Case Presentation
Rachel is a new patient at your family practice. She is a 38-year-old mother of four
and a registered nurse. She quit working two years ago due to disabling pain. “If I
told you about all of my aches and pains, you would think I was crazy,” she told the
physician. “I have had a million tests for my pain, fatigue, bowel problems and
numbness. I have difficulty remembering things and have restless sleep. Everything
comes back normal and doctors tell me that I am stressed and just need to relax. I
do not want to to talk about any of these problems. I am only here to get a
prescription for my migraines.”
The physician could see that Rachel
was frustrated with her previous
care. She reviews her lab results
obtained in the last 6 months
ordered from Rachel’s last
physician. Her complete blood
count, chemistry screen,
thyroid-stimulating hormone
(TSH), antinuclear antibody (ANA)
and erythrocyte sedimentation
rate (ESR) are within normal limits.
The physician performs a physical examination, palpating various points on her back,
shoulders, upper and lower extremities. Rachel states these areas are very tender.
The physician completes a widespread pain index (WPI) and a symptom severit
scale (SSS). The physician explains to Rachel that she most likely has fibromyalgia
based on the WPI, SSS, chronic symptoms and no other disorders to explain her
symptoms. Rachel is relieved that she has a diagnoses and asks the physician if
there is a cure.
Questions

1. Define the bold words.
2. Describe the cause of fibromyalgia.
3. Fibromyalgia is typically a disorder that is diagnosed because other conditions have
   been ruled out. Her previous physician ordered several labs, including TSH and ANA to
   rule out the autoimmune thyroid condition, Hashimoto’s disease. Compare the etiology,
   signs and symptoms, diagnosis and treatment for Hashimoto’s disease to fibromyalgia.
4. Rachel needs to be educated on the treatment for fibromyalgia. Explain the treatment
   using terms that Rachel can understand. At minimum this should include any athome-care, over the counter medications, prescriptions (includes physical therapy,
   occupational therapy, counseling), alternative or complementary care.
5. Explain the prognosis of the disease to Rachel and preventative measures that can
   be taken to prevent her condition from worsening.