Chronic Non-Cancer Pain, Neuropathic Pain, Musculoskeletal Syndromes, and Interventional Modalities — WACS Viva & Clinical Scenarios (Pre-Op & Pain Clinic Rotation)

Exam-style chronic non-cancer pain, neuropathic pain, musculoskeletal syndromes, and interventional modalities viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: A 50-year-old male civil servant presents to your outpatient chronic pain clinic with a 9-month history of burning, lancinating low back pain radiating down his left posterior thigh and lateral calf to the sole of his foot. His symptoms began after lifting a heavy generator. On examination, he has hypoaesthesia in the left S1 dermatome, absent left Achilles tendon reflex, and a positive left straight leg raise at 30 degrees. His DN4 score is 8/10. An MRI reveals an L5/S1 central-left paracentral disc protrusion. How would you systematically structure his pain management plan, incorporating neu
• SCENARIO 2: A 28-year-old woman is referred to the pain clinic 10 weeks following cast removal for a left distal radius fracture. She complains of intense, constant burning pain in her left hand and wrist that is out of proportion to the original injury. Physical examination reveals exquisite allodynia to light cotton wool brushing, diffuse non-pitting oedema, mottled bluish-red skin, increased sweating of the palm, and restricted active finger flexion. How will you apply the Budapest criteria to establish the diagnosis of Complex Regional Pain Syndrome (CRPS), and what is your comprehensive multimodal ma
• SCENARIO 3: A 68-year-old female with long-standing Type 2 diabetes mellitus presents with a 2-year history of bilateral, symmetrical, severe burning and tingling pain in both feet and lower legs (stocking distribution). She cannot tolerate bedsheets touching her feet at night. Her current medications include metformin and glibenclamide; her HbA1c is 8.4%. She has no history of peripheral vascular disease. Detail your step-by-step pharmacological escalation protocol for painful diabetic peripheral neuropathy, defending your first-, second-, and third-line drug choices and monitoring their adverse effect p
• SCENARIO 4: A 62-year-old male with severe chronic axial low back pain aggravated by lumbar extension and rotation, but with no lower limb radicular symptoms, is referred to your pain clinic. He has tried high-dose oral NSAIDs, resulting in an episode of upper gastrointestinal bleeding. Plain radiographs and MRI show advanced lumbar facet joint osteoarthritis at L4/L5 and L5/S1. Describe your diagnostic and therapeutic approach using diagnostic medial branch blocks (MBBs) and subsequent radiofrequency ablation (RFA).