The Case of an Educated Woman With Fibromyalgia Seeking CAM Therapies

Cases in CAM

Désirée Lie, MD, MSEd


November 03, 2010

The Case: A 38-Year-Old Woman With Fibromyalgia

Ms. M is a 38-year-old university lecturer who was diagnosed with fibromyalgia 2 years ago. She had extensive work-ups that excluded other underlying medical disorders, including other rheumatologic disease, and she met the American College of Rheumatology (ACR) criteria for the diagnosis. These criteria comprise chronic widespread pain on both sides of her body in the upper and lower axial skeleton, and tenderness at 15 of 18 sites.[1]

She was initially started on the tricyclic antidepressant amitriptyline and was later switched to the serotonin-norepinephrine reuptake inhibitor (SNRI) duloxetine. She has been taking 60 mg of duloxetine daily for the past 4 months. Nonsteroidal anti-inflammatory drugs have not helped her pain, and she continues to experience varying levels of pain, tenderness at multiple sites, fatigue, and insomnia. She denies other symptoms of depression.

She has a job with flexible hours and can work remotely from home, but reports that her symptoms are interfering with her job performance and scholarly productivity. She tries to exercise by walking her dog daily, but often feels too fatigued to go out and has not managed to return to the gym regularly. Although she believes that duloxetine has improved her symptoms somewhat, she would like to consider alternative therapies to further improve her symptoms and daily functioning. She asks for more information on the long-term efficacy of complementary and alternative medicine (CAM) therapies, such as acupuncture, which she has heard from friends might be helpful in relieving the symptoms of fibromyalgia.


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