Chronic Pain: GK is a 40-year-old female who was referred to you from her PCP for a mental health evaluation. The PCP feels the need to increase the dose of hydrocodone based upon the patient’s poor response to existing treatment. GK complains of “pain all over her body.” She describes the pain as muscular pain with a feeling of spasm or tightening. She has had this pain for over a year. Her PCP has treated her with both NSAIDs and opioids with minimal impact on pain. GK also complains of not sleeping well, having no energy and difficulty concentrating and completing work which she thinks is related to her poor sleep. Her past medical history includes: HTN diagnosed at age 38; hyperlipidemia diagnosed at age 38; depression diagnosed at age 35. She was adopted so little is known about her biological family history. She works as a secretary in a school office and is married with two children who are 11 and 9 years old. She smokes one pack of cigarettes per day and drinks only occasionally (a glass of wine at social gatherings). Her medication history includes:
She has no known allergies. Her labs are all within normal limits. Physical exam is normal with the exception of pain at 13 of the 18 tender point sites on digital palpitation. She also appears tired and older than her stated age.