
  3. NMDA receptors
  4. μ-opioid receptors
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Answer B: The α2δ subunit of voltage-gated calcium channels

Despite being structural analogues of GABA, gabapentinoids bind the α2δ subunit of spinal voltage-gated Ca²⁺ channels, reducing excitatory neurotransmitter release and producing antihyperalgesic effects.

Exam style: AIIMS INI-SS

Q2. Topical capsaicin produces analgesia by acting on:

  1. TRPV1 receptors on nociceptors
  2. Sodium channels Nav1.7
  3. Cannabinoid CB1 receptors
  4. P2X3 purinergic receptors
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Answer A: TRPV1 receptors on nociceptors

Capsaicin is a TRPV1 agonist: it initially activates heat/proton-sensitive nociceptors (burning), then causes defunctionalisation and depletion of substance P in nociceptive terminals, giving prolonged analgesia (e.g. 8% patch for post-herpetic neuralgia).

Exam style: NEET-SS Anaesthesia

Q3. For pre-emptive/preventive analgesia, a typical IV ketamine dose is:

  1. 0.15–0.25 mg/kg
  2. 1–2 mg/kg
  3. 4–6 mg/kg
  4. 10 mg/kg
Show answer

Answer A: 0.15–0.25 mg/kg

Sub-anaesthetic ketamine (≈ 0.15–0.25 mg/kg IV for preventive analgesia; 0.2–0.8 mg/kg IV for sedation/analgesia) reduces opioid consumption and hyperalgesia through NMDA antagonism, with fewer psychomimetic effects than induction doses (1–2 mg/kg IV).

Exam style: NEET-SS Anaesthesia

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