General IM Q47

A 51-year-old woman is referred for evaluation. She has a 10-year history of chronic pain that she describes as head-to-toe aching, twisting, and sometimes burning that involves several large muscle groups. The pain is constant, and she rates the severity as a 6 on a 10-point scale. She is able to work despite the pain but is constantly fatigued. Her current regimen of oxycodone provides minimal relief. She has tried three other opioid medications as well as gabapentin and milnacipran, all of which provided only minimal improvement in her pain. Medical history is also significant for generalized anxiety disorder treated with sertraline. On physical examination, vital signs are normal. There is tenderness in multiple large muscle groups. The remainder of the physical examination is normal.

In addition to slow tapering of oxycodone, which of the following is the most appropriate next step in treatment?

A Lorazepam

B Physical therapy

C Transcutaneous electrical nerve stimulation

D Transdermal fentanyl

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