Most Common ABA Pain Boards Topics

I. Basic Science & Pain Mechanisms

Pain pathways: spinothalamic tract, dorsal columns, trigeminothalamic system
Peripheral sensitization, central sensitization, wind-up, hyperalgesia, allodynia
Neurotransmitters: glutamate, substance P, CGRP, GABA, serotonin, norepinephrine, endorphins
Receptor pharmacology: NMDA, opioid receptors, sodium/calcium channels
Pain modulation: descending inhibitory pathways, gate control theory

II. Pharmacology

Opioids: mechanism, side effects, tolerance, hyperalgesia, conversions, methadone/QT risk, buprenorphine
Non-opioid analgesics: NSAIDs, acetaminophen, adjuvants (gabapentinoids, TCAs, SNRIs)
Muscle relaxants: baclofen, tizanidine, benzodiazepines
Interventional drugs: local anesthetics (toxicity, dosing, LAST), corticosteroids (particulate vs non-particulate)
Intrathecal/epidural medications: morphine, hydromorphone, ziconotide, clonidine

III. Pain Syndromes

Low back pain: disc, facet, SI joint, myofascial
Neuropathic pain: CRPS, postherpetic neuralgia, diabetic neuropathy, trigeminal neuralgia
Cancer pain: bone mets, plexopathies, intrathecal therapy, celiac plexus block
Headache: migraine, cluster, tension, occipital neuralgia
Fibromyalgia and centralized pain syndromes

IV. Interventional Procedures

Epidural steroid injections: caudal, interlaminar, transforaminal (safety, anatomy, complications)
Facet interventions: medial branch blocks, radiofrequency ablation
SI joint injections and lateral branch RFA
Sympathetic blocks: stellate ganglion, lumbar sympathetic, celiac, hypogastric, ganglion impar
Peripheral nerve and plexus blocks for pain (occipital, pudendal, intercostal, genicular)
Vertebral augmentation: vertebroplasty, kyphoplasty
Neuromodulation: spinal cord stimulation, DRG stimulation, peripheral nerve stimulation
Intrathecal pumps: drug selection, complications

V. Imaging & Anatomy

Fluoroscopic anatomy: lumbar spine, cervical spine, sacrum, SI joint
Ultrasound anatomy for pain procedures
MRI/CT findings: disc herniation, Modic changes, compression fractures, tumors, infections
Radiation safety principles

VI. Special Populations

Pediatric pain (rare, but basics covered)
Geriatric pain management considerations
Pregnancy and pain procedures
Patients with substance use disorder

VII. Ethics, Safety, and Systems

Opioid prescribing guidelines (CDC, FDA REMS, risk mitigation)
Urine drug testing interpretation
Informed consent and documentation for procedures
Practice management, coding (CPT/ICD-10), compliance issues
Psychological aspects of pain, biopsychosocial model
Addiction vs dependence vs tolerance

✅ Summary:
The exam is heavily weighted toward:

Pharmacology & mechanisms (opioids, adjuvants, local anesthetics)
Spine/sacroiliac interventions (procedural safety and anatomy)
Neuromodulation and intrathecal therapies
Cancer & neuropathic pain syndromes
Imaging + anatomy under fluoroscopy/ultrasound

Bones = 206 Skeletal Muscles = ~650 Spinal Nerves = 31 pairs Neurons = ~86 billion Alveoli = ~480 million

🧠 Nervous & Sensory System

Neurons = ~86 billion
→ Synaptic plasticity enables memory encoding, learning, and neurodegenerative disease progression.
Glial Cells = ~85–100 billion
→ Regulate neurotransmission, myelination, immune surveillance, and blood-brain barrier integrity.
Cranial Nerves = 12 pairs
→ Critical for sensorimotor function, brainstem lesion localization, and autonomic reflexes.
Spinal Nerves = 31 pairs
→ Segmental mapping aids in diagnosis of neuropathies, radiculopathies, and trauma.
Sensory Receptors = Trillions
→ Mediate somatosensation; differential adaptation rates inform clinical nerve testing.
Retinal Photoreceptors = ~120M rods, ~6M cones per eye
→ Degeneration leads to vision loss in retinitis pigmentosa and macular disease.
Olfactory Receptor Neurons = ~5–10 million
→ Early biomarkers for neurodegenerative diseases (e.g., Alzheimer’s anosmia prodrome).

💪 Musculoskeletal System

Skeletal Muscles = ~650–850
→ Sarcopenia and cachexia impact muscle mass, strength, and metabolic regulation.
Bones (Adult) = 206
→ Serve as hematopoietic niches and metastatic sites for various cancers.
Joints = >360
→ Degeneration results in osteoarthritis; inflammatory markers aid differential diagnosis.
Tendons = ~4,000+
→ Collagen matrix remodeling is impaired in tendinopathy and systemic sclerosis.
Ligaments = ~900+
→ Crucial for proprioception; injury predisposes to chronic instability and pain.

🩸 Cardiovascular & Hematologic System

Blood Vessels = ~60,000–100,000 miles
→ Atherosclerosis and endothelial dysfunction underlie stroke and myocardial infarction risk.
Heart Chambers = 4
→ Ventricular dysfunction quantified via ejection fraction in heart failure classification.
Red Blood Cells = ~25 trillion
→ Lifespan ~120 days; anemia alters oxygen delivery and compensatory mechanisms.
White Blood Cells = ~35 billion
→ Subtypes (e.g., neutrophils, lymphocytes) guide infection, leukemia, and autoimmune workup.
Platelets = ~1.5 trillion
→ Activated in thrombosis; function modulated by aspirin and P2Y12 inhibitors.

🫁 Respiratory & Digestive System

Alveoli = ~480 million
→ Decreased surface area limits gas exchange in COPD, fibrosis, and ARDS.
Bronchi & Bronchioles = >30,000+
→ Obstructive airflow patterns assessed via spirometry and FEV1/FVC ratio.
Intestinal Villi = ~4–5 million
→ Blunting in celiac disease reduces surface area, causing malabsorption and weight loss.
Enteric Neurons = ~500 million
→ Independent reflex arcs influence motility; disrupted in IBS and Parkinson’s.

🧬 Cellular, Immune & Endocrine System

Total Cells = ~37.2 trillion
→ Cell turnover rates inform cancer biology, regeneration, and radiation dosing.
Hormones = ~50+ primary human
→ Homeostasis disruption drives endocrine syndromes like Cushing’s, Addison’s, and acromegaly.
Lymph Nodes = ~500–700
→ Biopsy sites for lymphoma staging; sentinel nodes critical in cancer surgery.
Mitochondria = Billions total
→ Mitochondrial dysfunction implicated in metabolic, neurodegenerative, and aging-related diseases.

Board-Style Pain Diagnosis (Q + A same line)

Low back pain most commonly originates from which spinal structure? Intervertebral disc
Positive straight leg raise suggests what diagnosis? Lumbar radiculopathy (sciatica)
Most common level for lumbar disc herniation? L4–L5 or L5–S1
Facet joint pain often worsens with what motion? Extension
Radiculopathy from L5 nerve root causes weakness in what movement? Great toe dorsiflexion
Pain from sacroiliac joint often radiates to where? Buttock
Rheumatoid arthritis most commonly affects which cervical joint? Atlantoaxial (C1–C2)
Bamboo spine appearance is diagnostic for what? Ankylosing spondylitis
Complex Regional Pain Syndrome hallmark symptom? Disproportionate pain
Myofascial pain syndrome hallmark finding? Trigger points
Fibromyalgia diagnostic criterion involves how many tender points? 11 of 18
Most common cause of chronic low back pain in adults? Degenerative disc disease
Vertebral compression fractures are most often caused by what? Osteoporosis
Cancer pain most commonly due to what mechanism? Bone metastases
Postherpetic neuralgia follows infection by what virus? Varicella zoster
Pain improved with leaning forward suggests what spinal condition? Lumbar spinal stenosis
In Whiplash, which structure is commonly injured? Cervical soft tissues/ligaments
Pain out of proportion with allodynia suggests what? CRPS (Complex Regional Pain Syndrome)
Saddle anesthesia suggests what urgent diagnosis? Cauda equina syndrome
Knee osteoarthritis pain is worse with what activity? Weight bearing
Radiculopathy from S1 root affects what reflex? Ankle jerk reflex
Which cancer most often metastasizes to the spine? Breast
Burning foot pain in diabetes is due to what? Peripheral neuropathy
First-line imaging for suspected vertebral fracture? X-ray
Diffuse, widespread musculoskeletal pain lasting >3 months suggests what? Fibromyalgia
Psoriatic arthritis pain commonly involves what joints? Sacroiliac and peripheral joints
Gout most often begins in what joint? First metatarsophalangeal
Polymyalgia rheumatica presents with pain in what regions? Shoulders and hips
Shoulder pain worsened by overhead activity suggests what? Rotator cuff pathology
Median nerve compression at the wrist causes what syndrome? Carpal tunnel syndrome
Pain radiating down posterior leg to foot indicates which nerve root? S1
Night pain relieved by NSAIDs suggests what tumor? Osteoid osteoma
Chronic pelvic pain in women often due to what? Endometriosis
Temporal headache with jaw claudication suggests what? Giant cell arteritis
First-line treatment for fibromyalgia pain? Exercise and education
Which MRI sequence best detects vertebral metastases? T1-weighted
Vertebral hemangioma is usually what type of lesion? Benign
Pain relief when supine, worsened by standing = what? Spinal stenosis
Trigeminal neuralgia pain is classically described as what? Electric shock-like
Which vitamin deficiency may cause neuropathic pain? Vitamin B12
What systemic disease strongly predisposes to neuropathic pain? Diabetes mellitus
Phantom limb pain is what type of pain? Neuropathic
Which imaging is best for detecting disc herniation? MRI
Chronic widespread pain with fatigue and poor sleep? Fibromyalgia
Pain worse with sitting, better with standing suggests what? Discogenic pain
Pain radiating from SI joint down posterior thigh stops where? Above the knee
Chronic pancreatitis causes pain in what region? Epigastric with radiation to back
Which diagnosis involves both pain and abnormal sweating? CRPS
Vertebral compression fracture acute pain best seen on what MRI sequence? STIR
Which diagnosis often shows Modic endplate changes on MRI? Degenerative disc disease

Board-Style: Interventional Treatments (Q + A)

Most common indication for lumbar epidural steroid injection? Lumbar radiculopathy
Safe particulate steroid for lumbar epidural injection? Methylprednisolone or triamcinolone
Preferred steroid for cervical transforaminal injection? Dexamethasone (non-particulate)
Risk of intravascular injection in cervical transforaminal? Spinal cord infarction
Best imaging modality for guidance during epidural injections? Fluoroscopy
Caudal epidural injection enters through what structure? Sacral hiatus
Contrast spread in caudal epidural confirms what? Epidural space entry
Target for lumbar medial branch block? Medial branch at transverse process–superior articular process junction
Indication for radiofrequency ablation of medial branches? Facet joint pain
Duration of relief after successful medial branch RFA? 6–12 months
Discography evaluates what? Discogenic pain
Complication risk of discography? Discitis
Target for SI joint injection? Inferior one-third of joint
Indication for SI joint injection? Sacroiliitis or SI-mediated pain
Common imaging for SI injection? Fluoroscopy or CT
Celiac plexus block treats pain from what? Pancreatic or upper abdominal cancer
Superior hypogastric plexus block used for what? Pelvic pain
Stellate ganglion block treats what region? Head, neck, upper extremity sympathetics
Main complication of stellate ganglion block? Horner’s syndrome
Target for lumbar sympathetic block? Anterolateral L2–L4 vertebral bodies
Primary use of lumbar sympathetic block? CRPS of lower extremity
Intercostal nerve block indicated for what? Rib fracture or thoracic pain
Complication of intercostal nerve block? Pneumothorax
Dorsal root ganglion stimulation treats what? Focal neuropathic pain
Spinal cord stimulation indication? Failed back surgery syndrome or CRPS
Trial success criteria for spinal cord stimulation? ≥50% pain relief
Absolute contraindication to spinal cord stimulator implantation? Active infection
Intrathecal pump delivers what drug types? Opioids, baclofen, ziconotide
First-line intrathecal opioid? Morphine
Only non-opioid FDA-approved intrathecal analgesic? Ziconotide
Kyphoplasty treats what condition? Vertebral compression fracture
Difference between vertebroplasty and kyphoplasty? Balloon cavity creation in kyphoplasty
Complication of vertebroplasty/kyphoplasty? Cement leakage
Indication for occipital nerve block? Occipital neuralgia, cervicogenic headache
Genicular nerve block targets what pain? Knee osteoarthritis
Genicular nerve RFA used for what? Chronic knee pain post-arthroplasty
Diagnostic block before genicular RFA requires how much pain relief? ≥50%
Pudendal nerve block treats what? Pelvic or perineal pain
Greater trochanteric bursa injection treats what? Trochanteric bursitis
Piriformis injection targets what nerve compression? Sciatic nerve
Trigger point injection typically uses what agents? Local anesthetic ± steroid
Epidural blood patch treats what condition? Post-dural puncture headache
Preferred volume of autologous blood for blood patch? 15–20 mL
Transforaminal epidural injection delivers medication where? Around exiting nerve root
Indication for interlaminar epidural injection? Central or bilateral radicular pain
Superior cluneal nerve block used for what? Low back pain
Costovertebral joint injection treats pain from what? Thoracic facet arthropathy
Complication of cervical medial branch RFA? Neuropathic pain or neuritis
Which nerve is targeted in hip joint radiofrequency ablation? Femoral and obturator articular branches
First confirmatory step before RFA for facet pain? Positive diagnostic medial branch block

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