USMLE® Step 2 style questions USMLE
A 28-year-old woman comes to the clinic because of a heightened sense of pain in response to minor stimuli and severe fatigue for the past year. She also says that she has an amplified response to painful stimuli and even a small poke can cause a sharp stabbing pain. She has been exercising frequently and has been receiving psychological therapy. Physical examination shows many tender point in muscle bodies, tendon insertions, and at bony prominences. Pain is localized in 11 of 18 specified tender points and the diagnosis of fibromyalgia is confirmed. Her symptoms have continued despite treatments with pregabalin and duloxetine. Which pharmacologic therapy is an appropriate choice for this patient?