American Board of Internal Medicine (ABIM) Certification Practice Exam

In the treatment of fibromyalgia, combination therapy might be utilized for patients unresponsive to monotherapy. What can be an example of such a combination?

1. Amitriptyline with fluoxetine

2. Acetaminophen with ibuprofen

3. Gabapentin with tramadol

4. Dexmedetomidine with diazepam

The correct answer is: Amitriptyline with fluoxetine

Combination therapy for fibromyalgia can include various pharmacologic approaches aimed at addressing the complex symptomatology of the condition, which often includes chronic pain, fatigue, and mood disturbances. Utilizing a combination of amitriptyline and fluoxetine is an effective strategy due to their distinct mechanisms of action on neurotransmitters. Amitriptyline is a tricyclic antidepressant that has been shown to help with pain modulation and sleep disturbances, which are common in fibromyalgia. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), can help alleviate depressive symptoms and enhance mood, which are frequently comorbid with fibromyalgia. Together, they may provide a more comprehensive approach in managing both the psychological and physical symptoms of the disorder. In contrast, while acetaminophen and ibuprofen are often used for pain relief, they do not target the underlying biochemical pathways thought to be involved in fibromyalgia. Similarly, while gabapentin and tramadol can help with pain, they are different classes of medications and might not evidence the same synergistic effect seen with the combination of amitriptyline and fluoxetine. Dexmedetomidine and diazepam also do not align with the treatment strategy for fibromyalgia, as they are primarily