American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of medications are encouraged to be attempted first for treating painful diabetic neuropathy?

1. Costly newer medications

2. Tricyclic antidepressants

3. Opioids

4. Topical analgesics

The correct answer is: Tricyclic antidepressants

Tricyclic antidepressants are recommended as a first-line treatment option for painful diabetic neuropathy due to their established effectiveness in alleviating neuropathic pain. These medications, such as amitriptyline and nortriptyline, work by modifying pain pathways in the central nervous system. They help to block the reuptake of neurotransmitters such as serotonin and norepinephrine, which play a role in pain modulation. Research has shown that tricyclic antidepressants can significantly reduce pain and improve the quality of life for patients suffering from diabetic neuropathy. The choice of these medications is also supported by clinical guidelines which emphasize their benefit in managing neuropathic pain. While other treatments may also be beneficial, they are typically considered after tricyclic antidepressants. Costly newer medications may have advanced mechanisms but often come at a higher financial burden without necessarily providing superior efficacy. Opioids are not recommended as first-line therapies due to their potential for dependence and limited effectiveness in chronic pain management. Topical analgesics, such as capsaicin cream, can provide localized relief but are usually used in conjunction with systemic medications rather than as initial therapy. Thus, the recommendation for tricyclic antidepressants as a first attempt aligns with both clinical