Abstract

MAGALHAES, Ana Rita; PEIXOTO, Ana  and  TEIXEIRA, Pedro Miguel. Multifactorial chronic pain and the holistic approach of the general practitioner: about a clinical case. Rev Port Med Geral Fam [online]. 2020, vol.36, n.5, pp.425-429. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v36i5.12670.

Introduction: Chronic pain affects about 37% of the Portuguese adult population. It’s a challenge for all clinicians because of its multifactorial nature and the almost always need to involve interdisciplinary teams in its approach. General practitioners (GP) because of their privileged position in the ability to evaluate the patient as a whole, play a leading role, since they also have privileged information about the family, community, and social environment. This case demonstrates not only the importance of the holistic assessment but also the interdisciplinary approach that translated into an improvement, from self-perceived pain as an eight, according to the numerical scale, to a three. Case description: Female, 59 years old, hotel employee, history of rheumatoid arthritis, obesity, and bilateral gonarthrosis. She scheduled a consultation with her new GP because of lumbar and lower limb pain with years of onset, recent worsening, with no identifiable relief or aggravation factors, which she classifies baseline as a five, with peaks of seven/eight in NS. The following are identified as unknown problems: uncontrolled hypertension, depressed and generalized anxiety disorder, nonadherence, chronic venous disease. Follow-up was conducted regularly over eight months, with the need to investigate causes of uncontrolled hypertension and consequent discovery of sleep apnea syndrome, patient empowerment, pharmacological and non-pharmacological treatment of major depression, the involvement of psychologist, nutritionist and physiatrics team. Pain control was not initially achieved despite therapy instituted according to the World Health Organization analgesic escalation. Only when all the pathologies were being effectively addressed in an interdisciplinary way was it possible to obtain pain control of this patient. Comment: This case demonstrates the importance of the global assessment of the person with chronic pain that has revealed several associated pathologies, marked psychosomatic components, and the need for multi and interdisciplinary approaches. Only by addressing all health problems was it possible to giving her quality of life and enabling her to cope with her illnesses, illnesses, and pain(s).

Keywords : Chronic pain; Depression; Patient-centered medicine.

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