A 35-year-old woman comes to see you because of widespread pain that she says began approximately 3 months ago. She had been in her usual state of good health when she began to experience pain in her legs, upper and lower back, abdomen and shoulders. A few weeks prior to the onset of the pain she had a severe cold but can't recall any other health problem around that time. In addition to the pain she reports having problems sleeping, some morning stiffness, and has noticed that unless she makes an effort to concentrate, she at times has trouble with her memory.
She has tried ibuprofen and naproxen for the pain, both of which have alleviated other types of pain she has had in the past but they haven't had much effect on the current pain. She even tried oxycodone with tylenol that she had left over from dental surgery last year but while this sedated her, it didn't provide much relief from the pain.
The patient is a high school math teacher. She lives with her husband, a firefighter, and their 6- and 3-year-old children. While she admits that at times it is challenging for them to both hold full-time jobs while raising two young children, there have been no recent new stresses in her life. She has felt depressed at times recently about the pain and concerned that it may not go away but denies that these feelings have interfered with her functioning. She has no history of mental illness. She denies any history of overseas travel for the past year.
You examine the patient and except for some tenderness over the painful areas, you do not find any other problems. You order a CBC and metabolic panel both of which are normal.
1. Based on the history, physical, and lab work, which diagnosis would you consider to be most likely?
A. Lyme disease
B. Chronic fatigue syndrome
D. Major depressive disorder
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Agency for Healthcare Research and Quality. Treatment of fibromyalgia in adult subgroups. AHRQ Publication No. 15-EHC006-EF. Jan. 2015
Centers for Disease Control and Prevention. Fibromyalgia. Available at:
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