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Chronic pain

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.

Read other sections by using the navigation bar on the right side of every page. 

 Primary FRCA Syllabus

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?

Articles on chronic pain

Chronic pain
Assessment of acute and chronic pain
Management of chronic pain
Central mechanisms in chronic pain
NMDA receptor
Central pain
Management of neuropathic pain
Molecular mechanisms of peripheral sensitisation, physiological pain and clinical pain
Tricyclic antidepressants
Local anaesthetics
Opioids in chronic pain
Post-herpetic neuralgia
Management of post-herpetic neuralgia
Trigeminal neuralgia
Anatomy of the trigeminal nerve
Complex regional pain syndrome
Sympathetic nerve blocks
Phantom limb pain
Dorsal column stimulation
Stellate ganglion block
Coeliac plexus block
Guanethidine Biers blocks
Neurosurgical techniques in the treatment of chronic pain
Stimulation-produced analgesia: acupuncture, TENS and alternative techniques
Psychological techniques in chronic pain
Cognitive behavioural therapy
Organisation of pain management services

is endorsed by The British Pain Society for its role in education. Their site may be viewed by clicking on the icon.


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