Clinical vignette 1	Clinical vignette 2
Mrs Collette Comeau, aged 45, is married and has a full-time position as a medical archivist. She has two children, aged 8 and 12. Her husband is a pharmaceutical representative and has to spend many days a week away from home. Mrs Comeau has been suffering from fibromyalgia for 20 years. Pains spread over her whole body; they appeared without any precise causal event. She suffers from pains every day. On a scale from 0 to 10 where 0 represents “no pain” and 10 represents the “worst possible pain”, her average pain level is about 5 and varies from 0 to 7 depending on the time of day; it is weaker in the morning and increases throughout the day. Her pains considerably disturb her sleeping, and wake her up suddenly almost every night. Her pains interfere with her daily activities. She is often irritable, which interferes with her relationships with others. At work, she is not always fully efficacious, and she stays home about 10 days a year. She often refuses to participate in social and entertainment activities because of her pain. Mrs Comeau wants to remain independent. She often hesitates to ask for help. She does not believe she has power over her pain. Still, she believes her medication helps and medicine could perhaps one day completely relieve her pain.	Mr Jacques Levasseur, aged 68, is widowed and retired. He lives alone at home. He has three children and seven grandchildren who occasionally come to visit him. He suffers from arthritis for 10 years already. His pain is in all his joints, in particular in his knees. Although he always feels some pain (about 2 on a scale of 0 to 10), pain is not constant. Many times a week, pain becomes very acute, up to 9. His pain particularly interferes with walking and doing house-keeping tasks. Pain often prevents his sleeping and makes him sullen. His sudden mood swings affect his relationships with others. He often refuses to participate in social activities. Before pain appeared, he loved to play golf. Now, he does not dare play anymore, because he is afraid pain will worsen if he walks much. Mr Levasseur has little hope of one day being totally relieved. He often feels helpless, and useless.
Medical history	Medical history
➢ Pain control strategies  ○ Psychotherapy, several years ago  ○ Distraction techniques a few times a week  ○ Yoga twice a week ➢ Medical follow-up  ○ Family physician  ○ Not followed-up by a specialist physician  ○ No consultations for physiotherapy, ergotherapy, massotherapy, or chiropractic ➢ Medications  ○ Herbal tea for constipation  ○ Antiemetic medication (against nausea)  ○ Anti-acid medication (against heartburn) ○ Fentanyl patches (75 μg every 2 days) and 150 mg of pregabalin every day	➢ Pain control strategies  ○ Relaxation techniques ➢ Medical follow-up  ○ Family physician  ○ Has already consulted physiotherapists, occupational therapists, chiropractors, and osteopaths, without success ➢ Medications  ○ Acetaminophen a few times a week  ○ Muscle relaxant  ○ Anti-inflammatory medication (Celebrex 200 mg)