American Board of Internal Medicine (ABIM) Certification Practice Exam

Which alternative therapy might be considered for patients with fibromyalgia who cannot tolerate tricyclic antidepressants?

1. Topical NSAIDs

2. Cyclobenzaprine

3. Gabapentin

4. Surgery

The correct answer is: Gabapentin

Gabapentin is considered an alternative therapy for patients with fibromyalgia, especially for those who experience side effects from tricyclic antidepressants or cannot tolerate them. Gabapentin, an anticonvulsant medication, has been shown to help alleviate neuropathic pain and has a mechanism of action that may help in modulating pain pathways associated with fibromyalgia. In clinical settings, gabapentin is often used to treat various pain conditions, including fibromyalgia, by addressing the dysregulation of pain processing in the nervous system. Its side effect profile is generally well-tolerated compared to tricyclic antidepressants, making it a suitable option for patients seeking relief from fibromyalgia symptoms without the risks associated with other medications. Topical NSAIDs and cyclobenzaprine can provide relief for certain types of pain but may not be as effective for the widespread pain and other symptoms associated with fibromyalgia. Surgery is not indicated for fibromyalgia, as it is not a structural condition, and surgical intervention is unlikely to address the underlying issues related to fibromyalgia. Therefore, gabapentin stands out as a rational alternative therapy for patients with fibromyalgia who are unable to take tricyclic antidepressants.