ABR Pain Medicine common mistakes
ABR Pain Medicine · Understand the traps and how to avoid them.
When a vignette describes burning pain, allodynia, and hyperalgesia, the candidate escalates an opioid and omits a neuropathic adjuvant, treating every pain as nociceptive.
Acute postoperative and musculoskeletal pain templates dominate study, so neuropathic descriptors are underweighted and pattern-matched to opioid escalation.
What to do instead
Use a mechanism checklist that separately asks about nociceptive, neuropathic, and nociplastic features; match the descriptors and exam to adjuvant classes and comorbidity/risk checks.
The candidate attributes contralateral loss of pain and temperature to the dorsal columns, or names a dermatome one level off from the clinical deficit.
Pathway names are memorized without tracing decussation, ascent, and the segmental relationship of landmarks.
What to do instead
Draw the spinothalamic and dorsal column pathways from receptor to cortex, state where each crosses, and rehearse landmark dermatomes and myotomes until localization is automatic.
The candidate documents only a 0–10 pain score and omits red flags such as fever, unexplained weight loss, bowel or bladder dysfunction, progressive weakness, or cancer history.
The numeric score is quick to chart and is reinforced as a routine vital sign, while the structured history is time-consuming.
What to do instead
Use a fixed pain-history template that forces red-flag review, neurologic examination, functional status, and psychosocial screening before writing a formulation.
The candidate attributes axial pain to a mild disc bulge or facet hypertrophy on imaging without checking whether the pain pattern and examination are concordant.
Imaging abnormalities are common in asymptomatic people but are visually salient and easy to overinterpret.
What to do instead
State the prevalence of incidental findings, require concordant examination or a diagnostic block, and document imaging as supportive rather than diagnostic.
The candidate converts morphine to methadone or transdermal fentanyl using a single linear table and prescribes the full calculated dose.
Equianalgesic tables look arithmetic, so nonlinear potency and incomplete cross-tolerance are easily missed.
What to do instead
Use a validated conversion and opioid-rotation method, reduce the calculated dose by roughly 25–50% when rotating, reassess frequently, and never start a fentanyl patch in an opioid-naive patient.
The candidate continues morphine or meperidine in advanced kidney disease or starts duloxetine in decompensated liver disease without dose adjustment or metabolite review.
Study focuses on analgesic potency and mechanism while renal and hepatic pharmacokinetics are treated as an afterthought.
What to do instead
Check renal and hepatic function before prescribing, choose agents with favorable metabolites, avoid meperidine, adjust doses for dialysis or organ failure, and monitor for accumulation.
The candidate schedules an epidural steroid injection or medial branch block without documenting anticoagulant and antiplatelet status or applying guideline-based hold intervals.
Procedure steps are memorized as technical actions, and medication reconciliation is assumed to be a nursing task.
What to do instead
Use a preprocedure checklist that records the agent, indication, renal function, hold and restart plan, bleeding risk, and shared decision before the procedure is booked.
The candidate performs a block at a level or side taken from the referral note without independent verification, or skips a documented preprocedure time-out.
Time pressure and reliance on staff create a presumption that laterality and level are already correct.
What to do instead
Verify level and laterality against imaging, consent, and patient marking; perform and document a time-out; confirm needle position with imaging before injecting.
The candidate writes a purely pharmacologic or procedural plan without functional goals, psychological screening, physical therapy, or sleep self-management.
Pharmacology and procedures are concrete and testable, while the biopsychosocial model is treated as abstract background.
What to do instead
Include measurable functional goals, screen for depression, anxiety, and catastrophizing, refer to physical therapy or CBT when indicated, and reassess function rather than pain score alone.
The candidate documents controlled-substance continuation or an invasive procedure without a risk-benefit discussion, informed consent, aberrant-behavior plan, or prescription-monitoring review.
Documentation and regulatory content are perceived as clerical and low-yield compared with diagnosis and technique.
What to do instead
Use a standardized note or checklist covering indication, alternatives, consent, prescription-monitoring review, urine drug testing, naloxone, a written agreement, follow-up, and professional boundaries.