START

Rose Budd is a 39 yo lady, well known in your community for her theatrics. As well as playing lead contralto in light operas, her whole life is theatre, including her visits to your office. 

"Oh, doctor, you just have to do something. I just can't stand it any more" she wails, when marching into your office. "My back is killing me. I need painkillers...now!". She points somewhere between her shoulder blades.

What do you do first? (pick any but do in order of usefulness)