ABEM Pain Medicine case studies
ABEM Pain Medicine · Put your knowledge to work in context.
The ABEM Pain Medicine subspecialty certification is issued by the American Board of Emergency Medicine, an organization based in East Lansing, Michigan, whose stated purpose is to assure that emergency physicians have the knowledge and skills to deliver the highest quality care. ABEM maintains a Subspecialties section within its Get Certified and Stay Certified navigation, and Pain Medicine is one of the subspecialty areas associated with that structure. The ABEM Pain Medicine case studies are 5 cases and about 3,792 words.
1Diffuse Worsening Pain on Long-Term Opioids: Hyperalgesia, Tolerance, or Progression?
A 44-year-old woman developed L5 radiculopathy after a lifting injury three years ago. She had partial relief after laminectomy, and over two years her regimen was escalated to oxycodone ER 40 mg twice daily plus oxycodone IR 10 mg every 6 hours as needed, roughly 130 MME/day.
766 words, about 4 min2New Thoracic Pain in a Cancer Survivor Scheduled for Epidural Steroid Injection
A 64-year-old woman with stage II breast cancer treated with lumpectomy, radiation, and tamoxifen in 2018, now in remission, presents with six weeks of mid-thoracic pain. It began without trauma, is worse at night and when lying flat, and is not relieved by rest.
712 words, about 4 min3Analgesic Selection in Advanced CKD, Heart Failure, and Anticoagulation
A 72-year-old man with heart failure with reduced ejection fraction (30%), stage 4 chronic kidney disease (eGFR 26 mL/min/1.73 m²), and atrial fibrillation on warfarin presents with knee osteoarthritis pain rated 7/10 and six months of burning feet consistent with diabetic peripheral neuropathy. His other medications are furosemide, carvedilol, and sacubitril–valsartan.
744 words, about 4 min4Cervical Transforaminal Injection in a Patient on Apixaban with Prior Posterior Circulation Stroke
A 68-year-old man with C6 radicular pain and MRI showing a C5–6 disc herniation is referred for a C6–7 transforaminal epidural steroid injection. His history includes a posterior circulation stroke two years ago and atrial fibrillation; he takes apixaban 5 mg twice daily and aspirin 81 mg daily.
739 words, about 4 min5High-Dose Opioids, Severe Depression, and a Request for Escalation
A 52-year-old woman has chronic low back and leg pain six years after L4–S1 fusion. She takes hydromorphone 8 mg three times daily plus oxycodone 10 mg every 6 hours as needed, approximately 180 MME/day.
831 words, about 4 min