American Board of Internal Medicine (ABIM) Certification Practice Exam

According to the guidelines for managing chronic low back pain, which medication is recommended first?

1. Acetaminophen

2. Corticosteroids

3. NSAIDs

4. Duloxetine

The correct answer is: NSAIDs

The first-line medication recommended for managing chronic low back pain is NSAIDs (non-steroidal anti-inflammatory drugs). These medications are often favored due to their dual action of providing pain relief and reducing inflammation, which are common underlying issues in chronic low back pain. Clinical guidelines typically suggest starting treatment with NSAIDs because they have been shown to be effective in alleviating pain and improving function in patients with chronic low back pain. They are generally well-tolerated, and their effectiveness in treating musculoskeletal pain is well-documented. Acetaminophen, while a common analgesic, has not consistently demonstrated superior effectiveness compared to NSAIDs for chronic low back pain. Corticosteroids are typically reserved for more specific conditions or severe pain not relieved by other medications, due to their potential side effects and the typically short-term benefit. Duloxetine, which is an antidepressant with pain-modulating properties, is also considered for chronic pain management but is generally not the first choice when initiating treatment for chronic low back pain. Overall, the selection of NSAIDs aligns with best practices in managing this condition.