NEWEST PAIN MEDICINE CERTIFICATION
EXAM FOR THE AMERICAN BOARD OF
EMERGENCY MEDICINE (ABMS) | Q&A
WITH RATIONALES
1. A 45-year-old patient presents with chronic low
back pain radiating to the left leg below the knee,
numbness in the lateral foot, and weakness of ankle
dorsiflexion. The most likely nerve root involved is:
A) L4
B) L5
C) S1
D) L3
Correct answer: B
Rationale: L5 radiculopathy presents with pain
radiating to the lateral leg and dorsum of foot,
numbness in the first web space, and weakness of
ankle dorsiflexion (foot drop) and extensor hallucis
longus.
2. The first-line pharmacologic treatment for
neuropathic pain (e.g., diabetic peripheral
neuropathy, postherpetic neuralgia) is:
,A) Ibuprofen
B) Gabapentin, pregabalin, or tricyclic
antidepressants (amitriptyline, nortriptyline)
C) Acetaminophen
D) Cyclobenzaprine
Correct answer: B
Rationale: Gabapentinoids (gabapentin, pregabalin)
and tricyclic antidepressants (TCAs) are first-line for
neuropathic pain; NSAIDs and acetaminophen are
ineffective.
3. A patient with chronic low back pain and
suspected facet joint pain undergoes diagnostic
medial branch blocks. A positive response
(confirming facet-mediated pain) is defined as:
A) Any pain relief
B) ≥50% pain relief (or ≥80% in many practices) after
dual diagnostic blocks
C) Complete resolution of pain for 1 month
D) Pain worsening after injection
Correct answer: B
Rationale: Diagnostic medial branch blocks require
≥50-80% pain relief on two separate occasions to
predict successful radiofrequency ablation.
,4. The mechanism of action of duloxetine in chronic
pain is:
A) Sodium channel blockade
B) Serotonin and norepinephrine reuptake inhibition
(SNRI)
C) GABA-A agonism
D) NMDA receptor antagonism
Correct answer: B
Rationale: Duloxetine (Cymbalta) inhibits reuptake of
serotonin and norepinephrine, enhancing descending
inhibitory pain pathways.
5. A patient with complex regional pain syndrome
(CRPS) type I of the left foot has allodynia, edema,
and skin temperature changes. Which of the
following is a diagnostic criterion for CRPS (Budapest
criteria)?
A) Absence of allodynia
B) Continuing pain disproportionate to the inciting
event, with at least one symptom in three of four
categories (sensory, vasomotor, sudomotor/edema,
motor/trophic) and signs in two or more categories
C) Normal skin temperature
, D) No trophic changes
Correct answer: B
Rationale: Budapest criteria require continuing pain,
plus symptoms and signs in multiple categories
(sensory, vasomotor, sudomotor/edema,
motor/trophic).
6. The most effective preventive medication for
chronic migraine is:
A) Sumatriptan (acute, not preventive)
B) Topiramate, propranolol, or erenumab (CGRP
antagonist)
C) Ibuprofen
D) Cyclobenzaprine
Correct answer: B
Rationale: Topiramate, beta-blockers (propranolol),
tricyclics, and CGRP monoclonal antibodies
(erenumab, galcanezumab) are first-line preventives
for chronic migraine.
7. A patient with trigeminal neuralgia fails
carbamazepine due to side effects. The next best
medication is:
A) Gabapentin
EXAM FOR THE AMERICAN BOARD OF
EMERGENCY MEDICINE (ABMS) | Q&A
WITH RATIONALES
1. A 45-year-old patient presents with chronic low
back pain radiating to the left leg below the knee,
numbness in the lateral foot, and weakness of ankle
dorsiflexion. The most likely nerve root involved is:
A) L4
B) L5
C) S1
D) L3
Correct answer: B
Rationale: L5 radiculopathy presents with pain
radiating to the lateral leg and dorsum of foot,
numbness in the first web space, and weakness of
ankle dorsiflexion (foot drop) and extensor hallucis
longus.
2. The first-line pharmacologic treatment for
neuropathic pain (e.g., diabetic peripheral
neuropathy, postherpetic neuralgia) is:
,A) Ibuprofen
B) Gabapentin, pregabalin, or tricyclic
antidepressants (amitriptyline, nortriptyline)
C) Acetaminophen
D) Cyclobenzaprine
Correct answer: B
Rationale: Gabapentinoids (gabapentin, pregabalin)
and tricyclic antidepressants (TCAs) are first-line for
neuropathic pain; NSAIDs and acetaminophen are
ineffective.
3. A patient with chronic low back pain and
suspected facet joint pain undergoes diagnostic
medial branch blocks. A positive response
(confirming facet-mediated pain) is defined as:
A) Any pain relief
B) ≥50% pain relief (or ≥80% in many practices) after
dual diagnostic blocks
C) Complete resolution of pain for 1 month
D) Pain worsening after injection
Correct answer: B
Rationale: Diagnostic medial branch blocks require
≥50-80% pain relief on two separate occasions to
predict successful radiofrequency ablation.
,4. The mechanism of action of duloxetine in chronic
pain is:
A) Sodium channel blockade
B) Serotonin and norepinephrine reuptake inhibition
(SNRI)
C) GABA-A agonism
D) NMDA receptor antagonism
Correct answer: B
Rationale: Duloxetine (Cymbalta) inhibits reuptake of
serotonin and norepinephrine, enhancing descending
inhibitory pain pathways.
5. A patient with complex regional pain syndrome
(CRPS) type I of the left foot has allodynia, edema,
and skin temperature changes. Which of the
following is a diagnostic criterion for CRPS (Budapest
criteria)?
A) Absence of allodynia
B) Continuing pain disproportionate to the inciting
event, with at least one symptom in three of four
categories (sensory, vasomotor, sudomotor/edema,
motor/trophic) and signs in two or more categories
C) Normal skin temperature
, D) No trophic changes
Correct answer: B
Rationale: Budapest criteria require continuing pain,
plus symptoms and signs in multiple categories
(sensory, vasomotor, sudomotor/edema,
motor/trophic).
6. The most effective preventive medication for
chronic migraine is:
A) Sumatriptan (acute, not preventive)
B) Topiramate, propranolol, or erenumab (CGRP
antagonist)
C) Ibuprofen
D) Cyclobenzaprine
Correct answer: B
Rationale: Topiramate, beta-blockers (propranolol),
tricyclics, and CGRP monoclonal antibodies
(erenumab, galcanezumab) are first-line preventives
for chronic migraine.
7. A patient with trigeminal neuralgia fails
carbamazepine due to side effects. The next best
medication is:
A) Gabapentin
