ABA Pain Medicine › Topic library
Pain Medicine topic library
87 free review pages, organized by the ABA Pain Medicine content outline. Each gives the bottom line, the key points, the numbers to know and the common traps, with sources.
G1 · Background concepts
- Developmental neurobiology of neonatal painNeonatal pain for boards: infant fMRI overlap with adult pain, lower nociceptive thresholds, sucrose for heel lance and venipuncture, AAP procedural policy.
- Medicolegal essentials: malpractice, NPDB, HIPAA, surrogates and impaired colleaguesLegal and ethical rules for boards: the four elements of malpractice, NPDB reporting, HIPAA disclosures and access, surrogate decisions and impaired colleagues.
- Opioid regulation: buprenorphine prescribing, MATE training and PDMPsOpioid regulation for boards: the end of the X-waiver, MATE Act 8-hour training, methadone only through OTPs, the 3-day rule, and PDMP checks in CDC 2022.
- Pain and public health: prevalence, overdose and naloxonePain and public health for boards: US chronic and high-impact pain prevalence, groups at risk, fentanyl-driven overdose deaths, and over-the-counter naloxone.
- Pain genetics: sodium channelopathies and opioid pharmacogeneticsPain genetics for boards: SCN9A loss vs gain of function, erythermalgia vs PEPD, CIPA, Nav1.7 in idiopathic small fiber neuropathy, and CPIC CYP2D6 guidance.
- Pain neurobiology: nociceptors, channels and central sensitizationPain neurobiology for boards: Nav1.7 loss and gain of function, CIPA, TRPV1 and capsaicin, central sensitization vs windup, and sex differences in immunity.
- Pain research methods: NNT, trial designs and clinical importancePain research methods for boards: NNT and NNH arithmetic, enriched-enrollment withdrawal trials, IMMPACT 30% and 50% benchmarks, and publication bias.
- Teamwork, safety and practice management in pain medicineTeamwork for boards: coordinating with other prescribers, structured handoffs, burnout, FMEA versus root cause analysis, visit coding and analgesia disparities.
G2 · Assessment
- Electrodiagnostic testing in pain medicineElectrodiagnostics for boards: preserved SNAPs in radiculopathy, needle EMG sensitivity and chronicity, foot drop localization, small fiber disease.
- Interpreting spine imaging in pain practiceSpine imaging for boards: degenerative findings in pain-free adults by age, when to image back pain, disc herniation regression, and matching MRI to symptoms.
- Pain history, physical examination and red flagsPain assessment for pain boards: which red flags matter, straight leg raise accuracy, inflammatory back pain, hip and trochanteric exam, and trigger points.
- Pain outcome measures and clinically important changePain outcome measures for boards: IMMPACT core domains and instruments, 30% and 50% change benchmarks, the PEG three-item scale, between-group interpretation.
- Placebo and nocebo effects in painPlacebo and nocebo for boards: naloxone-reversible placebo analgesia, prefrontal non-opioid mechanisms, open-label placebo, and how wording creates nocebo.
- Psychosocial assessment in chronic painPsychosocial assessment for boards: STarT Back risk stratification, PHQ-9 and GAD-7 cut-offs, recovery expectations, and professional interpreters.
- Sex and gender differences in painSex and gender in pain for boards: clinical pain risk in women, experimental sensitivity, microglia vs T cells in mice, kappa-opioid responses, NIH SABV policy.
G3 · Pharmacotherapy
- Analgesics in kidney and liver diseaseAnalgesics in renal and hepatic disease for boards: avoid morphine and codeine in dialysis, hydromorphone and tramadol changes, pregabalin on dialysis.
- Antidepressants for pain: TCAs and SNRIsTCAs and SNRIs for pain boards: first-line neuropathic pain drugs, duloxetine for CIPN and back pain, renal and hepatic limits, and Beers cautions.
- Gabapentinoids and sodium-channel anticonvulsants for painAnticonvulsants for pain boards: gabapentin and pregabalin kinetics, renal dosing and respiratory risk, carbamazepine HLA-B*15:02 and oxcarbazepine sodium.
- Intrathecal and epidural drugs: ziconotide, baclofen, clonidine and morphineIntrathecal pharmacology for boards: ziconotide titration and toxicity, baclofen withdrawal, epidural clonidine tapering and hypotension, and morphine safety.
- Ketamine infusions for acute and chronic painKetamine infusions for pain boards: ASRA/AAPM/ASA dose ceilings, opioid-tolerant surgery, CRPS evidence, contraindications, and sickle cell crisis dosing.
- Methadone safety: conversion, QTc and interactionsMethadone safety for boards: nonlinear conversion, slow titration, delayed respiratory depression, QTc screening thresholds, and CYP interactions.
- NSAIDs, celecoxib, ketorolac and acetaminophenNonopioid analgesic pharmacology for pain boards: NSAID kidney and aspirin interactions, ketorolac limits, celecoxib contraindications and acetaminophen dosing.
- Opioid pharmacology, MME and opioid conversionOpioid pharmacology for pain boards: MME, the label definition of opioid tolerance, CYP2D6 prodrugs, renal metabolites and opioids to avoid in older adults.
- Opioid risk mitigation, naloxone and taperingCDC 2022 opioid safety for pain boards: the 50 MME trigger, naloxone, benzodiazepine co-use, urine testing limits and how fast to taper long-term opioids.
- Skeletal muscle relaxants and cannabinoids for painMuscle relaxants and cannabinoids for boards: tizanidine CYP1A2 interactions, carisoprodol limits, Beers cautions, ACP back pain use, and cannabinoid evidence.
- Topical analgesics: lidocaine, capsaicin and topical NSAIDsTopical analgesics for pain boards: lidocaine 5% patch limits, capsaicin 8% mechanism and timing, topical before oral NSAIDs, and their role in neuropathic pain
G4 · Procedural
- Anticoagulants and antiplatelets for interventional pain proceduresAntithrombotics and pain procedures for boards: ASRA and ASIPP bleeding-risk tiers, DOAC, warfarin and antiplatelet holds, bridging, epidural hematoma.
- Basivertebral nerve ablation for vertebrogenic painBasivertebral nerve ablation for boards: vertebrogenic pain, Modic 1 and 2 changes, L3–S1 selection criteria, BVN anatomy, and the sham and standard-care RCTs.
- Dorsal root ganglion stimulationDorsal root ganglion stimulation for boards: the ACCURATE trial in lower-limb CRPS, focal targeting versus dorsal column SCS, and DRG contraindications.
- DREZ lesioning, midline myelotomy and chemical neurolytic agentsNeuroablation beyond cordotomy for boards: DREZ lesioning for avulsion pain, midline myelotomy for visceral cancer pain, and how alcohol and phenol differ.
- Epidural steroid injections: efficacy and safetyEpidural steroid injections for boards: small short-term benefit in sciatica, particulate vs nonparticulate steroid, contrast tiers, and interlaminar safety.
- Facet medial branch blocks and radiofrequency ablationFacet interventions for pain boards: medial branch anatomy, one prognostic block at 50% relief, electrode orientation, repeat RFA rules and genicular targets.
- Intrathecal drug delivery: selection, safety and complicationsIntrathecal pumps for pain boards: who benefits, catheter-tip granuloma, baclofen withdrawal, ziconotide toxicity and bleeding-risk rules for pump implantation.
- Local anesthetic systemic toxicity (LAST)Local anesthetic systemic toxicity for boards: ASRA 2020 lipid dosing, seizure care, small-dose epinephrine, drugs to avoid, prevention and observation.
- Neuroablative procedures: cordotomy and neurolytic blocksNeuroablative procedures for boards: cordotomy anatomy, candidates and complications, celiac neurolysis effects, plexus territories, and alcohol neurolysis.
- Percutaneous image-guided lumbar decompression (mild)Percutaneous image-guided lumbar decompression for boards: ligamentum flavum ≥2.5 mm, MIST criteria and contraindications, technique, and MiDAS ENCORE.
- Peripheral nerve stimulationPeripheral nerve stimulation for boards: direct PNS vs field stimulation and TENS, 60-day leads, ASPN graded indications, and the post-amputation pain RCT.
- Radiation safety, contrast and gadolinium in pain proceduresRadiation and contrast safety for pain boards: the inverse square law, which procedures need iodinated contrast, steroid choice without it, gadolinium cautions.
- Sacroiliac joint injections, lateral branch ablation and fusionSacroiliac joint procedures for pain boards: provocation tests, injection volume, S1–S3 lateral branch ablation, 50% thresholds and fusion selection evidence.
- Spinal cord stimulation: selection, trials, evidence, complicationsSpinal cord stimulation for pain boards: SENZA-PDN and EVOKE, what a screening trial does and does not show, anticoagulant holds and device infection.
- Sympathetic blocks: stellate, celiac, hypogastric and imparSympathetic blocks for pain boards: matching stellate, celiac, hypogastric and impar targets to territory, neurolysis side effects and bleeding risk.
- TENS and 60-day peripheral nerve stimulationTENS and 60-day PNS for boards: TENS intensity dosing, the ACR stance in osteoarthritis, gate control, and how a temporary PNS course differs from a trial.
G5 · Psychological, physical and integrative
- CBT, ACT, graded exposure and operant therapy for painPsychological pain therapies for boards: fear-avoidance and graded exposure, operant therapy and partners, ACT versus CBT, and pain neuroscience education.
- Depression, anxiety and suicide risk in chronic painDepression, anxiety and suicide risk in chronic pain for boards: PHQ-9 and GAD-7, duloxetine, avoiding benzodiazepines with opioids, and safe opioid tapering.
- Exercise therapy and rehabilitation for chronic painRehabilitation for pain boards: exercise as core therapy, staying active, passive modalities to avoid, and rehab evidence for back pain, OA, tendons and CRPS.
- Integrative therapies: acupuncture, tai chi, yoga, mindfulnessComplementary and integrative therapies for pain boards: ACP and ACR/AF grades for acupuncture, tai chi, yoga, massage and MBSR, plus supplements to avoid.
- Opioid use disorder and chronic pain: MOUD and acute painOpioid use disorder with pain for boards: offering MOUD, buprenorphine after the X-waiver, and acute pain care on methadone or buprenorphine.
- PTSD, insomnia, alcohol use and somatic symptom disorder in chronic painPsychiatric comorbidity beyond depression for boards: PTSD therapy, CBT for insomnia, alcohol treatment with opioids, and managing somatic symptom disorder.
- Return to work and work disability in chronic painReturn to work for pain boards: workplace interventions, recovery expectations as a prognostic factor, and when physical conditioning shortens sickness absence.
C1 · Taxonomy: classification of pain syndromes
C2 · Chronic widespread pain syndromes
C3 · Acute, trauma and procedural pain
- Acute and perioperative pain, including opioid-tolerant patientsAcute and perioperative pain for boards: multimodal analgesia, PCA safety, ketamine for opioid-tolerant patients, rib fractures and dural puncture headache
- Perioperative buprenorphine and methadonePerioperative buprenorphine and methadone for boards: continue maintenance, add multimodal analgesia, titrate full agonists on top, dose methadone safely.
- Regional analgesia and recovery after trauma and surgeryRegional analgesia for boards: hip and rib fractures, paravertebral and plane blocks, compartment syndrome, persistent postsurgical pain and whiplash.
- Sickle cell disease pain: acute crisis and chronic painSickle cell pain for boards: ASH 2020 analgesia timing, NSAID and ketamine adjuncts, steroids to avoid, chronic pain options, and the CDC 2022 exclusion.
C4 · Musculoskeletal pain
- Cervical facet pain, third occipital headache and medial branch RFACervical facet interventions for boards: C2–C3 and the third occipital nerve, single medial branch block with 50% cut-off, RFA technique, and limits of imaging.
- Cervical radiculopathy: localization and managementCervical radiculopathy for boards: C5–T1 root localization, Spurling and other provocative tests, favorable natural history, surgical red flags, steroid safety.
- Inflammatory, metabolic and soft-tissue musculoskeletal painNon-mechanical musculoskeletal pain for boards: polymyalgia, gout, spondyloarthritis, rheumatoid neck, frozen shoulder, hypothyroid myopathy and Charcot foot.
- Knee and hip osteoarthritis pain managementKnee, hip and hand osteoarthritis for pain boards: ACR/AF 2019 strong and conditional recommendations, injections, PRP, genicular ablation and mimics.
- Low back pain: evaluation and managementAcute and chronic low back pain for pain boards: red flags, when not to image, ACP nondrug-first treatment, STarT Back risk stratification and key traps.
- Lumbar spinal stenosis and neurogenic claudicationLumbar spinal stenosis for boards: neurogenic vs vascular claudication, NASS natural history, MRI, and MIST options from epidural steroids to PILD and spacers.
- Lumbosacral radicular pain (sciatica)Lumbar radicular pain for boards: straight leg raise accuracy, L5 vs fibular localization, disc regression, cauda equina red flags and deep gluteal mimics.
- Regenerative injections: PRP, stem cells and prolotherapyRegenerative injections for boards: ACR stance on PRP, stem cells, prolotherapy and hyaluronic acid, the RESTORE cartilage trial, and bisphosphonates in CRPS.
C5 · Cancer and cancer-related pain
- Cancer pain pharmacotherapy and opioid titrationCancer pain drugs for pain boards: the WHO ladder, titrating strong opioids, opioid tolerance for fentanyl products, methadone conversion and bowel prophylaxis.
- Interventional cancer pain: neurolysis, intrathecal therapy, cordotomyInterventional cancer pain for boards: neurolysis by territory, intrathecal pumps for widespread pain, cordotomy for unilateral pain, and cord compression.
- Opioid-induced constipation and narcotic bowel syndromeOpioid GI effects for boards: preventing constipation with a stimulant laxative, methylnaltrexone and naloxegol, and recognizing narcotic bowel syndrome.
- Painful bone metastases: radiation, bone agents and cord compressionPainful bone metastases for boards: ASTRO single-fraction 8 Gy, SBRT selection, dexamethasone and surgery for cord compression, and bone-modifying agents.
- Palliative care, hospice and end-of-life ethics in cancer painEnd-of-life care for boards: Medicare hospice eligibility, palliative sedation limits, assisted suicide, surrogate decisions and hypercalcemia of malignancy.
C6 · Visceral pain
- Abdominal wall pain, ACNES and pudendal neuralgiaAbdominal wall and pudendal pain for boards: Carnett sign, ACNES diagnosis by local anesthetic injection, neurectomy for refractory cases, Nantes criteria.
- Chronic abdominal and gastrointestinal visceral painChronic GI visceral pain for boards: IBS subtypes, post-cholecystectomy pain, chronic pancreatitis, acute hepatic porphyria and chronic mesenteric ischemia.
- Chronic pelvic pain: bladder pain, endometriosis, pudendal neuralgiaChronic pelvic pain for pain boards: bladder pain syndrome per AUA 2022, first-line hormones for endometriosis, and the Nantes criteria for pudendal neuralgia.
C7 · Headache and orofacial pain
- Chronic migraine and medication-overuse headacheChronic migraine and medication-overuse headache for pain boards: ICHD-3 day counts, triptan vs gepant safety, Botox dosing and indomethacin-responsive TACs.
- Cluster headache: diagnosis and treatmentCluster headache for boards: ICHD-3 attack criteria, oxygen and triptans as Level A acute therapy, suboccipital steroid prevention, and triptan cardiac limits.
- Secondary headache: giant cell arteritis, intracranial hypertension and postdural punctureSecondary headache for boards: treating giant cell arteritis before biopsy, the papilledema workup, and when a blood patch is needed after dural puncture.
- Tension-type headache, temporomandibular disorders and burning mouthCommon chronic primary head and face pain for boards: tension-type headache criteria and prophylaxis, TMD treatment recommendations and burning mouth evidence.
- Trigeminal neuralgia: ICHD-3 criteria and treatmentTrigeminal neuralgia for boards: ICHD-3 criteria, classical vs secondary, MRI work-up, carbamazepine and oxcarbazepine safety, and microvascular decompression.
C8 · Neuropathic pain
- Complex regional pain syndrome (CRPS)CRPS for pain boards: the Budapest criteria, functional restoration as core therapy, bisphosphonates, ketamine, DRG stimulation evidence and pediatric CRPS.
- Focal and atypical neuropathies: plexopathy, entrapment and treatment-inducedNeuropathies that mimic radiculopathy for boards: neuralgic amyotrophy, diabetic amyotrophy, treatment-induced neuropathy of diabetes and meralgia paresthetica.
- Herpes zoster and postherpetic neuralgiaPostherpetic neuralgia for pain boards: allodynia, zoster vaccine after shingles, lidocaine and capsaicin patches, pregabalin renal dosing, choices in elders.
- Pain in neurologic disease: Guillain-Barré, multiple sclerosis and ParkinsonPain in neurologic disease for boards: Guillain-Barré pain before weakness, MS and secondary trigeminal neuralgia, and Parkinson off-period pain and dystonia.
- Painful diabetic neuropathyPainful diabetic neuropathy for pain boards: AAN 2022 drug classes, NeuPSIG lines of therapy, opioid stance, capsaicin 8% and 10-kHz spinal cord stimulation.
- Phantom limb pain and central post-stroke painPhantom limb and central post-stroke pain for boards: thalamic stroke pain, amitriptyline and gabapentinoids, mirror therapy protocols, and prevalence.
- Small fiber neuropathy: diagnosis and causesSmall fiber neuropathy for boards: normal nerve conduction, skin biopsy for IENF density, QST, corneal microscopy, causes from diabetes to Nav1.7, and HIV.
C9 · Special cases
- Pain management in older adultsPain in older adults for pain boards: AGS Beers 2023 drugs to avoid, CNS-drug stacking and falls, NSAID and ketorolac limits, topical-first choices, fractures.
- Pain management in pregnancy and lactationPain in pregnancy and lactation for boards: NSAIDs after 20 weeks, opioid use disorder care in pregnancy, breastfeeding on MOUD, postdural puncture headache.
- Pediatric pain: neonates, children and adolescentsPediatric pain for pain boards: neonatal pain processing, codeine and tramadol limits, post-tonsillectomy analgesia, sickle cell crises and pediatric CRPS.
- Professionalism, error disclosure and quality in pain practiceProfessionalism for boards: AMA guidance on disclosing medical errors, Open Payments industry disclosure, quality obligations, and professional interpreters.