LATEST PAIN MEDICINE CERTIFICATION EXAM
OFFERED BY MULTIPLE ABMS BOARDS —
ANESTHESIOLOGY, PHYSICAL MEDICINE &
REHABILITATION, PSYCHIATRY &
NEUROLOGY | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 55-year-old male with chronic low back pain and
lumbar radiculopathy has failed conservative
treatment (physical therapy, NSAIDs, gabapentin).
MRI shows a large left paracentral disc herniation at
L4-L5. Which is the most appropriate next step?
A) Lumbar epidural steroid injection (transforaminal)
B) Lumbar facet joint injection
C) Sacroiliac joint injection
D) Spinal cord stimulation trial
Correct answer: A
Rationale: Transforaminal epidural steroid injection
(TFESI) is indicated for radicular pain from disc
herniation.
2. A 65-year-old female with severe osteoarthritis of
the right knee is not a surgical candidate. She has
,failed acetaminophen, NSAIDs, and physical therapy.
Which is the most appropriate next step?
A) Intra-articular corticosteroid injection
B) Viscosupplementation (hyaluronic acid)
C) Opioid therapy (long-term)
D) Radiofrequency ablation of genicular nerves
Correct answer: A
Rationale: Intra-articular corticosteroid is first-line
for osteoarthritis flare; viscosupplementation has
weak evidence.
3. A 45-year-old male with chronic low back pain and
no radiculopathy has facet joint-mediated pain
confirmed by diagnostic medial branch blocks (≥80%
pain relief). Which is the most appropriate next step?
A) Radiofrequency ablation (RFA) of medial branches
B) Intra-articular facet joint corticosteroid injection
C) Lumbar epidural steroid injection
D) Sacroiliac joint injection
Correct answer: A
Rationale: RFA of medial branches is the standard of
care for facet joint pain after diagnostic blocks.
,4. A 55-year-old female with post-herpetic neuralgia
(PHN) of the thoracic dermatome reports severe
burning pain (8/10) despite gabapentin 1800 mg/day
and lidocaine patch 5%. Which is the most
appropriate next step?
A) Pregabalin (switch from gabapentin) or add
tricyclic antidepressant (nortriptyline)
B) Capsaicin 8% patch
C) Spinal cord stimulation
D) Opioid therapy (long-term)
Correct answer: B
Rationale: Capsaicin 8% patch (Qutenza) is FDA-
approved for PHN and is effective for localized
neuropathic pain.
5. A 60-year-old male with chronic low back pain and
spinal stenosis has neurogenic claudication (walking
tolerance 2 blocks). MRI shows severe central canal
stenosis at L3-L4. He has failed conservative therapy.
Which is the most appropriate next step?
A) Lumbar epidural steroid injection (interlaminar or
caudal)
B) Lumbar decompression surgery (laminectomy)
C) Spinal cord stimulation
, D) Intrathecal drug delivery system
Correct answer: B
Rationale: Neurogenic claudication from spinal
stenosis with failed conservative therapy is an
indication for surgical decompression.
6. A 45-year-old female with complex regional pain
syndrome (CRPS) type I of the left foot has failed
physical therapy, gabapentin, and NSAIDs. Which is
the most appropriate next step?
A) Lumbar sympathetic block
B) Spinal cord stimulation (SCS)
C) Intravenous bisphosphonate (pamidronate)
D) Opioid therapy
Correct answer: A
Rationale: Lumbar sympathetic block is diagnostic
and therapeutic for CRPS of the lower extremity.
7. A 50-year-old male with chronic low back pain and
negative imaging undergoes diagnostic medial
branch blocks (L3, L4, L5) with 50% pain relief. Which
is the most appropriate next step?
A) Repeat medial branch blocks with higher volume
(confirmatory)
OFFERED BY MULTIPLE ABMS BOARDS —
ANESTHESIOLOGY, PHYSICAL MEDICINE &
REHABILITATION, PSYCHIATRY &
NEUROLOGY | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 55-year-old male with chronic low back pain and
lumbar radiculopathy has failed conservative
treatment (physical therapy, NSAIDs, gabapentin).
MRI shows a large left paracentral disc herniation at
L4-L5. Which is the most appropriate next step?
A) Lumbar epidural steroid injection (transforaminal)
B) Lumbar facet joint injection
C) Sacroiliac joint injection
D) Spinal cord stimulation trial
Correct answer: A
Rationale: Transforaminal epidural steroid injection
(TFESI) is indicated for radicular pain from disc
herniation.
2. A 65-year-old female with severe osteoarthritis of
the right knee is not a surgical candidate. She has
,failed acetaminophen, NSAIDs, and physical therapy.
Which is the most appropriate next step?
A) Intra-articular corticosteroid injection
B) Viscosupplementation (hyaluronic acid)
C) Opioid therapy (long-term)
D) Radiofrequency ablation of genicular nerves
Correct answer: A
Rationale: Intra-articular corticosteroid is first-line
for osteoarthritis flare; viscosupplementation has
weak evidence.
3. A 45-year-old male with chronic low back pain and
no radiculopathy has facet joint-mediated pain
confirmed by diagnostic medial branch blocks (≥80%
pain relief). Which is the most appropriate next step?
A) Radiofrequency ablation (RFA) of medial branches
B) Intra-articular facet joint corticosteroid injection
C) Lumbar epidural steroid injection
D) Sacroiliac joint injection
Correct answer: A
Rationale: RFA of medial branches is the standard of
care for facet joint pain after diagnostic blocks.
,4. A 55-year-old female with post-herpetic neuralgia
(PHN) of the thoracic dermatome reports severe
burning pain (8/10) despite gabapentin 1800 mg/day
and lidocaine patch 5%. Which is the most
appropriate next step?
A) Pregabalin (switch from gabapentin) or add
tricyclic antidepressant (nortriptyline)
B) Capsaicin 8% patch
C) Spinal cord stimulation
D) Opioid therapy (long-term)
Correct answer: B
Rationale: Capsaicin 8% patch (Qutenza) is FDA-
approved for PHN and is effective for localized
neuropathic pain.
5. A 60-year-old male with chronic low back pain and
spinal stenosis has neurogenic claudication (walking
tolerance 2 blocks). MRI shows severe central canal
stenosis at L3-L4. He has failed conservative therapy.
Which is the most appropriate next step?
A) Lumbar epidural steroid injection (interlaminar or
caudal)
B) Lumbar decompression surgery (laminectomy)
C) Spinal cord stimulation
, D) Intrathecal drug delivery system
Correct answer: B
Rationale: Neurogenic claudication from spinal
stenosis with failed conservative therapy is an
indication for surgical decompression.
6. A 45-year-old female with complex regional pain
syndrome (CRPS) type I of the left foot has failed
physical therapy, gabapentin, and NSAIDs. Which is
the most appropriate next step?
A) Lumbar sympathetic block
B) Spinal cord stimulation (SCS)
C) Intravenous bisphosphonate (pamidronate)
D) Opioid therapy
Correct answer: A
Rationale: Lumbar sympathetic block is diagnostic
and therapeutic for CRPS of the lower extremity.
7. A 50-year-old male with chronic low back pain and
negative imaging undergoes diagnostic medial
branch blocks (L3, L4, L5) with 50% pain relief. Which
is the most appropriate next step?
A) Repeat medial branch blocks with higher volume
(confirmatory)
