ABR Pain Medicine study plan

Map the ascending nociceptive tracts (spinothalamic, spinoreticular, spinomesencephalic, dorsal column postsynaptic) from primary afferent to cortical target, labeling each synaptic relay and the spinal level of decussation.

Explain transduction at free nerve endings, naming the channels and receptors (TRPV1, TRPA1, Nav1.7, Nav1.8, ASICs, purinergic receptors) that generate the generator potential, and describe how peripheral sensitization lowers firing threshold after tissue injury.

Differentiate A-beta, A-delta, and C fiber properties (diameter, myelination, conduction velocity, receptive field, neurotransmitter content) and relate each to first pain, second pain, and mechanical allodynia.

Diagram the descending inhibitory network from periaqueductal gray through rostral ventromedial medulla to the dorsal horn, showing serotonergic and noradrenergic outflow and where opioids act within it.

Describe central sensitization at the dorsal horn (wind-up, NMDA-dependent long-term potentiation, glial activation) and connect each mechanism to a bedside finding such as hyperalgesia or expanded receptive fields.

Compare mu, kappa, and delta opioid receptor signaling (G-protein coupling, potassium efflux, calcium channel inhibition, cAMP modulation) and derive from that mechanism the clinical features of analgesia, respiratory depression, constipation, and pruritus.

Explain the pharmacology behind opioid tolerance, opioid-induced hyperalgesia, and physical dependence, distinguishing each from addiction in mechanistically explicit terms.

Contrast nonselective COX inhibitors with COX-2 selective agents on the basis of prostaglandin synthesis, platelet function, gastric mucosal protection, and renal hemodynamics, and state which patient comorbidities change the choice.

Relate local anesthetic pKa, lipid solubility, and protein binding to onset, potency, and duration, and explain why an inflamed, acidic tissue bed blunts block onset.

Classify adjuvants (gabapentinoids, SNRIs, tricyclics, topical agents, NMDA antagonists) by mechanism and match each to the pain phenotype with the strongest supporting rationale.

Describe neuraxial and paravertebral anatomy relevant to safe needle placement, including ligamentous layers, epidural space characteristics at different spinal levels, and the relationships of the stellate, celiac, and lumbar sympathetic ganglia to adjacent vascular and visceral structures.

Sequence the fluoroscopic and landmark steps for six core procedures (interlaminar epidural, medial branch block, radiofrequency ablation, stellate ganglion block, lumbar sympathetic block, and celiac plexus block), stating the bony target, endpoint, and confirmatory contrast pattern for each.

Apply anticoagulation and antiplatelet hold intervals to specific periprocedural scenarios and justify each decision by bleeding risk versus thrombotic risk.

Select particulate versus nonparticulate steroid and contrast agent for each procedure, articulating the vascular territory at risk and the mitigation strategy.

Recognize and outline immediate management of the major procedural complications: intravascular injection, pneumothorax, epidural hematoma, discitis, and spinal cord injury.

Recognize local anesthetic systemic toxicity by its progression from perioral tingling and tinnitus through seizures to cardiovascular collapse, and recite the weight-based lipid emulsion rescue protocol including maximum dose and repeat dosing.

Evaluate the systemic consequences of injected corticosteroid, including hypothalamic-pituitary-adrenal suppression, hyperglycemia, and infection risk, and specify which patients warrant altered dosing or deferral.

Apply radiation safety principles (ALARA, fluoroscopy time, collimation, pulsed imaging, distance) to reduce dose during image-guided procedures.

Design a post-procedure monitoring and follow-up plan matched to procedure risk, including what to document and when to reassess.

Integrate domains 1, 3, and 4 by explaining the mechanistic basis for choosing a particular interventional versus pharmacologic approach in a complex pain presentation.

Elicit a structured pain history that captures onset, quality, temporal pattern, radiation, aggravating and relieving factors, functional impact, and prior treatment response.

Identify red-flag features in the history and examination that mandate urgent workup (progressive neurologic deficit, bowel or bladder dysfunction, fever, night pain, unexplained weight loss, new pain in a patient with cancer history) and state the immediate next step for each.

Perform and document a focused neurologic and musculoskeletal examination of the spine and extremities, including provocative tests and their interpretation.

Select and interpret assessment instruments appropriately (numeric rating scale, DN4 or LANSS for neuropathic pain, PHQ-9, GAD-7, opioid risk tool), naming the limitation of each.

Formulate a prioritized differential diagnosis distinguishing nociceptive, neuropathic, and nociplastic mechanisms, and match the diagnostic test with the highest yield to each differential.

Screen for and quantify psychological modifiers of pain (catastrophizing, fear avoidance, depression, anxiety, sleep disruption) and explain how each changes treatment selection and prognosis.

Describe the mechanisms and outcome evidence for cognitive behavioral therapy, acceptance and commitment therapy, and pain neuroscience education, and specify which patients are appropriate referrals.

Assemble a multidisciplinary rehabilitation plan integrating physical therapy, graded activity and functional restoration, occupational therapy, and psychological care with explicit functional goals.

Demonstrate motivational interviewing technique by scripting a conversation with a patient ambivalent about tapering opioids or engaging in rehabilitation.

Analyze how social determinants, culture, language, and implicit bias influence pain assessment and treatment equity, and name concrete corrective actions in practice.

Apply controlled-substance prescribing requirements, including prescription drug monitoring program review, risk-benefit documentation, treatment agreements, and urine drug testing interpretation with confirmatory testing principles.

Explain informed consent, shared decision-making, and documentation standards for interventional procedures, including what must appear in the note to demonstrate appropriate selection.

Outline regulatory and ethical obligations around impaired colleagues, conflict of interest with industry, billing integrity, and patient confidentiality in multidisciplinary settings.

Describe disability, workers' compensation, and impairment assessment frameworks, distinguishing functional capacity from impairment rating.

Identify disparities in pain treatment access and outcomes and propose practice-level changes that improve equity.

Complete two timed, full-length self-written mock examinations of 60 questions each spanning all five domains, under test-like conditions without reference material.

Analyze the resulting error log to rank the five weakest subtopics and re-derive each from primary principles until you can teach it aloud in under three minutes.

Reconstruct from memory the key tables built in weeks 2 through 7 (drug classes, procedure checklists, red flags, anticoagulation rules) and compare against the originals to find drift.

Practice rapid case-based decision making by verbalizing a diagnosis-to-treatment pathway for 15 mixed scenarios in under 90 seconds each.