American Board of Internal Medicine (ABIM) Certification Practice Exam

What is an appropriate adjunctive treatment for persistent pain in chronic pancreatitis after initial analgesic trials?

1. Gabapentin

2. Pregabalin

3. Begin a low-dose corticosteroid

4. Topical anesthetics

The correct answer is: Pregabalin

In the management of persistent pain associated with chronic pancreatitis, adjunctive treatments can be crucial after initial analgesic trials have not provided adequate relief. Pregabalin is a medication that serves as an adjunctive analgesic for neuropathic pain and is particularly effective in cases where pain has a neuropathic component. This medication works by modulating calcium channels in the central nervous system, which helps inhibit excitatory neurotransmitter release. As a result, it can help alleviate pain effectively in patients experiencing chronic pain syndromes. Pregabalin has been supported by clinical studies showing its efficacy in managing neuropathic pain, which may also be part of the discomfort stemming from chronic pancreatitis, especially when inflammation or injury to nearby structures creates neuropathic features. Other treatments, such as gabapentin, can similarly be beneficial in managing chronic pain, but pregabalin has a more favorable pharmacokinetic profile, such as a more predictable absorption and dosing regimen, which may enhance its effectiveness as a treatment option. Low-dose corticosteroids, while having potential anti-inflammatory effects, might not directly address the type of pain commonly seen in chronic pancreatitis. Likewise, topical anesthetics typically are not used as a first-line treatment for this form of pain, as