ABSTRACT
Hilda Watson is 62 years old and suffers from chronic back pain. She has no psychiatric history. Her pain management consultant writes to a person stating that ten tablets of cocodamol per day no longer control her pain and she is requesting stronger opiate-based analgesia. The patient could be supplementing her own prescribed cocodamol with other medication/opiates. She would then become more tolerant of her prescribed opiates and would need a higher dose of opiates to achieve the same effect. It is also necessary to explore the relationship between her pain and the taking of her medication. She may be in constant pain and the prescribed cocodamol may not have any effect. She may be becoming addicted to opiates or chronic constipation could be causing the back pain. Depression needs to be ruled out. She has risk factors for depression and exacerbation of pain could be a symptom of depression.
