The Primary ( ) and Final () FRCA examinations require an extensive knowledge of chronic pain management. We have therefore written a new educational resource section on this topic. The tutorials have been tailored to the FRCA syllabus and we have also added some past questions relevant to these topics.

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Physiology and Biochemistry  Pain: afferent nociceptive pathways, dorsal horn, peripheral and central mechanisms, neuromodulatory systems, supraspinal mechanisms, visceral pain, neuropathic pain… influence of therapy on nociceptive mechanisms…   Q. Primary Viva Question Describe the principles of management of neuropathic pain

 

 Final FRCA Syllabus

Pain management  A detailed knowledge of the control of acute pain in the context of postoperative and post-traumatic conditions will be expected, as will an understanding of the principles of chronic pain management in the pain clinic setting. Anatomy, physiology, pharmacology and basic psychology relevant to pain management Assessment and measurement of acute pain - including special problems with children, the elderly and patients who are unconscious or in intensive care Assessment of patients with chronic pain and pain in patients with cancer Use of medication for pain management; conventional analgesics and adjuvant analgesics; side-effects; problems of drug dependency and addiction The role of and indications for neural blockade: Peripheral nerve, plexus, epidural and subarachnoid blocks, techniques of sympathetic blockade, neurolytic agents and procedures, implanted catheters and pumps for drug delivery Stimulation produced analgesia including transcutaneous techniques and acupuncture Other treatment modalities: Physical therapy, surgery, psychological approaches, rehabilitation approaches, pain management programmes Symptom control in terminal illness The organisation of pain management services Principles and ethics of pain research... Q. Final Viva Question You are consulted on the management of a 45-year-old woman with invasive cervical carcinoma whose pain is not controlled by oral or parenteral narcotics. What are the therapeutic options? What are the side-effects of these options? How will you manage the side-effects? A 56-year-old man is referred to your pain clinic because of persistent phantom limb pain 3 weeks after a mid-thigh amputation. What is your management?