Tylenol 1g 3x daily (max daily dose 3g/24 hours) mainstay for initial treatment
Tramadol (not an NSAID but a non-opioid pain reliever). Synergistic effect w/tylenol or NSAIDs.
NSAIDs~ use cautiously in patients at risk for cardiac toxicity, or renal & liver dysfx
Hyaluronans: intra-articular injections act as lubricant and improves fluid viscosity within the joint. Injected 1x week for 3-5 weeks. Benefits last for >6 months.
Kenalog and Depo-Medrol: corticosteroid intra-articular injections. After initial increase in pain, warmth and redness, most patients have significant pain relief. Cannot be done more often than every 3-4 months. Cautious w/patients taking oral prednisone or diabetics.
Other medications: opiates, neurontin, SSRIs, tricyclic antidepressants, OTC rubs and patches, lidocaine patches, topical NSAID gel (diclofenac)
Non pharmacologic management: : EXERCISE, PT and OT (strengthens structure, improves ROM, decreases pain, improves CV conditioning, weight reduction). Also stretching programs, supportive footwear, assistive devices, heat, ice. Weight reduction is a big factor in symptom improvement.
Complamentary: acupuncture, glucosamine with or w/o chondroiton (1500mg daily for 6 months - if no improvement, discontinue)
Also: omega-3, bromelain, dimethyl sulfoxide, ginger, MSM, SAM-e
Surgery (total joint replacement) if none of the above work.
Definition: More than 3 months of musculoskeletal pain above and below the waist bilaterally associated with pain on palpation of tender points.
Hallmark Sx: persistent, widespread pain & chronic fatigue; may report allodynnia or hyperalgesia (basically an exaggerated pain response to stimuli that is not painful), and pain worse w/repetition. Pain is typically constant throughout day.
Other somatic complaints and/or comorbidities: non restorative sleep, cognitive difficulties, auditory, vestibular and ocular complaints, chronic rhinitis or "allergies", migraines, palpitations, irritable bowel syndrome, subjective sense of joint swelling and mood disorders, TMJ, female urethreal syndrome, chronic fatigue syndrome, depression, anxiety.
8-9x more prevalent in women than men, usual onset is gradual at 40-50y/o; affects 3-6 million americans; accounts for 2% of all primary care visits; 10% of internal medicine referrals and 20% of rheumatology referrals.
Pt will have normal muscle strength, no evidence of synovitis or soft tissue inflammation
Rule out other diseases-reumatological, infectious, neurological, endocrine
Labwork all results are normal CBC, ESR, RF, ANA, TSH, but are important in excluding underlying autoimmune disorders i.e.. lupus, and RA