Miss B was referred to the Pain service by her GP. She was 37 years old and had a history of intermittent pain over the past 9 years. The pain started gradually in her hands and feet. She described her symptoms as improving periodically before recurring. Over the past 6 months, her shoulders had become very stiff and painful as well. She scored the pain as 10 out of 10 on a verbal rating scale in the morning, sometimes reducing to 6 out of 10 later in the day. She was struggling to look after her 3 children. She described herself as exhausted all the time and was tearful during the consultation. She said a previous GP had suggested that she had fibromyalgia.
She was taking 1g paracetamol QDS and 400mg ibuprofen TDS on most days. She thought ibuprofen had helped somewhat in the past but was not giving much relief currently. She had taken morphine previously but did not find it helped and stopped taking it when she was discovered she was pregnant with her first child.
Before continuing, consider the following questions:
- Is there any other information you would like to know?
- What are the potential differential diagnoses?
- Are there investigations that would be helpful?
- Would this patient benefit from evaluation by another specialty?