American Board of Internal Medicine (ABIM) Certification Practice Exam

In the treatment of fibromyalgia, which medication is often used as an initial pharmacologic treatment?

1. Milnacipran

2. Ibuprofen

3. Amitriptyline

4. Pregabalin

The correct answer is: Amitriptyline

Amitriptyline is frequently employed as an initial pharmacologic treatment for fibromyalgia due to its effectiveness in managing pain and improving sleep. It is a tricyclic antidepressant that has shown benefits in reducing fibromyalgia-associated pain as well as enhancing overall quality of life. Its sedative properties also contribute to alleviating insomnia, which is commonly experienced by patients with fibromyalgia. The use of amitriptyline in fibromyalgia leverages its ability to modulate pain pathways in the central nervous system, making it a suitable first-line option when considering the complex nature of fibromyalgia symptoms, which include both pain and sleep disturbances. While other medications, such as milnacipran, pregabalin, and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, are also used in the treatment of fibromyalgia, amitriptyline's well-established role as an initial therapy makes it a distinct choice in the management strategy for this condition.