Question of the Month – August 2019 Written by: Deepa Kattail, MD MHS FAAP McMaster University, Hamilton, Ontario, CanadaA 15 year old girl presents to the pediatric chronic pain clinic as referral from the family doctor. She complains of widespread musculoskeletal pain in her back, neck, shoulders, arms. Her mother is quite tearful and describes how much the pain has disrupted her daughter's life. She was previously a straight A student but now is struggling in school and misses at least one day of school per a week for the last one year. The patients also reports feelings of sadness and crying. Review of the chart reveals normal MRI of the spine, xray of bilateral arms also normal. On examination, she was tender in the areas of pain complaints but was otherwise grossly normally neurologically and had no issues with radicular pain symptoms. She has been prescribed NSAIDs by her family doctor. She is asking for help with pain management. What would be the best next step in managing this patient's pain? A. Prescribe enteral oxycodone to be taken as needed for pain. B. Provide epidural steroid injections for treatment of her back pain. C. Consider an interdisciplinary approach to pain management, including referral to psychologist and physiotherapist to further investigate multifactorial causes of pain. D. Decline referral, this patient would be best treated by a mental health program.