A 66-year-old man comes to the physician because of tingling in his feet and difficulty walking for the past 2 months. He says he has been tripping on sidewalks recently. He found a cut on his foot a month ago but has no knowledge of when it occurred. The patient has a 6-year history of HIV infection. He was not adherent to treatment initially but now takes antiretroviral therapy regularly. His most recent CD4 cell count was 550/mm³. Vital signs are within normal limits. Foot examination shows There is reduced proprioception, sensation to touch and loss of reflexes in both feet and ankles. There are no other focal neurologic deficits. Medication review shows no neurotoxic drugs and laboratory studies are within normal limits. Treatment with duloxetine is planned. This medication is most likely to improve this patient's symptoms via which of the following mechanisms?

Question

Quizplus · Accepted Answer

Eductional Objective: Serotonin-norepinephrine reuptake inhibitors are often used for neuropathic pain.  They increase norepinephrine in the central synapses, which modulates the descending pain pathway, leading to decreased central perception of pain.

A 66-Year-Old Man Comes to the Physician Because of Tingling