“No Offense, Doctor, But I Want a Referral for My Pain”

The Chiro.Org Blog

SOURCE:   Medscape Education Community CME
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Charles P. Vega, MD

Case Presentation

You are seeing a 42-year-old woman whom you diagnosed with fibromyalgia 4 weeks ago. Her main complaint continues to be diffuse, dull body pain, but she also reports occasional numbness in both hands. She says that she has felt fatigue for the past several years, and she blames poor sleep for this. She denies depression but says that she gets tearful when she thinks about her chronic symptoms and how they have limited her from what she has wanted to accomplish.

The patient was treated initially with some education regarding fibromyalgia and its manifestations, followed by several supporting phone calls from your staff. She was given a prescription for an exercise program, which she tried twice but could not continue due to exacerbation of her symptoms. She was also given a prescription for amitriptyline 50 mg at bedtime, which she stopped after 2 days due to dry mouth and increased fatigue.

Two weeks ago, you prescribed duloxetine 20 mg daily. She comes to your clinic today to tell you that this medication has had no effect on her symptoms. She tells you that she likes you as a person, but she requests that she be referred to someone who can treat her illness more effectively.

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