BACKGROUND
This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. At the beginning of the clinical interview, the client reports that his family doctor sent him for psychiatric assessment because the doctor felt that the pain was ll in his head. e further reports that his physician believes he is just making stuff up to get ¡rcotics to get high.®bsp;
SUBJECTIVE
The client reports that his pain began about 7 years ago when he sustained a fall at work. He states that he landed on his right hip. Over the years, he has had numerous diagnostic tests done (x-rays, CT scans, and MRIs). He reports that about 4 years ago, it was discovered that the cartilage surrounding his right hip joint was 75% torn (from the 3 oìock to 12 oìock position). He reports that none of the surgeons he saw would operate because they felt him too young for a total hip replacement and believed that the tissue would repair with the passage of time. Since then, he reported development of a strange constellation of symptoms including cooling of the extremity (measured by electromyogram). He also reports that he experiences severe cramping of the extremity. He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). However, the neurologist referred him back to his family doctor for treatment of this condition. He reports that his family doctor said (ere is no such thing as RSD, it comes from depression!nd this was what prompted the referral to psychiatry. He reports that one specialist he saw a few years ago suggested that he use a wheelchair, to which the client states `said ¯,4here is no need for a wheelchair, I can beat this!®bsp;
The client reports that he used to be a machinist where he made 2etty good money. e was engaged to be married, but his fianc’ot éck and tired of putting up with me and my pain, she thought I was just turning into a junkie.®bsp;
He reports that he does get /wn in the dumps&rom time to time when he sees how his life has turned out, but emphatically denies depression. He states ou can let yourself get depressed9ou can drive yourself crazy if you do. I`not really sure whatàwrong with me, but I know I can beat it.®bsp;
During the client interview, the client states è! Itàhappening, let me show you!4his prompts him to stand with the assistance of the corner of your desk, he pulls off his shoe and shows you his right leg. His leg is turning purple from the knee down, and his foot is clearly in a visible cramp as the toes are curled inward and his foot looks like it is folding in on itself. t will last about a minute or two, then it will let up(e reports. Sure enough, after about two minutes, the color begins to return and the cramping in the foot/toes appears to be releasing. The client states f there is anything you can do to help me with this pain, I would really appreciate it. e does report that his family doctor has been giving him hydrocodone, but he states that he uses is ðaringlyecause he does not like the side effects of feeling ìeepy!nd constipation. He also reports that the medication makes him /opy!nd doesn really do anything for the pain.
MENTAL STATUS EXAM
The client is alert
