“How do you prove you have fibromyalgia to the benefits people?”
55 years old
Conditions: Perthies disease, total hip replacement and a revision on the same hip chronic back pain depression
1) Aches/pains in ALL FOUR QUADRANTS of the body, meaning pains/aches in the RIGHT UPPER EXTREMITY/SHOULDER/UPPER BACK/NECK, LEFT UPPER EXTREMITY/SHOULDER/UPPER BACK/NECK and in the R LOWER BACK/HIP/BUTTOCKS/THIGH/ LEG, and LEFT LOWER BACK/HIP/BUTT/THIGH, and leg, sometimes referred to as "shoulder-hip girdle" aches and pains.
2) TRIGGER POINTS in multiple areas, especially tender spots located commonly in the neck, traps, upper back, shoulders, and proximal extremities
3) SLEEP DISORDER
4) More common in WOMEN, usually under 40-50 years old
5) May be associated with irritable bowel, migraine, anxiety, and depression
6) ALL BLOOD TESTS, X-RAYS, and IMAGING TESTS ARE NORMAL, and the PHYSICAL EXAM IS NORMAL (EXCEPT for TRIGGER POINTS), but there is NO swelling, redness, rash, joint findings, or muscle weakness present.
7) BETTER SLEEP, EXERCISE, and MAYBE a medication like NSAIDS (i.e., IBUPROFEN), low dose ELAVIL at night, or LYRICA (if more severe and fails the previous 2 drugs), and opiates -- e.g., TRAMADIL -- MAY be needed if all else fails and the patient is still having daily moderate to severe pain that interferes with her quality of life, job, or relationships at the lowest dose necessary to just "take the edge off" of the pain.
But the drug will NOT be expected to eliminate the pain, and the patient must be advised of this and made clear that becoming totally pain-free is probably NOT a realistic goal of taking the drug. The patient must be warned of potential habituation/addiction if the dose and/or frequency is too high (especially if there is an underlying psych problem or prior drug problem).