ABR Pain Medicine flashcards

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

A-delta nociceptors

A-delta fibers are thinly myelinated nociceptors that conduct sharp, fast pain and terminate mainly in dorsal horn lamina I and V.

C fibers

C fibers are unmyelinated nociceptors that conduct slow, dull pain and terminate predominantly in dorsal horn lamina I and II.

Spinothalamic tract

The spinothalamic tract carries nociceptive and thermal information from the dorsal horn across the midline and upward to the thalamus.

Dorsal horn lamina II

Lamina II, the substantia gelatinosa, receives many C-fiber nociceptive inputs and modulates pain transmission through interneurons and opioid receptors.

Central sensitization

Central sensitization is increased nociceptive neuron excitability after sustained input, producing hyperalgesia and allodynia through NMDA receptor-dependent plasticity.

Descending pain modulation

Descending pathways from the periaqueductal gray and rostral ventromedial medulla can inhibit or facilitate spinal nociceptive transmission.

Neuropathic pain mechanism

Neuropathic pain arises from lesion or disease of the somatosensory nervous system and involves ectopic discharges, altered ion channels, and central reorganization.

Numeric rating scale

The numeric rating scale asks patients to rate pain from 0 to 10, with 0 meaning no pain and 10 meaning worst imaginable pain.

DN4 questionnaire

The DN4 questionnaire screens for neuropathic pain using sensory descriptors and bedside examination items; a score of 4 or more suggests neuropathic pain.

LANSS scale

The Leeds Assessment of Neuropathic Symptoms and Signs uses symptom items and sensory examination; a total score of 12 or more suggests neuropathic pain.

Red flag headache

New headache with fever, neck stiffness, focal deficit, papilledema, or sudden severe onset warrants urgent evaluation for dangerous secondary causes.

Pain history elements

A pain history documents onset, location, quality, intensity, timing, aggravating and relieving factors, associated symptoms, and prior treatments.

Diagnostic block

A diagnostic block temporarily interrupts a specific nerve or structure with local anesthetic to test whether that pathway contributes to the patient's pain.

PHQ-9 in pain

The PHQ-9 quantifies depressive symptom severity over two weeks and helps identify depression that may amplify pain-related disability.

Acetaminophen ceiling dose

For most adults, acetaminophen should not exceed 3,000 to 4,000 mg per day; lower limits apply with liver disease or chronic alcohol use.

Opioid equianalgesia

Opioid equianalgesia converts one opioid dose to another using approximate potency ratios, then reduces for incomplete cross-tolerance and patient-specific factors.

Naloxone reversal

Naloxone rapidly reverses opioid-induced respiratory depression; repeat doses may be needed because naloxone has a shorter duration than many opioids.

Gabapentinoid use

Gabapentin and pregabalin bind alpha-2-delta calcium channel subunits and are used for neuropathic pain, with renal dose adjustment required.

SNRI neuropathic pain

Duloxetine and venlafaxine treat neuropathic pain by inhibiting serotonin and norepinephrine reuptake; duloxetine is FDA-approved for diabetic peripheral neuropathic pain.

NSAID gastrointestinal risk

NSAIDs increase gastrointestinal bleeding risk, especially with age over 65, ulcer history, anticoagulants, corticosteroids, or high-dose long-term use.

Epidural steroid indication

Epidural corticosteroid injection is considered for radicular pain when conservative care fails, after excluding infection, coagulopathy, and progressive neurologic deficit.

Facet radiofrequency

Medial branch radiofrequency ablation treats facet-mediated pain after diagnostic medial branch blocks confirm the affected levels.

Stellate ganglion block

A stellate ganglion block targets sympathetic fibers in the lower cervical chain and may relieve complex regional pain syndrome of the upper limb.

Trigger point injection

Trigger point injection delivers local anesthetic or saline into a taut muscle band to relieve myofascial pain and restore muscle function.

Spinal cord stimulation

Spinal cord stimulation applies electrical pulses to dorsal columns to modulate pain transmission and is used for persistent neuropathic limb pain.

Anticoagulation before block

Before interventional pain procedures, anticoagulants and antiplatelets must be managed according to bleeding risk and guideline-specific interruption intervals.

Biopsychosocial model

The biopsychosocial model explains pain and disability through interacting biological, psychological, and social factors rather than tissue pathology alone.

Cognitive behavioral therapy

CBT for chronic pain targets unhelpful thoughts and behaviors, teaching coping skills to reduce distress and improve function.

Graded exposure

Graded exposure gradually increases activity or movement that fear has avoided, reducing fear-avoidance and improving functional tolerance.

Opioid treatment agreement

An opioid treatment agreement documents informed consent, monitoring expectations, safe storage, refill rules, and reasons for discontinuation.

Prescription drug monitoring

Prescription drug monitoring programs track controlled substance dispensing and help clinicians identify multiple prescribers, overlapping opioids, and risky combinations.

Interdisciplinary pain team

Interdisciplinary pain care coordinates physicians, psychologists, physical therapists, and others toward shared functional goals rather than isolated symptom reduction.