American Board of Internal Medicine (ABIM) Certification Practice Exam

What second-line therapy is recommended by the ACP for chronic low back pain patients?

1. Gabapentin

2. Duloxetine

3. Baclofen

4. Physical therapy

The correct answer is: Duloxetine

Duloxetine is recommended by the American College of Physicians (ACP) as a second-line therapy for chronic low back pain in patients who do not respond to non-pharmacological treatments or when these treatments are insufficient. This recommendation is based on the efficacy of duloxetine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI), in managing chronic pain conditions, including chronic low back pain, in addition to its role in treating depression and anxiety disorders. Duloxetine works by enhancing the levels of neurotransmitters in the brain that regulate mood and pain perception, leading to pain relief in patients suffering from chronic low back pain associated with these conditions. The efficacy of duloxetine has been supported by clinical studies that demonstrate its effectiveness in reducing pain and improving function in patients with chronic low back pain, particularly when used along with other non-pharmacological approaches. This makes it an appropriate choice for second-line therapy according to current clinical guidelines. The other options, although they have their own benefits and indications, do not hold the same level of recommendation or evidence in the context of second-line therapy for chronic low back pain as stipulated by the ACP guidelines.