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The Pain Management exam has 200 questions and runs 4 hours.
These 10 free Pain Management questions are organized by exam domain, so you can see how each part of the Certification in Pain Management blueprint is tested. Reveal the answer and explanation under each question.
A physician plans a prognostic nerve block for the right L5-S1 facet joint before considering radiofrequency neurotomy. Which pair of nerves supplies this joint and should be targeted?
Correct answer: D - Right L4 medial branch and L5 dorsal ramus
Electrodiagnostic testing is obtained six weeks after the onset of back pain radiating to the dorsum of the right foot. Ankle dorsiflexion, inversion, and hip abduction are weak. Sensory nerve action potentials are preserved. Needle EMG shows denervation in L5-innervated muscles supplied by different peripheral nerves and in the ipsilateral lumbar paraspinals. The patient has never had lumbar surgery. The findings localize the lesion most strongly to the:
Correct answer: D - Right L5 nerve root
Ten weeks after a distal radius fracture, a woman has persistent regional hand pain disproportionate to the healed injury. She reports pain from clothing, episodic color changes, swelling, and difficulty moving her fingers. Examination demonstrates brush allodynia, edema, and restricted finger motion extending beyond a single nerve territory. Infection, inflammatory arthritis, and focal nerve injury have been excluded. A three-phase bone scan is normal. How should the normal scan affect the assessment for complex regional pain syndrome?
Correct answer: C - It does not preclude diagnosis when the Budapest clinical criteria are fulfilled.
A 76-year-old taking a stable oral morphine regimen develops dehydration and acute kidney injury. Over the next two days, he becomes drowsy, sees insects on the wall, and has multifocal myoclonus. No doses were missed, and no other medications were added. Which pharmacologic explanation best accounts for this change despite an unchanged prescription?
Correct answer: A - Accumulation of renally cleared morphine glucuronides
A patient with chronic noncancer pain takes extended-release oxycodone 15 mg every 12 hours and immediate-release oxycodone 5 mg up to every 6 hours as needed. A medication diary confirms both scheduled doses and exactly two immediate-release doses each day. There are no other opioids. Walking tolerance has improved, and the patient reports no sedation. Using the CDC 2022 oral oxycodone factor of 1.5, which assessment correctly combines actual daily exposure with its clinical implication?
Correct answer: A - 60 MME/day; reassess benefits and risks rather than require tapering solely because of this value.
A patient who has tolerated an oral muscle relaxant for months develops marked somnolence and hypotension shortly after ciprofloxacin is added for a urinary infection. Evaluation finds no sepsis, volume depletion, or deterioration in renal function. Which medication is the characteristic cause of this contraindicated CYP1A2 interaction?
Correct answer: C - Tizanidine
At a preoperative visit for total knee arthroplasty, a patient reports sustained remission of opioid use disorder on buprenorphine-naloxone 8 mg/2 mg sublingually each day. The addiction clinician confirms stability. Regional analgesia and nonopioid medications are available, and substantial postoperative pain is anticipated. Which perioperative strategy is best supported?
Correct answer: B - Continue buprenorphine and add regional and multimodal analgesia, with supplemental opioids if needed.
A headache diary records eight to twelve attacks daily for six weeks. Each consists of severe left orbital pain lasting 10-20 minutes, with ipsilateral tearing and nasal congestion; the patient paces during attacks and is pain-free between them. Neurologic examination and appropriate imaging reveal no secondary cause. An adequately dosed, supervised indomethacin trial abolishes the attacks completely. The combination of attack pattern and treatment response identifies:
Correct answer: C - Paroxysmal hemicrania
An awake, preverbal 2-year-old is assessed after surgery using FLACC. The child keeps the jaw clenched, draws the legs up, squirms and shifts position, and occasionally whimpers. Holding and quiet talking provide reassurance. Breathing is unlabored, and the surgical examination reveals no unexpected complication. Which documentation and response fit these observations?
Correct answer: B - FLACC 7/10; provide appropriate analgesia and reassess the pain-associated behaviors.
A patient prescribed oxycodone has an unexpectedly negative urine result labeled 'opiates.' Prescription-monitoring records are consistent with the treatment plan, and the patient reports taking a dose that morning. The laboratory says its initial test is a morphine-calibrated class immunoassay; no oxycodone-specific test was ordered. Before making a major prescribing decision, the clinician should:
Correct answer: D - Discuss the result and obtain testing that specifically detects oxycodone and its metabolites.
The Pain Management exam also covers these domains. Drill them in the full free practice test:
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