Pain Medicine (Acute and Chronic)
Acute Pain
Understand the physiology of nociception and the multimodal analgesia approach. Know the role of opioids, NSAIDs, acetaminophen, regional techniques, and adjuncts such as ketamine and gabapentinoids. Understand the concept of opioid tolerance and opioid-induced hyperalgesia, and the management of acute pain in patients on chronic opioids.
Chronic Pain
Know the classification of pain (nociceptive, neuropathic, central), the principles of neuropathic pain management (tricyclic antidepressants, gabapentinoids, SNRIs), and the role of interventional techniques. Understand the biopsychosocial model and the importance of multidisciplinary care.
Specific Syndromes
Know complex regional pain syndrome, phantom limb pain, and low back pain. Understand the indications and complications of epidural steroid injections and nerve blocks.
Traps
Questions often test the first-line agent for neuropathic pain (gabapentin or a TCA, not an opioid) and the recognition of opioid-induced hyperalgesia. Another trap is the belief that all chronic pain requires escalating opioids; the biopsychosocial approach and non-opioid adjuvants are preferred. Also know that NSAIDs should be avoided in renal impairment and after some surgical procedures.
Worked Example
A patient with diabetic neuropathy and a burning pain in the feet. First-line treatment is a gabapentinoid or a tricyclic antidepressant, with titration to effect; opioids are not first-line.