Medication

Explain tactfully that since there is no clinical evidence of inflammation, his NSAIDs can be ceased. Because he is depressed with an anxiety component and insomnia, an antidepressant can be prescribed to be taken at night ( click here for an explanation for the patient). He can be assured that not only will this help his psychological state but it should help 'shut the pain pathway gate' and reverse the overactivity of the nervous system.

Patient education including patient education handouts about possible side effects and how to cope with them would be appropriate.

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