How would you validate the diagnosis of fibromyalgia?
In diagnosing fibromyalgia, the patient should report a widespread (pain on both sides of the body) chronic pain for 3 or more months. During assessment, the patient should report moderate pain on palpation in no less than 11 of the 18 tender points, including the cervical, thoracic, or lumbar spine. These tender points include the sub-occipital muscle; the anterior lower cervical inter-transverse spaces at C5–7; the second rib costochondral junctions; the supraspinatus beginning above the medial border of the scapular spine; the upper trapezius; the elbow lateral epicondyle; the gluteal ; the greater trochanter; and the medial fat pad of the knee, proximal to the joint line (Schub & March, …show more content…
Moreover, there has not been any clinical evidence that supports the prescription of opioids for the treatment of fibromyalgia (Pino, 2017). However, evidence has shown that patients that have not responded to initial treatment reported significantly greater pain improvement with combination of agents. Therefore, I would order EP a low dose of a serotonin and norepinephrine reuptake inhibitor (SNRI)(eg. Milnacipran 100 mg daily) to be taken in the morning and a low dose of an anticonvulsant (eg, Pregabalin 300 or 450 mg daily) to be take in the evening (Goldenberg, 2017b). I will also provide education for EP on the disease process and the treatment plan including the adverse effect of long term …show more content…
The treatment goal for fibromyalgia is aimed at lowering the major symptoms, these include insomnia, fatigue, chronic widespread pain, and cognitive dysfunction. Therefore, the treatment plan will include patient education on the disease process and the treatment approach; an exercise program and a prescription of a low dose tricyclic antidepressants, selected antidepressants or anticonvulsants (Goldenberg, 2017a), in addition to NSAIDs and long-acting opioids (Schub & March, 2016). Drugs that are U.S. Food and Drug Administration (FDA) approved for the treatment of fibromyalgia are Duloxetine, milnacipran, and pregabalin (Schub & March, 2016).
Would you recommend any nontraditional therapies?
I would recommend nontraditional therapies like physical therapy and a cognitive behavioral therapy (CBT) for EP because, the treatment for fibromyalgia should be supportive and symptom driven. Therefore, the patient's treatment should consist of an integrated, multidisciplinary nonpharmacologic and pharmacologic approach (Schub & March, 2016). A CBT may help with the patient's ability to cope with pain and lower depressed mood (Goldenberg, 2017).
In diagnosing fibromyalgia, the patient should report a widespread (pain on both sides of the body) chronic pain for 3 or more months. During assessment, the patient should report moderate pain on palpation in no less than 11 of the 18 tender points, including the cervical, thoracic, or lumbar spine. These tender points include the sub-occipital muscle; the anterior lower cervical inter-transverse spaces at C5–7; the second rib costochondral junctions; the supraspinatus beginning above the medial border of the scapular spine; the upper trapezius; the elbow lateral epicondyle; the gluteal ; the greater trochanter; and the medial fat pad of the knee, proximal to the joint line (Schub & March, …show more content…
Moreover, there has not been any clinical evidence that supports the prescription of opioids for the treatment of fibromyalgia (Pino, 2017). However, evidence has shown that patients that have not responded to initial treatment reported significantly greater pain improvement with combination of agents. Therefore, I would order EP a low dose of a serotonin and norepinephrine reuptake inhibitor (SNRI)(eg. Milnacipran 100 mg daily) to be taken in the morning and a low dose of an anticonvulsant (eg, Pregabalin 300 or 450 mg daily) to be take in the evening (Goldenberg, 2017b). I will also provide education for EP on the disease process and the treatment plan including the adverse effect of long term …show more content…
The treatment goal for fibromyalgia is aimed at lowering the major symptoms, these include insomnia, fatigue, chronic widespread pain, and cognitive dysfunction. Therefore, the treatment plan will include patient education on the disease process and the treatment approach; an exercise program and a prescription of a low dose tricyclic antidepressants, selected antidepressants or anticonvulsants (Goldenberg, 2017a), in addition to NSAIDs and long-acting opioids (Schub & March, 2016). Drugs that are U.S. Food and Drug Administration (FDA) approved for the treatment of fibromyalgia are Duloxetine, milnacipran, and pregabalin (Schub & March, 2016).
Would you recommend any nontraditional therapies?
I would recommend nontraditional therapies like physical therapy and a cognitive behavioral therapy (CBT) for EP because, the treatment for fibromyalgia should be supportive and symptom driven. Therefore, the patient's treatment should consist of an integrated, multidisciplinary nonpharmacologic and pharmacologic approach (Schub & March, 2016). A CBT may help with the patient's ability to cope with pain and lower depressed mood (Goldenberg, 2017).