A 52-year-old woman with chronic low back pain and radiologically confirmed lumbar spondylosis has inadequate relief from paracetamol and graded exercise. Comorbid depression is well controlled. Which drug is an appropriate next pharmacological choice for her chronic musculoskeletal pain?
- A Codeine phosphate long term
- B Carbamazepine
- C Duloxetine ✓
- D Oral prednisolone taper
Correct answer: C. Duloxetine
Explanation
Duloxetine, a serotonin-noradrenaline reuptake inhibitor that enhances descending inhibitory pathways, is licensed for chronic musculoskeletal pain including chronic low back pain and osteoarthritis pain, and is endorsed by major guidelines. Carbamazepine is indicated for trigeminal neuralgia and other paroxysmal neuropathies, not axial musculoskeletal pain. Long-term weak opioids carry dependence risk without proven chronic benefit, and systemic steroids have no role in degenerative spondylosis, which rules out the remaining options.
Reference: Bonica's Management of Pain, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.