A 33- year old Caucasian female has a four-month history of diffusemusculoskeletal pain, stiffness, fatigue, dry eyes, menstrual cycle,and frequent dyspareunia. The pain varies with weather and worsens inthe morning. Physical exam showed remarkable widespread pain.
The differentialdiagnosis of this patient includes fibromyalgia, myofascial painsyndrome, chronic fatigue syndrome, and hypothyroidism. Hechtman, L.(2012) argues that these conditions have some of the above symptomsin common. The differential diagnosis, therefore, is not straightforward and done through exclusion. Myofascial pain syndrome (MPS) ischaracterized by localized pain in tender areas of the muscles. Thepatient has widespread pain while MPS is localized and arises fromtrigger points in the muscles (Hechtman, L. 2012). Chronic fatiguesyndrome is associated with inflammation, low-grade fever, lymphgland enlargement. However, there is no inflammation in the patient’scase. Individuals with hypothyroidism experience profound fatigue,muscle weakness, generalized malaise, and hair loss (Cutler E. &Tunkel R., 2013). Hypothyroidism is ruled out since it is norcharacterized by dyspareunia which is present in the patient. is the suitable diagnosis for the patient since sheexhibits the symptoms of this condition.
The management of fibromyalgia ranges from pharmacologic tonon-pharmacologic methods. Pharmacologic methods involve the use oftricyclic anti-depressants, muscle relaxants, sedatives, andcorticosteroids. A dose of 10g of Amitriptyline 1-2 hours beforesleep will help her improve the quality of sleep, morning stiffnessand pain. 10 mg dose of cyclobenzaprine over a period of 12 weeksalso helps in improving sleep and reduce pain during the morning. Thepatient and her family should be educated on self-managementstrategies that focus on quality sleep, stress-free life, anddepression reduction. Education through cognitive behavioralstrategies involves setting goals and priorities will also beeffective on her (Cecil, Goldman & Schafer, 2012). Over 80% ofpatients with fibromyalgia are women. Some symptoms of fibromyalgiaare different between women and men. Women with the conditionexperience irritating bowel, and irregular and painful menstrualperiods. The diagnosis, treatment, and management of fibromyalgiaperformed on women differ from that in men due to the differences inthe symptoms displayed (Marcus, D. A., & Deodhar, A. 2011).
Cecil, R. L., Goldman, L., & Schafer, A. I. (2012). Goldman`sCecil medicine. Philadelphia: Elsevier/Saunders.
Cutler E. & Tunkel R. (2013), Clearing the Way to Health andWellness: Reversing Chronic Conditions by Freeing the Body of Food,Environmental, and Other Sensitivities, iUniverse
Hechtman, L. (2012). Clinical naturopathic medicine.Chatswood, N.S.W: Elsevier Australia.
Marcus, D. A., & Deodhar, A. (2011). : Apractical clinical guide. New York: Springer Science+BusinessMedia, LLC.