1
ABFM + KSA Pain Management Exam
Actual Exam 2026/2027 | American Board
of Family Medicine | Questions with
Verified Answers | 100% Correct | Pass
Guaranteed
Q001: A 55-year-old male with chronic low back pain for 6 years presents
requesting oxycodone after his primary physician retired. His previous regimen
was oxycodone 10mg every 6 hours. Review of the state prescription drug
monitoring program shows he has filled prescriptions from three different
providers in the last 3 months. Which initial step is most appropriate according to
the 2026 CDC opioid prescribing guidelines?
Options:
A. Continue his current oxycodone regimen without changes
B. Immediately taper his opioids to discontinuation over 1 week
C. Conduct a comprehensive biopsychosocial pain assessment and use the COWS
scale before making any prescribing decisions
D. Prescribe a higher dose to prevent him from seeking other providers
ANSWER: C
Q002: A 68-year-old female with diabetic peripheral neuropathy reports burning
pain in her feet rated 7/10. She has tried acetaminophen and ibuprofen without
relief. Her renal function is normal. What is the first-line pharmacologic treatment
for neuropathic pain in this scenario?
Options:
A. Tramadol 50mg every 6 hours
, 2
B. Gabapentin, starting at 100mg at bedtime and titrating up
C. Oxycodone 5mg every 4 hours PRN
D. Topical lidocaine patch 5% applied daily
ANSWER: B
Q003: A 34-year-old construction worker sustains a right ankle fracture and is
discharged with oxycodone 5mg every 6 hours for pain. He returns in 3 days
stating the pain is well-controlled and he has taken only 4 tablets total. He asks for
a refill "just in case." According to 2026 CDC recommendations for acute pain,
what is the most appropriate action?
Options:
A. Refill the prescription for the same quantity and dose
B. Switch to a longer-acting opioid to prevent frequent dosing
C. Recommend non-pharmacologic measures and acetaminophen/ibuprofen; do
not provide additional opioid prescription
D. Prescribe a 30-day supply to avoid return visits
ANSWER: C
Q004: A 72-year-old male with metastatic prostate cancer reports severe, constant
bone pain rated 9/10, unrelieved by his current regimen of sustained-release
morphine 30mg BID. He has no cognitive impairment. What is the most
appropriate next step in his pain management?
Options:
A. Increase his morphine dose by 25-50% and add a bowel regimen
B. Switch to tramadol for a safer side effect profile
C. Discontinue opioids and start NSAIDs only
D. Refer only to physical therapy
ANSWER: A
, 3
Q005: A 45-year-old female with fibromyalgia reports widespread pain and
fatigue. She is frustrated that "nothing helps." She has no signs of inflammatory
arthritis. What is the most effective first-line, non-pharmacologic, multimodal
intervention?
Options:
A. Prescribe prednisone 10mg daily
B. Recommend graded exercise program and cognitive behavioral therapy
C. Order monthly trigger point injections
D. Start a high-dose opioid regimen
ANSWER: B
Q006: A 58-year-old male with a history of opioid use disorder in remission
undergoes a total knee replacement. He is on buprenorphine-naloxone 8mg/2mg
daily. His postoperative pain is severe. What is the recommended perioperative
pain management strategy?
Options:
A. Discontinue his buprenorphine and start high-dose full agonist opioids
B. Continue his buprenorphine and use multimodal analgesia; coordinate with an
addiction specialist
C. Avoid all opioids postoperatively
D. Give only NSAIDs
ANSWER: B
Q007: A 62-year-old female with chronic knee osteoarthritis has been taking
celecoxib 200mg daily for 6 months with good pain control. She has well-
controlled hypertension and no GI bleeding history. Her creatinine is 1.4 mg/dL.
What monitoring is recommended for long-term NSAID use?
Options:
A. No monitoring needed; continue indefinitely
ABFM + KSA Pain Management Exam
Actual Exam 2026/2027 | American Board
of Family Medicine | Questions with
Verified Answers | 100% Correct | Pass
Guaranteed
Q001: A 55-year-old male with chronic low back pain for 6 years presents
requesting oxycodone after his primary physician retired. His previous regimen
was oxycodone 10mg every 6 hours. Review of the state prescription drug
monitoring program shows he has filled prescriptions from three different
providers in the last 3 months. Which initial step is most appropriate according to
the 2026 CDC opioid prescribing guidelines?
Options:
A. Continue his current oxycodone regimen without changes
B. Immediately taper his opioids to discontinuation over 1 week
C. Conduct a comprehensive biopsychosocial pain assessment and use the COWS
scale before making any prescribing decisions
D. Prescribe a higher dose to prevent him from seeking other providers
ANSWER: C
Q002: A 68-year-old female with diabetic peripheral neuropathy reports burning
pain in her feet rated 7/10. She has tried acetaminophen and ibuprofen without
relief. Her renal function is normal. What is the first-line pharmacologic treatment
for neuropathic pain in this scenario?
Options:
A. Tramadol 50mg every 6 hours
, 2
B. Gabapentin, starting at 100mg at bedtime and titrating up
C. Oxycodone 5mg every 4 hours PRN
D. Topical lidocaine patch 5% applied daily
ANSWER: B
Q003: A 34-year-old construction worker sustains a right ankle fracture and is
discharged with oxycodone 5mg every 6 hours for pain. He returns in 3 days
stating the pain is well-controlled and he has taken only 4 tablets total. He asks for
a refill "just in case." According to 2026 CDC recommendations for acute pain,
what is the most appropriate action?
Options:
A. Refill the prescription for the same quantity and dose
B. Switch to a longer-acting opioid to prevent frequent dosing
C. Recommend non-pharmacologic measures and acetaminophen/ibuprofen; do
not provide additional opioid prescription
D. Prescribe a 30-day supply to avoid return visits
ANSWER: C
Q004: A 72-year-old male with metastatic prostate cancer reports severe, constant
bone pain rated 9/10, unrelieved by his current regimen of sustained-release
morphine 30mg BID. He has no cognitive impairment. What is the most
appropriate next step in his pain management?
Options:
A. Increase his morphine dose by 25-50% and add a bowel regimen
B. Switch to tramadol for a safer side effect profile
C. Discontinue opioids and start NSAIDs only
D. Refer only to physical therapy
ANSWER: A
, 3
Q005: A 45-year-old female with fibromyalgia reports widespread pain and
fatigue. She is frustrated that "nothing helps." She has no signs of inflammatory
arthritis. What is the most effective first-line, non-pharmacologic, multimodal
intervention?
Options:
A. Prescribe prednisone 10mg daily
B. Recommend graded exercise program and cognitive behavioral therapy
C. Order monthly trigger point injections
D. Start a high-dose opioid regimen
ANSWER: B
Q006: A 58-year-old male with a history of opioid use disorder in remission
undergoes a total knee replacement. He is on buprenorphine-naloxone 8mg/2mg
daily. His postoperative pain is severe. What is the recommended perioperative
pain management strategy?
Options:
A. Discontinue his buprenorphine and start high-dose full agonist opioids
B. Continue his buprenorphine and use multimodal analgesia; coordinate with an
addiction specialist
C. Avoid all opioids postoperatively
D. Give only NSAIDs
ANSWER: B
Q007: A 62-year-old female with chronic knee osteoarthritis has been taking
celecoxib 200mg daily for 6 months with good pain control. She has well-
controlled hypertension and no GI bleeding history. Her creatinine is 1.4 mg/dL.
What monitoring is recommended for long-term NSAID use?
Options:
A. No monitoring needed; continue indefinitely
