ABFM Pain Medicine flashcards

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

Numeric Rating Scale

A self-report scale from 0 (no pain) to 10 (worst pain imaginable); a 2-point or 30% reduction is often used as a clinically meaningful improvement in chronic pain.

DN4 questionnaire

A 10-item neuropathic pain screen with 7 symptom and 3 examination items; a score of 4 or more out of 10 suggests a neuropathic component.

PainDETECT

A nine-item self-report questionnaire scored 0 to 38; 19 or higher suggests a likely neuropathic component, 13 to 18 is uncertain, and 12 or lower is unlikely.

Widespread Pain Index

A 0-to-19 count of painful body regions in the past week used in fibromyalgia assessment; it is combined with a 0-to-12 symptom severity score.

Fibromyalgia 2010 criteria

Diagnosis requires widespread pain for at least 3 months plus WPI 7 or more and SS 5 or more, or WPI 4-6 and SS 9 or more, without another explanation.

Pain Catastrophizing Scale

A 13-item measure scored 0 to 52 that assesses rumination, magnification, and helplessness about pain; scores of 30 or higher suggest clinically relevant catastrophizing.

Red flag headache features

New headache with fever, neurologic deficit, cancer history, age over 50, sudden maximal onset, or papilledema requires urgent evaluation for secondary causes such as infection or hemorrhage.

Acetaminophen ceiling dose

For most adults acetaminophen is limited to 3 g per day; 4 g per day is reserved for supervised short-term use, and liver disease or chronic alcohol use lowers the safe limit.

Naloxone dosing

For suspected opioid overdose, give intranasal naloxone 4 mg or intramuscular or intravenous naloxone 0.4 mg, repeating every 2 to 3 minutes while supporting ventilation.

Tramadol key risks

Tramadol is a weak mu agonist and serotonin-norepinephrine reuptake inhibitor; it lowers seizure threshold, can cause serotonin syndrome, and its analgesia depends on CYP2D6 metabolism.

Duloxetine pain uses

Duloxetine is approved for diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain; it is started at 30 mg daily and often titrated to 60 mg daily.

Gabapentin renal dosing

Gabapentin and pregabalin bind alpha-2-delta subunits and require dose reduction in renal impairment; common adverse effects include sedation, dizziness, peripheral edema, and weight gain.

Buprenorphine pharmacology

Buprenorphine is a partial mu-opioid agonist with high receptor affinity; it can precipitate withdrawal in opioid-dependent patients and has a ceiling effect on respiratory depression.

CDC 2022 opioid advice

The 2022 CDC guideline recommends individualized opioid therapy, prescription drug monitoring program review, naloxone when risk is elevated, and gradual tapering rather than abrupt discontinuation.

Medial branch block

A diagnostic injection of local anesthetic near the medial branch of the dorsal ramus; temporary relief of facet-mediated pain supports proceeding to radiofrequency ablation of the nerve.

Stellate ganglion block

An injection at the C6 level targeting the stellate ganglion; a successful block causes Horner syndrome with ptosis, miosis, and anhidrosis and may help upper-extremity complex regional pain syndrome.

Celiac plexus block

A sympathetic block used for upper abdominal visceral pain, especially pancreatic cancer pain; image guidance improves safety by avoiding the aorta, inferior vena cava, and diaphragmatic crura.

Spinal cord stimulation

Neuromodulation used for failed back surgery syndrome and complex regional pain syndrome; a successful trial precedes implantation, and lead migration or infection can occur.

Epidural steroid risks

Epidural steroid injection can cause infection, bleeding, dural puncture, nerve injury, and transient adrenal suppression; particulate steroids near the spinal cord carry a rare embolic risk.

Trigger point injection

Injection of a taut band with local anesthetic, with or without steroid, can relieve myofascial trigger point pain; evidence is limited and landmark guidance is typical.

CBT for chronic pain

Cognitive behavioral therapy targets maladaptive thoughts, catastrophizing, and fear-avoidance; it modestly improves pain coping and function and is a core psychological treatment for chronic pain.

Graded exposure

A rehabilitation approach that gradually introduces feared movements or activities to reduce fear-avoidance and disability; it is used when pain-related fear drives inactivity.

Acceptance and commitment therapy

ACT aims to increase psychological flexibility, accept unpleasant sensations, and commit to valued activity; mindfulness and values-based action are central components in chronic pain treatment.

Pain neuroscience education

Structured education explains pain as a protective output modulated by biological and psychosocial factors; it can reduce catastrophizing and fear when combined with active rehabilitation.

CBT-I first line

Cognitive behavioral therapy for insomnia is first-line treatment for chronic insomnia, including insomnia with chronic pain; it improves sleep and often pain-related function without medication.

Tampa Scale of Kinesiophobia

A 17-item self-report questionnaire measuring fear of movement and reinjury; higher scores indicate greater kinesiophobia, which can predict disability in chronic pain.

Biopsychosocial model

The biopsychosocial model explains pain through interacting biological, psychological, and social factors; it underpins multidisciplinary assessment and treatment rather than a purely biomedical approach.

MME conversion

Morphine milligram equivalents standardize opioid doses; morphine 30 mg equals 30 MME, oxycodone 20 mg equals 30 MME, and fentanyl 25 mcg/hour equals 60 MME.

PDMP check

A prescription drug monitoring program database tracks controlled substance dispensing; checking it before starting opioids and periodically helps identify multiple prescribers, overlapping prescriptions, and overdose risk.

Naloxone co-prescribing

Naloxone should be offered to patients at elevated opioid overdose risk, including those taking 50 MME or more daily, concurrent benzodiazepines, or with a substance use disorder history.

Urine drug testing

Urine drug testing in pain care confirms prescribed medication use and detects nonprescribed substances; unexpected results require clinical reassessment rather than automatic dismissal from care.

Interdisciplinary pain team

An interdisciplinary team includes medicine, psychology, physical therapy, occupational therapy, pharmacy, nursing, and social work, coordinating shared goals and treatments in a comprehensive pain program.