ABSTRACT
This chapter presents a case of a 52-year-old medical secretary who visits her general practitioner surgery with a 3-month history of back pain, generalized body ache and tiredness. She feels absolutely exhausted and has found it difficult to go to work. The pain is located in the lower back and is described as a constricting non-radiating pain, which seems to be better when she is lying down. The pain in her back and her body ache do seem to get better as the day goes along. She feels preoccupied with her pain, does not enjoy the taste of food and has lost weight, which is one 'silver lining to the cloud'. There is no localized tenderness or inflammation and systemic examination is normal. She appears slow, tired, takes a long time to answer questions and her voice is soft. She reports feeling 'empty' and lethargic with little interest in work or previously pleasurable activities.
