Mrs. T., 49-year-old accountant:

Further questioning reveals:

• Pain is in her shoulders, neck, back, arms, elbows and knees.
  
• Pain has been present for about six months and has now worsened. The involved areas are sore and she complains of generalized stiffness, which is worse in the mornings.
  
• Mrs. T. says she does not wake up refreshed, has non-restorative sleep, although she sleeps eight hours.
  

For pain relief Mrs. T. has tried:

• ASA but with little effect
  
• Other nonsteroidal anti-inflammatories (NSAIDs) (OTC) but they did not provide much relief
  
• Analgesics with codeine have been effective but the pain returns once their effect has worn off.
  
• Four cups of coffee/tea per day including bedtime; use of a "night cap". (i.e., alcoholic beverage to help induce sleep).

Other details:

• Mrs. T. admits to having a decreased appetite and some weight loss in the past few months.
• Mrs. T admits to feeling depressed lately.