American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line therapy for managing fibromyalgia?

1. Pharmacologic therapy

2. Nonpharmacologic therapy

3. Acupuncture

4. Cognitive behavioral therapy

The correct answer is: Nonpharmacologic therapy

Nonpharmacologic therapy is considered the first-line approach for managing fibromyalgia. This is primarily because fibromyalgia is a complex condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. Given its multifactorial nature, nonpharmacologic interventions can effectively address various symptoms and improve patients' overall quality of life. Nonpharmacologic therapy includes a variety of strategies, such as exercise (particularly aerobic exercise and strength training), physical therapy, patient education, cognitive behavioral therapy, and mindfulness techniques. These approaches help patients develop coping strategies, address their pain, and improve their function and mood. Exercise, for instance, has been shown to decrease pain and disability in fibromyalgia patients, enhancing both physical and psychological well-being. While pharmacologic therapies can play a role in treating fibromyalgia, they are generally introduced after nonpharmacologic methods, particularly when symptoms are more severe or debilitating. Medication options typically include antidepressants and anticonvulsants, but they are usually not the initial step in management.