American Board of Internal Medicine (ABIM) Certification Practice Exam

If first-line therapy for osteoarthritis is ineffective, what is the next step for pain management?

1. Increase physical therapy sessions

2. Prescribe an opioid

3. Start an NSAID

4. Refer to a specialist

The correct answer is: Start an NSAID

In the management of osteoarthritis, if first-line therapies such as acetaminophen or lifestyle modifications are not providing the desired pain relief, the next step is often to initiate a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are advantageous because they not only help reduce pain but also address inflammation that can accompany osteoarthritis. They are a widely accepted option in clinical practice for managing symptoms of this condition and are effective for many patients. Increasing physical therapy sessions may provide additional support and improve function, but it does not directly address the pain in the same way that medications can. Referring to a specialist can be a subsequent action, particularly if the condition is severe or not responding to treatments, but it is typically not the immediate next step for pain management. Prescribing opioids may be considered in certain cases, especially for more severe pain or when NSAIDs are not an option, but it is generally not the first alternative to consider following initial therapies due to potential side effects and dependency risks. For managing osteoarthritis pain effectively after first-line modalities fail, starting an NSAID strikes a balance between efficacy and safety, making it the preferred next step.