HER STORY Melissa arrived in my office looking exhausted but relatively healthy, so I was surprised when she told me she’d been in constant pain for 6 months. At first, Melissa had thought the dull aches in her knees, elbows, and shoulders were early signs of osteoarthritis.

Don't use plagiarized sources. Get Your Custom Essay on
From $8/Page
Order Essay

At night, the pain kept her up, and as it got worse, she found it harder to play tennis, a sport she’d always enjoyed. She also started to put on weight and over the course of 6 months had gained 20 pounds. In addition, Melissa had been extremely tired. Even on nights when she managed to sleep 9 hours or more, she was having trouble getting out of bed and staying awake at her job as a technical writer.

THE EVALUATION By the time she came to see me, Melissa was no longer certain she had arthritis, but she was eager to find out what was causing her baffling symptoms, especially her deep muscle aches. She mentioned that she’d recently been in a minor car accident and was still experiencing neck pain.

In addition to a routine physical exam, I tested her deep tendon reflexes and did some range-of-motion testing. The tests showed that the nerves in her muscles were fine, and she still had mobility in her joints and some muscle strength. Melissa also described her debilitating fatigue. She was having difficulties concentrating, and no matter how much sleep she got, she was tired.

THE DIAGNOSIS Although the fatigue sounded like chronic fatigue syndrome, I began to suspect that Melissa actually had fibromyalgia, a condition that causes chronic widespread pain, sleep disturbances, and fatigue. Fibromyalgia is a mysterious condition that affects around 4% of all Americans, the vast majority of them women. The cause is unknown, though some experts suspect there is a genetic link. Many patients develop it after a major stressor such as a car accident, viral infection, or emotional or physical stress.

Because there is no definitive test for this syndrome, making a diagnosis first involves ruling out other conditions. The pain wasn’t in her joints, so I crossed arthritis off the list of possibilities. Blood tests ruled out conditions such as anemia or lupus, which could also have accounted for Melissa’s symptoms.

The only way to confirm that Melissa had fibromyalgia was to do a digital palpation exam, in which I applied pressure to specific sites on her body. The exam revealed that she had many tender points—areas where she was sensitive to the pressure of my touch—in her shoulders, neck, elbows, knees, and below the buttocks. To meet the diagnosis criteria for fibromyalgia, a patient must have widespread pain for at least 3 months and must also be tender in at least 11 of 18 specific sites on the body. Melissa had pain in 13 of those sites and had significant sleep disruptions and severe fatigue, all symptoms of fibromyalgia.

THE TREATMENT To help her sleep, I prescribed a low dose of trazodone (Desyrel), an antidepressant that would not only improve the quality of her sleep but also help her fall back to sleep when she awoke in the night. I also prescribed the antidepressant duloxetine (Cymbalta), which would block the transmission of pain signals in the spinal cord so Melissa’s muscles wouldn’t hurt so much.


Exercise was essential to her treatment, too. Since she’d gotten out of shape, I told her to start by taking a brisk 5- minute walk and to then increase that by a minute a day until she was doing 30–45 minutes a day most days of the week. I suggested that she see an exercise physiologist to develop an ongoing program once she was comfortable with walking. Exercise would ease pain, improve sleep, and help Melissa begin the gradual process of losing weight. In addition, I suggested that Melissa find a qualified massage therapist and obtain myofascial release treatment, which I thought might help restore some of her strength, flexibility, and muscle function.

CASE CLOSED Fibromyalgia fluctuates, and Melissa’s situation was no exception. After an initial period of improved energy, she had a slight setback 6 months later when her pain got worse. I put her on pregabalin (Lyrica), an antiseizure drug that relieves pain.

It’s been almost a year since Melissa’s diagnosis, and she has made great progress. After overcoming that slight setback at 6 months, she is now doing yoga twice a week. Now that she’s active again, she’s sleeping better and feeling better.

Discussion Questions 1. What are the word parts that make up the term fibromyalgia?

2. The doctor refers Melissa to an exercise physiologist. What does an exercise physiologist do?

3. The doctor considers and then rules out chronic fatigue syndrome. What is this?

4. Melissa is advised to try myofascial release. What is this?



Calculate the price
Make an order in advance and get the best price
Pages (550 words)
*Price with a welcome 20% discount applied.
Pro tip: If you want to save more money and pay the lowest price, you need to set a more extended deadline.
We know how difficult it is to be a student these days. That's why our prices are one of the most affordable on the market, and there are no hidden fees.

Instead, we offer bonuses, discounts, and free services to make your experience outstanding.
How it works
Receive a 100% original paper that will pass Turnitin from a top essay writing service
step 1
Upload your instructions
Fill out the order form and provide paper details. You can even attach screenshots or add additional instructions later. If something is not clear or missing, the writer will contact you for clarification.
Pro service tips
How to get the most out of your experience with Top Writers 4Me
One writer throughout the entire course
If you like the writer, you can hire them again. Just copy & paste their ID on the order form ("Preferred Writer's ID" field). This way, your vocabulary will be uniform, and the writer will be aware of your needs.
The same paper from different writers
You can order essay or any other work from two different writers to choose the best one or give another version to a friend. This can be done through the add-on "Same paper from another writer."
Copy of sources used by the writer
Our college essay writers work with ScienceDirect and other databases. They can send you articles or materials used in PDF or through screenshots. Just tick the "Copy of sources" field on the order form.
See why 10k+ students have chosen us as their sole writing assistance provider
Check out the latest reviews and opinions submitted by real customers worldwide and make an informed decision.
On point! Appreciate all the hard work!!
Customer 452483, August 16th, 2021
Good job! Thank you.
Customer 452487, October 26th, 2021
Well done! I thank you very much!
Customer 452483, July 9th, 2021
Introduction to Sociology
Amazing! Thank you so much for your hard work, appreciate it!!
Customer 452483, October 24th, 2021
English 101
Thank you guys for always being there and helping me always get a 100% on my assignments!
Customer 452483, August 16th, 2021
English 101
I would like to thank you for the writing, it was a very busy week for me and had no time this week to do a writing. I would recommend you to others and would utilize you again.
Customer 452639, October 16th, 2022
Classic English Literature
Great paper, thank you!
Customer 452591, May 5th, 2022
Thank you! It was great :)
Customer 452483, July 26th, 2021
Thank you for your help
Customer 452555, February 16th, 2022
Very clear, and complete information presented. I, thank you for all of your hard work, appreciate it!
Customer 452483, August 9th, 2021
Thank you so much for revising this paper for me. It looks great, truly appreciate it! You're awesome :)
Customer 452483, September 14th, 2021
Thank you so much for all of your hard work & help! It’s perfect! Appreciate it!!
Customer 452483, September 11th, 2021
Customer reviews in total
Current satisfaction rate
2 pages
Average paper length
Customers referred by a friend
20% OFF your first order
Use a coupon TOP20 and enjoy expert help with any task at the most affordable price.
Claim my 20% OFF Order in Chat