Question of the Month – January 2020 Patricia Richardson, PhDPediatric Pain Psychology Postdoctoral FellowStanford University A 16-year-old girl presented with widespread musculoskeletal pain and headaches. Symptoms were treated with medication management and outpatient physical therapy (PT). Several months into follow-up, the patient was not making progress, continued to report elevated pain, and had stopped attending school. It was revealed that she was not taking prescribed medication or engaging in PT because she did not think these services would be helpful. Her life was further complicated by ongoing stress related to poor familial relationships and her parents’ impending divorce.Addressing complex family dynamics that may be contributing to symptom presentation and undermining treatment progressSupporting medication and physiotherapy adherence by developing intrinsic motivation for the patient to take medications as prescribedCommence report to child protective services for parental medical neglectTeach the child pain self-management techniques to directly reduce pain intensitySupport acquisition of academic accommodations (e.g. 504 plan or individualized education plan) that allow the patient to remain at school Time is Up!