ABPM Certification Exam

Examination Outline

I. Anatomy and Physiology (14%)

A. Head and face (including eyes, ears, nose, and throat)

B. Gastrointestinal and urogenital

C. Metabolic/endocrine

D. Respiratory/cardiovascular

E. Spine (facets, discs, bony anatomy)

F. Joints (nonspinal)

G. Muscles, connective tissue, integument

H. Central nervous system (brain and spinal cord)

I. Cranial nerves (including plexi and spinal roots)

J. Peripheral nervous system

K. Autonomic nervous system

L. Pain neurophysiology (including neurotransmitters)

II. Diagnostic Testing (12%)

Proper usage and limitations of:

A. Laboratory studies

B. Imaging studies

C. Electrodiagnostic studies (EMG, NCV, SSEP, BAEP, VEP)

D. Autonomic function studies

E. Vascular studies

F. Diagnostic nerve blocks

G. Functional capacity evaluation

H. Physical examination

I.  Sleep studies/EEG

III. Types of Pain (13%)

A. Headaches

B. Orofacial (temporomandibular disorder, dental,

ENT, atypical facial pain)

C. Chest

D. Abdominal

E. Pelvic/genital

F. Spinal disorders (includes osteoporosis)

G. Trigeminal neuralgia

H. Trauma (e.g., musculoskeletal pain)

I. Postamputation

J. Spinal cord injury

K. Burn

L. Postoperative

M. Cancer

N. Vascular/Ischemic

O. Sickle-cell disease


Q. Rheumatologic disorders (articular, nonarticular), connective tissue disorders, tendonitis

R. Myofascial pain syndrome/fibromyalgia syndrome

S. Central nervous system lesions (CVA, MS)

T. Diabetic neuropathies

U. Herpes zoster/postherpetic neuralgia

V. Complex Regional Pain Syndromes types I & II (reflex

sympathetic dystrophy/causalgia), sympathetically maintained/sympathetically independent pain

W. Other peripheral neuropathies

X. Radiculopathy (cervical, thoracic, lumbar)

Y. Pain in children

Z. Pain in elderly


IV. Pain Assessment (11%)

A. Addiction

Impact of the following on patient report of pain:

B. Cultural background

C. Age

D. Psychological factors

Proper usage and limitations of:

E. Subjective report methods (e.g., visual analogue scale, verbal descriptors, McGill Pain Questionnaire)

F. Pain behavior ratings/activity reports

G. Pain treatment outcomes assessment

H. Placebo trials, placebo and adverse placebo

(nocebo) effects

V. Pharmacology (18%)

A. Tolerance and physical dependence

B. Detoxification and withdrawal syndromes

C. General pharmacokinetics and pharmacodynamic principles

D. Routes of administration (including intrathecal/epidural pumps/catheters)

E. Equianalegesic doses

F. Drug interactions

G. Drug genomics

Mechanisms of action, contraindications, side effects, and interaction of:

H. Acetaminophen

I. Nonsteroidal anti-inflammatory agents

J. Corticosteroids

K. Local anesthetics

L. Antiarrhythmics

M. Muscle relaxants

N. Stimulants

O. Opioids

P. Anticonvulsants

Q. Antidepressants

R. Antipsychotics

S. Lithium

T. 5HT drugs (serotonin agonists/antagonists)

U. Ergot derivatives

V. Beta blockers

W. Benzodiazepines

X. Nonbenzodiazepine anxiolytics/hypnotics

Y. Neurolytic agents

Z. NMDA antagonists

AA. Calcium channel blockers

BB. Alpha agonists/antagonists

CC. Baclofen, etc.

DD. Tramadol

EE. Capsaicin

FF. Calcitonin

GG. Strontium

HH.  Bultabital preparations

II.     Miscellaneous (e.g. Midrin)


VI. Techniques of Pain Medicine (13%)

Indications, contraindications, complications, technical aspects

A. Therapeutic nerve blocks

B. Epidural/subarachnoid anesthetic blocks

C. Continuous infusion of neuroaxial agents (e.g.

morphine, baclofen)

D. Soft tissue injection

E. Intra-articular injections

F. Neurolytic techniques (chemical, cryogenic, radiofrequency)

G. Stimulation procedures (peripheral nerve, spinal cord)

H. Central nervous system ablative surgical techniques

I. Decompressive surgical procedures (peripheral nerve, nerve root)

J. Therapeutic heat and cold

K. Manipulation and massage

L. Physical therapy


N. Casting/splinting/orthotics

O. Conditioning/exercise

P. Radiation therapy (includes radiosurgery)

Q. Cognitive behavioral therapy

R. Psychotherapy

S. Hypnosis

T. Biofeedback

U. Relaxation training

V. Occupational therapy

W. Vocational assessment/rehabilitation

X. Functional restoration (e.g., ergonomics, energy conservation)

Y. Nutrition

Z. Alternative/complementary treatments (acupuncture, homeopathy, naturopathy)

AA. Hospice care

BB. Multidisciplinary pain treatment


VII. Psychological/Behavioral Aspects of Pain (10%)

A. Impact of psychological factors on pain treatment

B. DSM diagnosis of Pain Disorder

C. Other psychiatric diagnoses (e.g., somatoform, factitious, depressive, panic, anxiety, and posttraumatic stress disorders)

D. Interaction of pain problem/disorder with personality traits/disorders

E. Psychometric assessment not specific to pain (e.g., MMPI, Beck Depression Inventory ): principles and tools

F. Impact of pain on work and family and influence of familial and occupational factors on pain

G. Secondary gain

H. Sexual dysfunction

I. Relationship between pain and sleep disorders

VIII. Compensation/Disability and Medical-Legal, Practice, and Ethical Issues (9%)

A. Differences between disease, impairment, and disability

B. Standardized guidelines for assessing impairment and disability

C. Malingering

D. Compensation and disability systems

E. Expert witness testimony

F. Interaction with the legal/regulatory system (confidentiality, medical records)

G. Documentation (medical records, informed consent)

H. Coding requirements/documentation (ICD 9/10, CPT)

I. Controlled Substances Act/methadone maintenance

J. Ethics (living wills, do-not-resuscitate orders, durable power of attorney, assisted suicide)