A 43-year-old woman presents to your office because of musculoskeletal pain and weight gain. Over the past 6 months, she has noted generalized aches and pains of muscles and joints, fatigue, and poor sleep quality. She admits to wanting to stay in bed rather than socialize with her friends and family. She denies fever, night sweats, morning stiffness, joint redness, blood loss, easy bruising, or daytime somnolence. Physical examination reveals normal BMI, normal thyroid, normal cardiovascular examination, normal joints, and no tenderness to palpation. CBC, TSH, ESR, ANA, rheumatoid factor, electrolytes, liver enzymes, and kidney function tests are normal. She wants pain control.
Which treatment is most likely to relieve her symptoms?
A. Long-acting opiatesThis patient is suffering from the emotional and physical symptoms of depression. Her weight gain is due to her sedentary lifestyle. Initiation of an antidepressant is the most appropriate pharmacologic management, either with a selective serotonin reuptake inhibitor, or with a serotoninnorepinephrine reuptake inhibitor. The SNRI may provide more relief from her physical symptoms than SSRI therapy. Opiate therapy for the pain of depression is inappropriate and exposes the patient unnecessarily to potential addiction. Steroids are not clinically indicated. DMARDs are reserved for specific rheumatologic diseases, not nonspecific musculoskeletal symptoms.