ABPN Pain Medicine flashcards

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

DN4 questionnaire

A ten-item screening tool for neuropathic pain; seven symptom items and three examination items; a total score of four or more suggests neuropathic pain.

LANSS scale

Leeds Assessment of Neuropathic Symptoms and Signs; seven items including dynamic mechanical allodynia and pinprick; maximum 24; score 12 or higher suggests neuropathic pain.

PainDETECT

A nine-item screening questionnaire for neuropathic pain; total score ranges from negative one to 38; 19 or higher indicates likely neuropathic pain, 12 or lower makes it unlikely.

Numeric Rating Scale

A single-item pain intensity measure from zero to ten, where zero means no pain and ten means worst imaginable pain; easy to administer but captures only intensity.

Red flags in pain

Clinical features suggesting serious pathology, including fever, unexplained weight loss, night pain, progressive neurologic deficit, bowel or bladder dysfunction, cancer history, and significant trauma.

Central sensitization

Amplified nociceptive signaling in the central nervous system producing hypersensitivity, allodynia, and spreading pain beyond the original injury site; common in fibromyalgia and chronic widespread pain.

Acetaminophen ceiling dose

For most adults the maximum recommended acetaminophen dose is 4,000 mg per day; lower limits are advised with liver disease, heavy alcohol use, or malnutrition because hepatotoxicity risk rises.

NSAID risks

Nonsteroidal anti-inflammatory drugs inhibit cyclooxygenase, reducing prostaglandins; they can cause gastrointestinal bleeding, renal injury, fluid retention, and increased cardiovascular events, especially with long-term use.

Tramadol mechanism

Tramadol is a weak mu-opioid agonist and serotonin-norepinephrine reuptake inhibitor; it lowers seizure threshold and can precipitate serotonin syndrome, especially with serotonergic drugs.

Duloxetine indication

A serotonin-norepinephrine reuptake inhibitor approved for diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain; usual starting dose is 30 mg daily, often increased to 60 mg.

Buprenorphine properties

A partial mu-opioid agonist with high receptor affinity and ceiling effect on respiratory depression; it can precipitate withdrawal in opioid-dependent patients and is used for chronic pain and opioid use disorder.

Naloxone reversal

An opioid antagonist used for suspected opioid overdose; it reverses respiratory depression but may precipitate acute withdrawal; repeated doses or infusion may be needed because its duration is shorter than many opioids.

Facet medial branch block

A diagnostic injection targeting the medial branch nerves that innervate a facet joint; pain relief from the block supports proceeding to radiofrequency ablation of those nerves.

Radiofrequency ablation

A procedure using heat generated by radiofrequency current to create a controlled nerve lesion; it reduces pain transmission and is commonly applied to medial branches for facet-mediated pain.

Stellate ganglion block

A sympathetic block at the cervicothoracic level used for upper extremity complex regional pain syndrome; risks include Horner syndrome, hoarseness, pneumothorax, and inadvertent vascular injection.

Celiac plexus block

A sympathetic block targeting the celiac plexus to relieve upper abdominal visceral pain, especially pancreatic cancer pain; it can cause hypotension, diarrhea, and back pain.

Spinal cord stimulation

Neuromodulation delivering electrical pulses to the dorsal columns through implanted electrodes; it is used for persistent neuropathic pain and failed back surgery syndrome after conservative treatment fails.

Epidural steroid injection

Delivery of corticosteroid, often with local anesthetic, into the epidural space for radicular pain; risks include infection, bleeding, dural puncture, and transient steroid effects such as hyperglycemia.

Cognitive behavioral therapy

A structured psychological treatment targeting maladaptive thoughts and behaviors related to pain; it reduces catastrophizing and disability and is recommended for chronic pain.

Fear-avoidance model

A model proposing that catastrophic interpretations of pain lead to fear, avoidance, disuse, and depression; graded exposure aims to interrupt this cycle and restore activity.

Graded activity

A rehabilitation approach that starts with baseline activity and gradually increases duration or intensity according to a planned quota, rather than waiting for pain to disappear.

Pain catastrophizing

An exaggerated negative mental set toward pain, including rumination, magnification, and helplessness; higher scores predict greater disability and are measured with the Pain Catastrophizing Scale.

Operant conditioning

A behavioral model in which pain behaviors are reinforced by attention, rest, or medication while well behaviors are ignored; treatment reinforces activity and self-management instead of illness behavior.

Biopsychosocial model

An approach explaining pain and disability through interacting biological, psychological, and social factors; it guides assessment and multimodal treatment rather than focusing only on tissue pathology.

Interdisciplinary team

A team with a shared assessment and treatment plan that communicates regularly across disciplines; it differs from a multidisciplinary team, which may provide separate services without integrated goals.

Functional restoration

An intensive interdisciplinary program combining physical conditioning, pain education, and psychological support to improve function and work capacity in chronic disabling pain.

Shared decision making

A collaborative process in which clinicians present evidence-based options and patients express values and preferences; together they select a treatment plan consistent with patient goals.

Stepped care

A care model starting with low-intensity, lower-risk interventions and advancing to more intensive or specialized treatments when response is inadequate or risk increases.

Informed consent elements

Valid informed consent requires capacity, disclosure of diagnosis, proposed procedure, material risks and benefits, alternatives, and no guarantee of outcome, followed by voluntary authorization.

HIPAA minimum necessary

A privacy rule principle requiring covered entities to limit protected health information disclosure to the minimum needed for the purpose, except for treatment, certain operations, and authorized requests.

Schedule II refills

Controlled substances in Schedule II cannot be refilled without a new prescription; in contrast, Schedule III to V prescriptions may allow up to five refills within six months.

Malpractice elements

A negligence claim requires duty of care, breach of that duty, causation linking breach to harm, and damages; all four elements must be established for liability.