American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the drug class of choice for treating non-neuropathic pain in critically ill patients?

1. NSAIDs

2. Opioids

3. Acetaminophen

4. Antidepressants

The correct answer is: Opioids

Opioids are the drug class of choice for treating non-neuropathic pain in critically ill patients due to their potent analgesic properties, which provide effective relief from severe pain often associated with critical illness and invasive procedures. In the setting of critical illness, patients may experience intense discomfort due to conditions such as trauma, surgical recovery, or medical complications, and opioids are invaluable in managing this pain. Opioids act on the central nervous system by binding to specific receptors, leading to a decrease in the perception of pain as well as the emotional response to pain. This mechanism is particularly beneficial in critically ill patients, who may not be able to express their pain levels effectively or may be experiencing significant distress. While other options, such as NSAIDs, acetaminophen, and antidepressants, may have their places in pain management or adjunctive therapy, they are not considered first-line for managing severe non-neuropathic pain in critically ill patients. NSAIDs can have adverse effects in this population, especially concerning renal function and gastrointestinal risks. Acetaminophen, while effective for mild pain, does not provide the same level of analgesia for severe pain compared to opioids. Antidepressants are primarily used for neuropathic pain or as