American Board of Internal Medicine (ABIM) Certification Practice Exam

What other medications can be beneficial in treating neuropathic pain besides serotonin-norepinephrine reuptake inhibitors?

1. Dopamine agonists

2. Pregabalin and gabapentin

3. Tramadol

4. Carbamazepine

The correct answer is: Pregabalin and gabapentin

Pregabalin and gabapentin are indeed beneficial in treating neuropathic pain, making this the correct choice. These medications are anticonvulsants that work by modulating calcium channels in the nervous system, which helps to decrease excitatory neurotransmitter release. This mechanism addresses the underlying neural hyperexcitability often seen in neuropathic pain syndromes. Pregabalin is often prescribed for conditions such as diabetic neuropathy, post-herpetic neuralgia, and fibromyalgia, while gabapentin is commonly used for similar indications. Evidence from clinical studies supports their efficacy in reducing pain and improving quality of life for patients suffering from neuropathic pain. In contrast, while dopamine agonists can be effective for conditions like Parkinson's disease, they are not typically used for neuropathic pain; hence, their relevance is limited in this context. Tramadol may provide some pain relief, but it is not specifically indicated for neuropathic pain and has mixed evidence regarding efficacy compared to the other first-line treatments. Carbamazepine is primarily used for certain types of neuropathic pain, particularly trigeminal neuralgia, but it is not as broadly effective or frequently prescribed as pregabalin and gabapentin for a wider