A 41-year-old male patient presents to your primary care clinic and complains of “pain all over my body”. He reports this has been ongoing for many years but now seems to be worsening in the last 3 months. There was no incident that seemed to trigger the symptoms.
Patient Diagnosis Case Study: Pain Management
Read the patient scenario and answer the following questions.
Note: You have two attempts. You can choose to just do it all on one attempt. However, because it is a case study, go in the first time and copy down the questions and answers work on it, then go back in later on your second attempt and answer the questions. Do not put in any answers on your first attempt. You should receive a 0. This should not be an opportunity to play with the correct or wrong answers. If you put in answers on the first attempt (or get a score other than 0) I will count this as your attempt.
Patient Scenario
A 41-year-old male patient presents to your primary care clinic and complains of “pain all over my body”. He reports this has been ongoing for many years but now seems to be worsening in the last 3 months. There was no incident that seemed to trigger the symptoms.
Question 1Complaints of generalized body wide pain can be difficult to properly diagnose and likewise treat. From the list provided, which are not possible etiologies that would explain his pain? Select all that apply.
Complex Regional Pain Syndrome (CRPS)
Fibromyalgia
Autoimmune disease (rheumatism)
NSAID overuse disorder
Depression
Myofascial pain syndrome
Thyroid Disease
Peripheral Vascular disease
Question 2In order to narrow down the possible diagnosis you realize you should try to determine whether the pain is more of a central sensitization issue versus neuropathic versus nociceptive. Which of the following is an example of an etiology related to central sensitization?
Fibromyalgia
Degenerative Disc Disease (DDD)
Stroke
Pain secondary to a torn medial meniscus
Question 3Now that you have a short list in your mind of the possibilities, you decide to further explore the complaint of “body wide pain”. Based on the list of questions provided below, which 2 questions would you not ask to better characterize “body wide pain”? You decide you should ask all the following to better characterize the pain except:
Can you pinpoint where you feel your pain?
Do you have pain in your large or small joints or both?
Does the pain get worse with activity or at different times of day?
Do you want some pain medication today?
Do you have any family history of autoimmune disease?
Have you felt sad lately or had trouble sleeping?
Do you take your blood pressure medication as prescribed?
Question 4The patient has responded to your questions with the following:
My joints hurt sometimes but not every day. The pain does not travel, and it is more achy feeling. I seem to sleep fine and I’m not sad. The pain is usually worse with activity. I think my mom may have had Lupus or something.
Which 2 of the following options seem to be the most likely etiology?
Fibromyalgia
Spine etiology
Rheumatism
Osteoarthritis
Lyme Disease
Question 5Before you discuss treatment, you decide you want to explore in more depth the treatments the patient has already tried. You ask all the of following pertinent and appropriate questions except: (select 1)
Have you been to physical therapy in the last 6 months?
Do you use OTC medications to try to alleviate pain?
Have you seen a Chiropractor or tried acupuncture in the last 6 months?
Have you tried any injection-based therapy?
Have you tried ice/heat/stretching?
Are you addicted to opiates?
Question 6The patient responds “Nothing works” but does not seem to have tried anything you asked other than some over the counter (OTC) medication. Now that the patient’s condition is better evaluated, you begin to consider treatment options and recommendations.
Review the following statements which will serve as the patient education you will deliver during the visit. Which 2 statements should not be included as part of your patient education?
You may be suffering from spine pain secondary to degenerative disease. This is a chronic disease…
NSAID have been shown to provide benefit in improving this pain, take as much as you need.
The key to managing this type of disease is to engage in multi-modal treatment with the goal being to make slow steady progress.
Opiates are not indicated in managing this kind of chronic disease.
If you don’t improve after initial attempts at treatment, we may have you undergo further testing.
Medications should be the only thing you need to make your pain go away.
It is also possible you may have pain from rheumatological etiology. Should you fail to improve, we can consider consultation and further testing.
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