Lucille has a diagnosis of somatic symptom disorder, predominantly pain. Which of the following medications would the psychiatric nurse practitioner most likely prescribe for Lucille?

Somatic symptom disorderpresents with recurrent physical complaints that are distressing and often medically unexplained. These symptoms are real, persistent, and emotionally charged. Nursing care must balance validationwith structured boundaries to avoid reinforcing symptom preoccupation. Therapeutic communication should acknowledge the symptom while maintaining routine and promoting functional engagement.

Rationale for correct answers

3.This response acknowledges the symptom and ensures continuityof care by reporting it, while maintaining structureby encouraging group therapy attendance.

Rationale for incorrect answers

1.Dismissing the complaint as “in your head” reflects invalidatinglanguage and undermines therapeutic rapport, increasing emotional distress.

2.Skipping group therapy reinforces avoidance, which may worsen functional impairment and reduce engagement in therapeutic activities.

4.Offering new medication without assessment promotes reinforcementof somatic focus and may lead to unnecessary pharmacologic interventions.

Take Home Points

• Nursing responses should validate symptoms while maintaining therapeutic boundaries and routine.
• Avoid reinforcing symptom preoccupation through excessive attention or unnecessary interventions.
• Encourage participation in structured activities to promote functional improvement.
• Balance empathy with clinical judgment to support emotional and physical well-being.

Duloxetineis a serotonin-norepinephrine reuptake inhibitor (SNRI) used for chronic pain, major depression, and generalized anxiety disorder. It modulates descending inhibitory pain pathways by increasing serotonin and norepinephrine levels in the central nervous system. It is FDA-approved for fibromyalgia, diabetic neuropathy, and musculoskeletal pain, making it suitable for patients with somatic symptom disorder where pain is the predominant feature. It is contraindicated in uncontrolled narrow-angle glaucoma and should be used cautiously in hepatic impairment.

Rationale for correct answers

4.Duloxetine targets both painand mood symptoms by enhancing serotonergic and noradrenergic transmission, making it effective for somatic symptom disorder with pain predominance.

Rationale for incorrect answers

1.Chlorpromazine is an antipsychotic used for psychosis, not indicated for somatic symptom disorder or pain management.

2.Diazepam is a benzodiazepine used for anxietyand muscle spasms, but it carries dependency risks and lacks efficacy for chronic pain.

3.Carbamazepine is an anticonvulsant used for seizuresand trigeminal neuralgia, not appropriate for generalized somatic pain.

Take Home Points

• Duloxetine is effective for somatic symptom disorder with predominant pain due to its dual action on serotonin and norepinephrine.
• Benzodiazepines are not first-line for chronic somatic pain due to tolerance and dependency risks.
• Antipsychotics and anticonvulsants are reserved for specific psychiatric or neurological conditions, not somatic pain syndromes.
• Always assess comorbidities and contraindications before initiating pharmacologic treatment for somatic symptom presentations.