It is Monday morning, and your nurse hands you charts for 4 new patients. Each patient is a woman with widespread body pain, stiffness, and fatigue. In each patient, the pain affects both sides of the body above and below the waist. Each of these patients has already been evaluated by another physician: the diagnosis in each case was stress and fibromyalgia. The women were all advised that the pain was "nothing to worry about" and that they should reduce stress and practice distraction techniques. They are in your office today seeking a second opinion.
Here are the stories each patient has told your nurse.
PATIENT NO. 1 Mrs Sterns, 55 years old, has had generalized pain for the past 6 months. Every spring, she plants a showcase flower garden. This year, she hasn't even emptied out last year's beds. "I feel totally fatigued. I have no energy and just want to curl up in bed. All of my muscles and joints just ache."
PATIENT NO. 2 Ms Thomas, a 48-year-old hospital administrator, used to exercise in the gym every morning, complete a 10-hour workday, and then jog in the evening. For the past 2 years, she has been sore and achy all over and it takes all of her energy just to put in 8 hours at work. "I feel like an old lady who only wants to sit in a rocking chair knitting. Whenever I tell someone I feel bad, they say, 'But you look great!'"
PATIENT NO. 3 Mrs Brownley is a 45-year-old piano teacher who has had pain for the past 6 months. "I feel so run down and achy. I have pain from my neck to my toes. I really dread having my students come in for lessons."
PATIENT NO. 4 Mrs Schmidt is a 67-year-old homemaker who has experienced generalized pain for the past 4 months. Her husband just retired and they had planned to travel extensively, but her pain is holding them back. "Everything seems to cause me pain. It hurts to start moving in the morning, and I can't even comb my hair without severe pain."
What are the likely causes of widespread body pain in these 4 patients?
(Go to the next page to find out.)
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