Fibromyalgia Adelaide Bradshaw

Patient History

• 23 year old Caucasian female

• Chief Complaint of Fatigue, widespread pain and Anhedonia

• Laparoscopy performed July 27, 2013 diagnosis of Endometriosis established.

• Non smoker no drug or alcohol abuse

• Single sexually active with one pregnancy delivered vaginally August 23, 2010 no complications

• Full time student

• Moderately active, but struggles with pain during periods of increased physical activity

Medication History

• Analgesics (Pain Killers)• 5mg Hydrocodone (Vicodin)

• 25 mg Tramadol

• Muscle Relaxants• 5mg Cyclobenzaprine (Flexeril)

• Sedatives and Sleep Aids• 5mg Zolpidem (Ambien)

• 10mg Melatonin

• Selective Serotonin Reuptake Inhibitors (SSRIs)• 25mg Steraline (Zoloft)

Family History

• Mother and maternal grandmother with Endometriosis both resulting in full hysterectomies

• Maternal grandmother with Fibromyalgia, COPD, hypertension and congestive heart failure in 2008

• History of cancer, endometriosis and depression on distant maternal side

• Father and paternal grandparents healthy

• No family history of drug or alcohol abuse

• Lack of interest in activities

• Excessive daytime fatigue

• Chronic pain that spreads throughout the bilateral

upper extremities and bilateral lower extremities

• Worsened pain during physical activity

Onset of Symptoms occurred following a routine Laparoscopy in 2013 with a diagnosis of Endometriosis

Patient Symptoms

Examination and Findings

• Upon physical examination the patient complains of excessive daytime drowsiness and chronic widespread pain. Problems of fatigue affecting her ability to function throughout the day, and the inability to feel fully energized despite a full night’s sleep.

• Pain primarily located around the suboccipital muscle insertions, above the medial border of scapular spine and the upper outer quadrant of buttocks

• A manual tender point survey was performed with digital palpation of tender points following established Fibromyalgia diagnostic guidelines 15 of 18 were painful with intensity ranging from 6 to 10

• Superior Pelvic Pain, Signs of mild depression and Slightly elevated DHEA level 380 ug/dL

Diagnosis and Management

• Patient has been diagnosed with Fibromyalgia

Patient has been informed that Fibromyalgia is an idiopathic disease and there is no known treatment to cure the disease, but the individualized plan created based off her symptoms and response to previously prescribed therapies should minimalize her pain and discomfort as well as help with her insomnia.• She has been prescribed Pramepixole (Mirapex) starting at .25mg to be taken once

daily 2-3 hours prior to bed time which will be increased to .5mg after a week.

• Continue taking 5mg of Zolpidem as needed before bed to aid in falling asleep and we are going to start her on Provigil 200mg once a day in the morning to assist in her daytime fatigue.

• Informed of importance of exercise and healthy diet.

• Is to be seen back in 3 months to evaluate how her management plan is going as well as a recheck on blood work.

References

Sugerman, Deborah Tolmach. Fibromyalgia. JAMA : the journal of the American Medical Association 311.15 16 Apr 2014: 1577. American Medical Association. 26 Oct 2014.

 

Deodhar, Atul. Fibromyalgia: A Practical Clinical Guide.Springer Science + Business Media, 01 Jan 2011.

 

Sabal, N. Fireworks over fibromyalgia, CFS, and IBS. Postgraduate medicine 102.6 01 Dec 1997: 44. McGraw-Hill. 26 Oct 2014.

 

Wolfe, Frederick. Fibromyalgia diagnosis and diagnostic criteria. Annals of medicine (Helsinki) 43.7 01 Nov 2011: 495-502. Taylor & Francis. 26 Oct 2014.

 

Pasoto, S. Rheumatic clinical manifestations and fibromyalgia in association with endometriosis. Fertility and sterility 77 2002: S7-S7. Elsevier. 26 Oct 2014.