Prescribing Safety Assessment (PSA) Practice Exam

What is considered the first-line treatment for neuropathic pain?

1. Amitriptyline 10mg PO ON

2. Gabapentin 300mg

3. Cyclobenzaprine 5mg

4. Pregabalin 150mg

The correct answer is: Amitriptyline 10mg PO ON

Amitriptyline is considered a first-line treatment for neuropathic pain primarily due to its established efficacy in managing chronic pain conditions, especially those of neuropathic origin. Amitriptyline, a tricyclic antidepressant, works by inhibiting the reuptake of serotonin and norepinephrine, which can help modulate pain transmission pathways in the nervous system. Studies have indicated that lower doses of amitriptyline, such as 10mg taken once daily at night, can provide significant pain relief while also minimizing common side effects often associated with higher doses. Additionally, its sedative properties can be beneficial for patients who may also suffer from sleep disturbances related to their pain. Other treatments, such as gabapentin and pregabalin, are also used for neuropathic pain but may be considered after a trial of amitriptyline or when a patient has contraindications or intolerances to it. Cyclobenzaprine, on the other hand, is primarily a muscle relaxant and does not have the same established effectiveness for neuropathic pain, making it more appropriate for conditions involving musculoskeletal pain rather than neuropathy. In summary, amitriptyline is favored for its dual action in