Tuesday, February 26, 2013

Pop Quiz. What Else Does This Patient Have?

I recently had a patient who had one of the most extensive list of drug allergies I'd ever seen. It filled up nearly two screens worth of data on our electronic medical record. While looking through it, I spied the usual suspects. Of course narcotics are on the list. Doesn't everybody say that morphine or codeine makes them nauseated or cause altered mental status? Then of course there is lidocaine because most people have had dentists who told them that lidocaine causes their heart rates to accelerate when it was probably the epinephrine mixed in the lidocaine that did that. Can't forget about the latex allergy because if you're in the hospital often enough, somebody is bound to claim that rash on your skin was caused by a latex glove.

After perusing the list, I had little doubt about what I would find in the patient's medical history. Of course I was right--fibromyalgia was listed in her H+P. I'm not the only who has noticed an association with fibromyalgia and extensive drug allergies. These patients are difficult to treat perioperatively, mainly because their symptoms are so elusive. There is nonspecific body aches, GI symptoms, and psychological issues. Many are on chronic pain meds to control their disease.

Because of their vagueness, doctors have a hard time coming to terms with fibromyalgia. It doesn't fit neatly into any of our well defined physiologic or infectious causes of disease. What kind of disease has listed treatments that include, "Deal with negative thoughts" or "Seek out enjoyable activities". That sounds like a mantra repeated at some luxury spa in Palm Springs. It's hard for us to take this seriously.

But they are out there. There are millions of people in America diagnosed with fibromyalgia which means you'll most likely be treating one sooner rather than later. In fact you may even have to fill out their application for a handicapped parking permit despite your misgivings about the legitimacy of their illness. So put on your best Marcus Welby bedside manner when a patient like this arrives at your office. You'll be glad you have your Pain Medicine doctor on speed dial as you prepare to kick the world's longest punt.

1 comment:

  1. Sure, they are tough to treat. Dont' remember even studying it in med school, and I even checked the
    Websites of Digitalization of Healthcare to find out what good medical sources there are on the net that has up to date info on this tricky malady. Most I have seen are on narcotics, so, with that in the mix, it makes it harder if the pain is real.

    jb md