ABEM Pain Medicine flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

A-delta fibers

Thinly myelinated primary afferent fibers with fast conduction velocity that transmit sharp, well-localized first pain via glutamate release onto dorsal horn neurons.

C fibers

Unmyelinated, slow-conducting nociceptors that mediate dull, burning second pain and release substance P and glutamate in the dorsal horn.

Substantia gelatinosa

Lamina II of the dorsal horn, rich in interneurons and opioid receptors, where primary afferent input is modulated before projection to higher centers.

Gate control theory

Melzack and Wall model in which large-diameter Abeta mechanoreceptor input activates inhibitory interneurons in the dorsal horn, reducing transmission of nociceptive signals from A-delta and C fibers.

Mu opioid receptor

Gi-coupled receptor whose activation inhibits adenylyl cyclase, opens potassium channels, and closes calcium channels, reducing neuronal excitability and neurotransmitter release.

Local anesthetic mechanism

Bind the intracellular side of voltage-gated sodium channels, blocking sodium influx and action potential propagation; inflamed tissue has lower pH, increasing ionized drug and slowing onset.

DN4 questionnaire

Ten-item clinician-administered screening tool for neuropathic pain; a total score of 4 or more out of 10 suggests neuropathic pain and warrants further evaluation.

SOCRATES mnemonic

A mnemonic for pain history: Site, Onset, Character, Radiation, Associated symptoms, Time course, Exacerbating and relieving factors, and Severity.

Allodynia

Pain produced by a stimulus that does not normally provoke pain, such as light touch, and often indicates central or peripheral sensitization in neuropathic states.

Hyperalgesia

An increased painful response to a stimulus that is normally painful, reflecting sensitization of nociceptors or central pain pathways.

Red flags back pain

Features suggesting serious spinal pathology, including fever, unexplained weight loss, cancer history, bowel or bladder dysfunction, saddle anesthesia, and progressive neurologic deficit.

Acetaminophen maximum dose

Usual adult maximum is 4,000 mg per day; consider limiting to 3,000 mg or less in hepatic impairment, chronic alcohol use, malnutrition, or low body weight.

Tramadol risks

Weak mu-opioid agonist and serotonin-norepinephrine reuptake inhibitor; lowers seizure threshold, can precipitate serotonin syndrome, and is contraindicated with monoamine oxidase inhibitors.

Buprenorphine ceiling effect

Partial mu agonist with high receptor affinity; respiratory depression plateaus at higher doses, but it can precipitate withdrawal in patients receiving full agonist opioids.

Gabapentin mechanism

Binds the alpha-2-delta subunit of voltage-gated calcium channels on presynaptic terminals, reducing calcium influx and release of excitatory neurotransmitters such as glutamate and substance P.

Duloxetine indication

Serotonin-norepinephrine reuptake inhibitor approved for diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain; efficacy is independent of coexisting depression.

Meperidine metabolite

Normeperidine, a renally cleared active metabolite that accumulates with repeated dosing and can cause myoclonus, agitation, and seizures; meperidine is avoided for chronic pain.

Medial branch block

Diagnostic injection of local anesthetic onto the medial branch of the dorsal ramus to identify facet joint-mediated pain; concordant relief of 80% or more supports radiofrequency denervation.

Transforaminal epidural risk

Particulate corticosteroids can occlude small radicular arteries and cause spinal cord infarction; nonparticulate dexamethasone is often preferred, and injection should stop if vascular uptake occurs.

Stellate ganglion block

Injection near the C6 anterior tubercle targeting the sympathetic chain; successful block produces Horner syndrome with ptosis, miosis, and anhidrosis, and may relieve complex regional pain syndrome.

Spinal cord stimulation

Implanted epidural electrodes delivering electrical pulses to dorsal columns; paresthesia-based and paresthesia-free waveforms are used mainly for persistent radicular pain after spine surgery.

Ziconotide

Intrathecal synthetic conopeptide that blocks N-type voltage-gated calcium channels; it requires slow titration because of risks of confusion, ataxia, and psychiatric symptoms.

Cognitive behavioral therapy

Structured psychological treatment targeting maladaptive thoughts and behaviors that maintain pain-related disability; it has strong evidence for improving function and distress in chronic pain.

Graded exposure

Behavioral technique in which patients gradually confront feared movements or activities in a planned hierarchy, reducing fear avoidance and restoring function without triggering excessive pain.

Fear avoidance model

Model proposing that catastrophic misinterpretation of pain leads to avoidance of activity, deconditioning, and disability, creating a self-reinforcing cycle of chronic pain.

Pacing

Activity regulation strategy alternating activity and rest before pain flares, aiming to avoid the overactivity-underactivity cycle and improve sustained function.

Multidisciplinary pain program

Coordinated care combining medical management, physical therapy, and psychological intervention, often with group sessions; it improves function and reduces healthcare use in chronic pain.

Prescription drug monitoring program

State database of controlled substance prescriptions; querying it before prescribing helps identify multiple prescribers, high doses, and possible misuse.

Schedule II prescribing

Controlled substances with high abuse potential and accepted medical use; federal rules prohibit refills, require a written or qualifying electronic prescription, and limit quantity.

Informed consent elements

Must include diagnosis, nature and purpose of the proposed procedure, material risks and benefits, alternatives including no treatment, and confirmation of patient understanding and voluntary agreement.

HIPAA

Federal law protecting identifiable health information; permitted disclosures include treatment, payment, and operations, while other uses generally require patient authorization or de-identification.

ALARA principle

As Low As Reasonably Achievable principle for radiation safety: minimize fluoroscopy time, use pulsed mode and collimation, and maximize distance from the radiation source.