Greetings Alexandra .
I am Dr. Phophalia and would assist you today.What were the investigations done by the rheumatologist?Were the diagnosis like chronic fatigue syndrome or fibromyalgia considered?
I haven't seen the rheumotologist yet; but I am not holding on to hope b/c other Doctors havent found anything....
fibro mas considered...but the weird part is that I only have the pain mostly on the left side. I haven't been checked from chronic fatigue syndrome...
I forgot to mention, I have had my thyroid gland tested and also an ESR test performed.
1) passive stretching of the affected muscle after application of sprayed vapocoolant.
2) physical therapy; simple muscle stretch, augmented muscle stretch, post-isometric relaxation.
3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, high voltage galvanic stimulation, biofeedback.
4) local analgesic patch / ointment / spray
5) anti-inflammatory analgesics; Ibuprofen (Motrin / Advil)
6) ischemic compression therapy; pressure on the points
8) steroid shots
Th e headache is what we term as cervicogenic headache. This headache is caused by referred pain from the upper neck (cervical) joints. The headache is caused by neck movement or sustained awkward head positioning. So people who work long hours on computers are liable to have this kind of headache. Migraine and tension-type headache can be the other possibility.
Physical therapy is the preferred initial treatment for cervicogenic headache. The other modalities employed for the treatment are done by pain management physician and are invasive modalities. These are;
1) Percutaneous radiofrequency neurotomy
2) Steroid injection
Your physician may consider a trial of Gabapentin or Pregabalin as an initial medical treatment to see the response with the physical therapy.
Laboratory studies and investigative work up like following are done to help rule out diseases with similar manifestations and to assist in diagnosis of certain inflammatory diseases that frequently coexist with fibromyalgia and chronic fatigue syndrome;
1) Complete blood cell (CBC) count and differential count,
2) Basic metabolic panel,
4) Thyroid-stimulating hormone: Hypothyroidism has many similar clinical features with fibromyalgia, especially muscle pain and fatigue.Seems to be normal in your case.
5) Creatinine phosphokinase (CPK) to rule out inflammatory myopathies
6) Erythrocyte sedimentation rate (ESR); already done
7) Antinuclear antibodies (ANAs): Many patients with SLE have comorbid fibromyalgia.
8) Rheumatoid factor
9) Sleep studies
If fibromyalgia, lupus, sleep disorders etc can be ruled out; other consideration would be;
1) chronic fatigue syndrome; unexplained, persistent or relapsing fatigue with unrefreshing sleep, muscle pain, concentration problems, headache, sore throat etc.
2) idiopathic fatigue; it does not meet the above criteria.
I would be happy to assist you further, if you need any more information.
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