Fibromyalgia Pain Case Study

Pregabalin is an antiepileptic agent, which acts by reducing calcium inpouring in neuronal cells. As a results, this decrease the release of some neurotransmitters involved in pain processing (Mease, 2011). Pregabalin is one of the most effective drugs to treat fibromyalgia. However, there are many side effects associated with it. These side effects are drowsiness, dizziness, dry mouth, constipation, difficulty concentrating, swollen arms, and legs (Mease, 2011). Duloxotine is also used to treat fibromyalgia. It is SNRI, serotonin- norepinephrine reuptake inhibitor. This medication acts by inhibiting the reuptake of serotonin and norepinephrine, which modulates the sesation of pain (Mease, 2011). Milnacipran a SNRI, acts in the same way. Some side effects of Duloxotine and Milnacipran are nausea vomiting, dizziness, drowsiness, headaches, hot flashes, and weight changes (Mease, 2011). Nevertheless, the side effects of these drugs. These drugs have had documented success in the treatment of fibromyalgia. As a matter of fact, a 12-month study conducted by researchers, showed the responses of a research group to Pregabalin, Duloxotine, and Milnacipran. Overall, Pregabalin was the most successful in the treatment of fibromyalgia. Overall, the study revealed that over a 12-month period 50% of the research group have had a significant reduction in pain, while

It is intermittently worse and he does not want to be on a medication on a daily basis. He is wondering if there is anything he could take during those periods of time when the tremor is worse. I did discuss the possibility of a low dose Inderal to be taken p.r.n. We both agreed that we should wait until after his cardiology evaluation for his bradycardia. Also the patient was told that there is a possibility that he is going in and out of atrial fibrillation. This cardiac evaluation may or may not have an effect on how we proceed with the right corona radiata lesion. To me this looks like an old bleed, possibly a bleed into a cavernous hemangioma. If, indeed he is in atrial fibrillation and may have to go on Coumadin, we do need to better identify the vasculature involved with this lesion. Therefore, I am going to set him up for CT angiogram to make sure that he does not have any evidence for aneurysm or other obvious vascular malformations would be at increased risk of bleeding, if he is put on Coumadin. Another possibility is that if he does have atrial fibrillation, it is possible that this lesion could have been a small cerebral emboli that

Mr. scored an 18 on the Braden sale, The patient showed no signs and symptoms of sensory

The patient is a 77-year-old obese Caucasian male with a history of abdominal hernia, stage 1 carcinoma of the bladder, and cataract, of which all have been resolved with previous surgeries. The patient also has a history of chronic atrial fibrillation (AFib) and dyslipidemia. The patient was admitted to the Emergency Room on 2/17/15 with a diagnosis of unspecified transient cerebral ischemic attack. The patient stated that he became confused while preparing dinner. He started asking his family repetitive questions. Shortly after,

The patient is 77-year-old female who is brought to the hospital by ambulance because she evidently has periods to losing consciousness on and off for a few minutes at a time. Her medical history is significant in that she is a known diabetic, hypertensive, she has had an old CVA, she valve regurgitation she has had an aortic valvuloplasty and she is presently on Coumadin. The daughter notes that the patient has had a change in her mental status and the attending physician Dr. Nil also notes that although she is awake and alert he finds her to be very disoriented to time place and person since the last time he has seen her. She does remember exactly what happened to her. She does not know why she is in the emergency. Her lab data reveals

A previously healthy 33-year-old woman was brought to the Emergency Department with chief complaint decreased of consciousness. She couldn’t be woken up since 3 hours ago. She had no history of nausea, vomiting, headache, blurred vision, fever, night sweat, weight loss, cough, extremity weakness, movement disorder, seizure or personality change. Her family denied any drug intake, substance abuse, pre-existing illness or hereditary disease. Her hemodynamic and temperature were normal. Her Glasgow Coma Scale (GCS) at admission was 235. On physical examination, she showed no extremity weakness, no tremor, and negative Kernig and Brudzinsky test. The laboratory examination was normal, including normal leukocyte count and serum chemistry. Her serum toxicology profile was negative. Non-contrast head Computed Tomography (CT) was done (Fig. 1a-b), followed by CT Angiography (CTA, Fig. 2a-c).

The patient is a 58-year-old female who presents to the ED because of progression of left-sided facial numbness of the face and arm with slurred speech. The facial droop which occurred approximately a week prior to admission, cleared spontaneously, recurred again and that is when she presented to the ED. The patient is known to have end-stage renal disease. In the ED showed mildly elevated troponins. CAT scan of the head showed progression of severe diffuse white matter lucencies. She is also known to have diverticular disease and cysts to kidney. The neurologic exam reveals a mild ataxic hemiparesis on the left and the patient was placed by the attending physician in observation status. Unfortunately she was discharged before condition

The patient is a 99-year-old female who presents from the Daughters of Miriam after sustaining a fall the morning of presentation. The patient states she was trying to get out of bed which is very difficult for her due to her Parkinson's disease the next thing she knows she was falling. She denies any trauma to her head, back, her hips. She denies any lightheadedness, dizziness or chest tightness. Her medical history is significant for hypertension and chronic atrial fibrillation for which she is on anticoagulation, coronary artery disease, history of bilateral breast cancer and Parkinson's disease. The neurologic exam reveals that she has a tremor in the upper extremities and she has rigidity. The neurologic evaluation is increasing

The patient is 70-year-old gentleman who presents to the ED after having an episode at home of confusion. Initially in the morning he was slightly confused. He took a nap and when he woke up from his nap appeared more confused. to his wife. She therefore called the ambulance and brought him to the hospital. The patient has past history of a hemorrhagic stroke in 2012. He was left with left hemiplegia which is completely cleared. He does have some dysphagia and dysarthria since that time and several months after the seizure was placed on Keppra. There is something in the history that he may not be taking his Keppra. He is followed by physicians that do not primarily come to St. Joseph's Paterson. His laboratory was completely normal.

Three months ago, she had severe weight loss (around 20 kilos) and she complained of subacute headache, without cranial nerve involvement, associated to ow grade fever and vomiting on day of admission.

EXTREMITIES: Not tender and moves well. However, she has great difficulty rolling herself on her side for an exam, but does exhibit normal motor and sensory function.

In the analysis of the muscle, joints, nerves and blood vessels she has occasional pain but not severe complaints.

Sholder and feet trouble which hurts her back she receives P/T; she stutters, Recepitve and expressive difficulties,

Her childhood was marked by recurrent diarrhea that was thought to be caused by lactose intolerance but that was never confirmed. Since the age of 26 years she suffered multiple episodes of stroke, resulting in persistent right hemiparesis. She also complained of intermittent tinnitus, asthma, headache and recurrent depressive symptoms. At the age of 34 years, she underwent bilateral cataract surgery. Extensive diagnosis including cerebral MR revealing vasculitis-like changes was undertaken and finally neurosarcoidosis was suspected. She was put on several treatments

To office testing, she is oriented x3, alert and cooperative. Good short-term, long-term and intermediate memory, except for amnesia for some of the period of illness from March to May, otherwise her memory is good for short-term and intermediate and long-term. Normal attention and concentration. Normal language. Normal fund of knowledge.