FPM Exam Handbook

Published: 19/05/2022

Preparing for the examination

The examination will test the Knowledge part of the Pain Medicine and generic parts (Annexe A) of the CCT curriculum; Skills and Attitudes are assessed predominantly at a local level by the Work Place Based Assessments, quarterly assessments, case reports and MSF, which are well known to trainers and trainees. The new examination is not about practical skills; it is about core and advanced knowledge of the basic science of pain, clinical assessment and care of patients. The examination has been carefully crafted to ensure that all aspects of the curriculum are assessed in breadth and most importantly in depth. Trainees must be able to demonstrate knowledge that reflects detailed, reflective and broad study of the science and the art of Pain Medicine.  It is suggested that at least 6 months of diligent academic endeavour would normally be expected in preparation for an examination of this type. A variety of sources are required; these include the RCoA curriculum documents and the IASP core curriculum. In addition it is anticipated that candidates should be familiar with current opinion, national and international review articles and ‘hot topics’ in Pain Medicine.

Reading advice

The Faculty does not endorse any textbooks and the list below is not exhaustive, however, some example texts are given as a guide.  

As stated above, significant depth of knowledge of the basic science underlying pain medicine is expected of candidates. Preparing for this aspect of the examination can seem a daunting task, when much of the trainee’s time is rightly spent developing the clinical skills and attitudes required to practise as a consultant in Pain Medicine. However, with a careful structured approach to reading and study, the necessary knowledge can be acquired within the limited time available. This section is not intended as an exhaustive reading list, rather as a guide to signpost trainees towards useful references. Reading will need to be targeted and efficient, but it is always rewarding to read more deeply around subjects which you find most interesting. Advice and support from the RAPM should be taken with regard to preparation for the FFPMRCA.

One of the successful examinees also produced his suggested revision guide as an example for future candidates. (Note that its inclusion here does not represent official FPM endorsement). 

Journals

Candidates should have reviewed recent editorials in the more significant pain journals including Pain, EJP and Pain Medicine. Significant pain-related publications in major journals such as Nature, Nature Neuroscience or Journal of Neuroscience should also be reviewed. The anaesthetic literature should also be scanned for pain-relevant educational supplements, editorials, review articles and research in the BJA, Anaesthesia and Anesthesia and Analgesia. Specifically, the IASP produce excellent brief clinical updates on topical pain subjects.

General texts

As a general reference textbook, Wall and Melzack’s Textbook of Pain 5th Edition, edited by McMahon & Koltzenburg contains a wealth of information but it is lengthy. Also available is the more approachable paperback Handbook of Pain Management: A Clinical Companion to the Textbook of Pain. Also, the IASP publications produced after each World Congress on Pain are essential general reading. Pain 2008 an Updated Review Refresher Course Syllabus edited by Castro-Lopes, Raja and Schmeltz and the 2010 Review edited by Mogil, J.S. are the two most recent publications. Candidates are also expected to be familiar with NICE guidance as it applies to Pain Medicine and all British Pain Society publications and guidelines, including their regular Reviews in Pain publication.

Acute pain

An excellent acute pain resource is available online, produced by the Australian and New Zealand College of Anaesthetists and faculty of Pain Medicine. Acute Pain Management: Scientific Evidence 5thEdition 2020, edited by Schug et al is available at: 

https://www.anzca.edu.au/getattachment/38ed54b7-fd19-4891-9ece-40d2f03b24f9/Acute-Pain-Management-Scientific-Evidence-5th-edition-(2020)#page=

Basic science

a. Epidemiology, systematic reviews and outcome measures

The epidemiology of pain has been studied in depth, and the Cochrane Collaboration has reviewed the evidence for many pain treatments. The authors of note are McQuay, H.J. and Moore, R.A. The measurement of outcomes in Pain Medicine has been updated by the IMMPACT group, including among its members Dworkin, R.H.; Raja, S.N. and Turk, D.C.   

b. Plasticity and sensitisation 

A thorough understanding of the transduction, transmission and central processing of nociceptive information is essential to the effective practice of Pain Medicine. These processes should be considered both in the resting, physiological state as well as in pathological pain states such as neuropathic and chronic pain. Emphasis should be placed on an understanding of plasticity in the somatosensory system, both in development and pathology. Underlying these changes in function are the processes of peripheral and central sensitisation, which need to be understood in depth. Many review articles have been published on these subjects. 

c. Central pain processing 

The advent of MRI has revolutionized pain research. The relationship between pain, emotion and attention and the mechanism of placebo are now far better understood. Examination preparation should include coverage of the most recent studies. 

d. Pharmacology

Particular attention should be paid to studies assessing the clinical effectiveness of drugs used in pain medicine (Finnerup, N.B.) and on the pharmacology of opioids. The Pharmacology of Pain, edited by Beaulieu, P. et al IASP Press 2010 is a good reference text.     

e. Psychology

General review articles on the role of psychology in Pain Medicine have been published in most of the journals mentioned above. 
The areas of musculoskeletal pain and visceral pain processing require address and again are covered in recent articles in the journals mentioned above.

Other learning resources

The FPMANZCA open access areas are recommended.

Course

The Faculty runs a bi-annual Examination Tutorial, which covers a selection of topics for the examination and has SOE practice.  These take place in March and September to coincide with the FFPMRCA SOE examination and are a day of lectures and VIVA practice.  More detail is available on our events page

The Faculty have a document with exam questions available