1/13. Perspectives on posttraumatic fibromyalgia: a random survey of Canadian general practitioners, orthopedists, physiatrists, and rheumatologists.OBJECTIVE: To determine which factors physicians consider important in patients with chronic generalized posttraumatic pain. methods: Using physician membership directories, random samples of 287 Canadian general practitioners, 160 orthopedists, 160 physiatrists, and 160 rheumatologists were surveyed. Each subject was mailed a case scenario describing a 45-year-old woman who sustained a whiplash injury and subsequently developed chronic, generalized pain, fatigue, sleep difficulties, and diffuse muscle tenderness. Respondents were asked whether they agreed with a diagnosis of fibromyalgia (FM), and what factors they considered to be important in the development of chronic, generalized posttraumatic pain. RESULTS: More-recent medical school graduates were more likely to agree with the FM diagnosis. Orthopedists (28.8%) were least likely to agree, while rheumatologists (83.0%) were most likely to agree. On multivariate analysis, 5 factors predicted agreement or disagreement with the diagnosis of FM: (1) number of FM cases diagnosed by the respondent per week (p < 0.0001); (2) patient's sex (p < 0.0001); (3) force of initial impact (p = 0.003); (4) patient's pre-collision psychiatric history (p = 0.03); and (5) severity of initial injuries (p = 0.03). The force of initial impact and the patient's pre-collision psychiatric history were both negatively correlated with agreement in diagnosis. Patient related factors (personality, emotional stress, pre-collision physical, mental health) were considered more important than trauma related factors in the development of chronic, widespread pain. CONCLUSION: Future studies of the association between trauma and FM should identify potential cases outside of specialty clinics, and baseline assessments should include some measurement of personality, stress, and pre-collision physical and mental health.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/13. chronic pain in a family of 6 in the context of litigation.We describe a family of 6 (2 parents and 4 children), evaluated 6 and 8 years after a minor car accident for chronic pain. A near identical complex of multiple physical, constitutional, and psychological symptoms were shared by all family members, all of whom bore the diagnosis of fibromyalgia. The case was brought to court after nearly a decade of symptomatology and extensive use of the health care system. The minor compensation awarded was consumed ultimately by legal fees. Psychosocial/personality issues and iatrogenic and medico-legal contributions in the evolution and resolution of the legal claim are discussed.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
3/13. fibromyalgia and Tinel's sign in the foot.In the physical examination of the patient suspected of having tarsal tunnel syndrome, the podiatric physician relies on Tinel's sign: tapping the posterior tibial nerve in the tarsal tunnel should produce a distally radiating sensation if the nerve is pathologically compressed at this location. The American College of rheumatology recognizes fibromyalgia as a condition characterized by multiple "tender points" on physical examination. This report compares the locations of the 18 critical diagnostic fibromyalgia points with known sites of anatomical entrapment of peripheral nerves in the lower extremity. We also describe a patient with both fibromyalgia and tarsal tunnel syndrome. Tinel's sign in the lower extremity is a valid technique for assessing peripheral nerve compression in the patient with fibromyalgia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/13. Chronic fatigue syndrome.fatigue is one of the most common complaints among patients seen in the primary care setting. Chronic fatigue syndrome, which has recently been called chronic fatigue immune dysfunction syndrome, is distinctive, with an abrupt onset of symptoms that wax and wane for at least six months. Usually there is low-grade fever, pharyngitis and tender, but not enlarged, lymph nodes. The fatigue can be disabling and is often made worse by physical activity. Some patients with this disorder have also been found to have highly characteristic immunologic abnormalities. Treatment can be rewarding and is based on patient education and support, exercise and symptomatic therapies for abnormal sleep patterns, musculoskeletal pain and other symptoms.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
5/13. Clinical holistic medicine: whiplash, fibromyalgia, and chronic fatigue.Holistic treatment of the highly complex, "new diseases" are often possible with the tools of consciousness-based medicine. The treatment is more complicated and the cure usually takes longer than for less-complex diseases. The problem with these patients is that they have less easily accessible resources than most patients, as they suffer from a combined socio-psycho-physical problem with depression, poor social standing, low confidence, and low self-esteem. Often, they have also already tried most of the specialist and alternative treatments on the market. To cure them, the most important thing is to coach them to improve their social life by changing their behavior to be of more value to others. Holding and processing must be especially careful and the contract with the patients must be extremely explicit in order to work on their personal development for 6-12 months. The new diseases can be cured with consciousness-based medicine if the patients are motivated and keep their appointments and agreements. Low responsibility, low personal energy, little joy of life, and limited insight into self and existence are some of the features of the new diseases that make them difficult to cure. The important thing is to keep a pace the patient can follow and give the patient a row of small successes and as few failures as possible. The new diseases are a challenge, a unique chance to improve communication, holding, and processing skills.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
6/13. Multifactorial facial pain--differential diagnosis: a case report.A multidisciplinary algology team was formed to facilitate the diagnosis and treatment of complex head and neck pain disorders. The standard patient evaluation includes a history and physical, surface electromyography, minnesota Multi-phasic personality inventory (mmpi), brief psychiatric interview, dental/occlusal analysis, a postural/musculoskeletal examination; and necessary diagnostic imaging. Clinicians meet in conference after each clinic session. Organic and psychiatric findings are compiled and a differential diagnosis is made. Treatment recommendations are outlined and a review of the evaluation and the therapeutic plan are forwarded to the referring doctor. A typical conference discussion is presented here.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
7/13. Localized fibromyalgia in a child.A 14-year-old male was investigated because of a limp and a localized sharp pain in the right lumber paravertebral region radiating to the lower abdomen and the medial aspect of the thigh, which started following forced physical activity. With the diagnosis of fibromyalgia the patient received two perifacetal injections of local anaesthetics with steroids followed by transcutaneous electrical nerve stimulation (TENS). Following the injections, pain intensity dropped dramatically, disability was reduced and muscle swelling resolved. The possible association of symptoms to sport activity raises the question of sport-induced fibromyalgia, and the excellent response to treatment may suggest a facet joint irritation as possible aetiology.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
8/13. phenobarbital-induced fibromyalgia as the cause of bilateral shoulder pain.A female swimming instructor was seen with chronic bilateral shoulder pain and loss of range of motion. Intensive physical therapy significantly improved the range of motion but did not alleviate the pain. Osteopathic manipulative treatment produced no further improvement in pain or function. Results of laboratory tests were all within normal limits. Four months after the initial consultation, the patient, who was taking medication for tonic/clonic seizures, recalled that her symptoms began after her anticonvulsant medication was switched from hydantoin sodium to phenobarbital. Therefore, phenobarbital-induced fibromyalgia was diagnosed. In 4 months, pain had completely disappeared. The authors discuss several theories regarding the cause of fibromyalgia and the mechanism of action of phenobarbital, including its relationship to sleep disturbance, a probable contributor to pain and dysfunction in the patient described.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
9/13. sleep apnea in male patients with the fibromyalgia syndrome.PURPOSE: fibromyalgia is a common pain syndrome that is often associated with sleep disturbances. The most characteristic pattern noted on formal sleep study is alpha-wave intrusion on delta-wave sleep. This nonrestorative sleep pattern may be endogenous, or caused by any of a number of sleep disturbances. Our goal was to determine the frequency of sleep apnea and its relationship to a nonrestorative sleep pattern in our patients with fibromyalgia syndrome. patients AND methods: All new fibromyalgia patients seen in the rheumatology Clinic at Fitzsimons Army Medical Center were screened using history and physical examination for suspicion of sleep apnea. When this condition was suspected, the patients underwent formal polysomnography to delineate any sleep disturbance. RESULTS: Four of 92 women, and 13 of 25 men with the new diagnosis of fibromyalgia syndrome underwent polysomnography. Of the women, 2.2% (2 of 92) had significant sleep apnea at formal evaluation; both were obese and had obstructive findings. In contrast, 44% (11 of 25) of the men had significant sleep apnea. CONCLUSIONS: sleep apnea is not a significant cause of fibromyalgia symptoms in females. In male patients with fibromyalgia, sleep apnea was observed in a large percentage. fibromyalgia may be a marker for occult sleep apnea in males.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
10/13. Medical problems affecting musicians.The physical demands of performing on musical instruments can cause pain, sensory loss, and lack of coordination. Five cases illustrate common problems. knowledge of the interaction between the technique of playing the instrument and the particular musician can help physicians diagnose and resolve problems.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
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