American Board of Internal Medicine (ABIM) Certification Practice Exam

What does the American College of Physicians recommend for the initial management of acute low back pain?

1. Rest and immobilization

2. Heat therapy

3. High-dose corticosteroids

4. Nonsteroidal anti-inflammatory drugs (NSAIDs)

The correct answer is: Heat therapy

The American College of Physicians recommends nonsteroidal anti-inflammatory drugs (NSAIDs) as the first-line treatment for acute low back pain. The choice of NSAIDs is supported by clinical guidelines that advocate for the use of medications that relieve pain and reduce inflammation as a primary management strategy. These medications have been shown to be effective in alleviating acute pain, enhancing function, and promoting early return to daily activities. Heat therapy can also be beneficial and is often recommended as a complementary treatment; however, it is not considered the primary initial approach. Evidence suggests that while heat can help relieve discomfort and improve mobility, the immediate use of NSAIDs tends to provide more substantial and rapid relief. Rest and immobilization are outdated strategies and can lead to prolonged disability and deconditioning. Patients are encouraged to remain active, and prolonged bed rest is generally not recommended. High-dose corticosteroids are not advised for the initial management of acute low back pain, as they are generally reserved for more severe cases involving specific conditions, such as radiculopathy or herniated discs, rather than standard acute pain management. Understanding these recommendations helps ensure that patients receive effective management tailored to their needs, promoting recovery and minimizing the risk of chronic pain development.