A 43-Year-Old Woman Comes to the Office for an Initial

A 43-year-old woman comes to the office for an initial appointment due to ongoing abdominal pain, general weakness, decreased appetite, and dizziness.  She says the pain is ruining her life and is worried that her previous physicians may have missed something.  Over the past several years, the patient has been hospitalized 3 times with similar symptoms.  No etiology for the pain has been identified despite extensive workups, including several abdominal CT scans and an exploratory laparotomy.  The patient describes chronic abdominal pain since adolescence and is concerned as the nonprescription analgesics she takes are ineffective.  She has no history of psychiatric diagnoses or substance abuse.  Physical examination, vital signs, and laboratory tests (including chemistry panel, complete blood count, and urinalysis) are within normal limits.  Which of the following is the most appropriate next step in the management of this patient?

A) Explain that symptoms are psychological in nature
B) Obtain gastroenterology consult
C) Order abdominal MRI scan
D) Prescribe an opioid analgesic
E) Reassure that all tests are negative and further workup is not indicated
F) Refer for psychiatric treatment
G) Schedule regular outpatient office visits

Correct Answer:

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