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Chronic nonspecific low back pain — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareChronic nonspecific low back painUSMLE Step 3

A 60-year-old man with chronic low back pain asks for opioid therapy. Pain has persisted for 8 months without red flags. He has normal strength, reflexes, and sensation; straight-leg raise is negative. He has not tried structured physical therapy. Which of the following is the most appropriate next step in management?

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Correct answer: E — Recommend exercise-based physical therapy and nonopioid analgesia

Chronic nonspecific low back pain without neurologic deficits should be managed initially with nonpharmacologic therapy such as exercise-based physical therapy and nonopioid medications when needed.

Reference: ACP low back pain guideline