Where does it hurt? These are the “four little words” that Eli Lilly (in ubiquitous ads) is encouraging us to ask our depressed patients.

Here's a fairly typical scenario: An elderly woman comes to you as a referral from her PCP for the treatment of depression and anxiety. She hands you a well-worn 3-by-5 card with her meds listed in shaky handwriting.

When a patient tells you that she has fibromyalgia, what should you, a psychiatrist, do? Should the diagnosis alter your treatment in any way?

Dr. Fishman, you are boarded in both internal medicine and psychiatry, and have gone on to specialize in pain medicine. Can you outline your basic approach to pain symptoms in a psychiatric patient?

Although heroin-then known as diacetylmorphine-was first derived from morphine in England in 1874, it was the Bayer company in Germany that saw its commercial value as a cough remedy and pain reliever.