American Board of Internal Medicine (ABIM) Certification Practice Exam

How long should conservative management be tried before considering diagnostic testing for low back pain?

1. 2 weeks

2. 4 to 6 weeks

3. 8 weeks

4. 12 weeks

The correct answer is: 4 to 6 weeks

For patients experiencing low back pain, conservative management is typically advised as the first course of action. This conservative approach may include rest, physical therapy, pain relief medications, and education on staying active despite discomfort. The rationale for initially opting for conservative management is based on the general nature of low back pain, which often resolves on its own over time, particularly if there is no significant underlying pathology. The recommendation to pursue conservative management for 4 to 6 weeks before considering diagnostic testing is rooted in clinical guidelines that suggest allowing sufficient time for the majority of acute low back pain cases to improve without invasive interventions. Most patients will notice significant improvement during this timeframe, and recent studies show that less than 10% of patients with uncomplicated low back pain will develop significant problems requiring further imaging or diagnostic tests. After this period of conservative management, if there is no significant improvement or if red flags—such as severe neurological deficits, trauma, or signs of infection—emerge, this would warrant further diagnostic evaluation to rule out serious conditions. Thus, a timeframe of 4 to 6 weeks is practical and aligned with current best practices in managing uncomplicated low back pain before any invasive or additional diagnostic measures are considered.