American Board of Internal Medicine (ABIM) Certification Practice Exam

What initial treatment for pain control is generally recommended in patients with osteoarthritis?

1. Ibuprofen

2. Aspirin

3. Acetaminophen

4. Naproxen

The correct answer is: Acetaminophen

The initial treatment for pain control in patients with osteoarthritis is generally recommended to be acetaminophen. Acetaminophen is preferred due to its analgesic properties and its relatively mild side effect profile compared to nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. The rationale behind using acetaminophen first stems from its effectiveness in managing mild to moderate pain and its suitability for older adults who may be at higher risk for gastrointestinal complications associated with NSAIDs. It is also less likely to cause renal impairment, which can be a concern in patients who may have comorbidities such as hypertension or chronic kidney disease. While other options like ibuprofen, aspirin, and naproxen are also effective analgesics and anti-inflammatory agents, their use may be limited due to potential adverse effects, particularly in populations that are more sensitive to these risks. For instance, prolonged use of NSAIDs may lead to gastrointestinal bleeding or cardiovascular issues. Therefore, acetaminophen stands out as a safer first-line choice for managing osteoarthritis pain, allowing for a balanced approach to treatment that prioritizes safety while managing symptoms effectively.