The pain in many areas to touch (tenderness) need investigations. One of the possibility of the diagnosis is fibromyalgia. Following investigations may be needed:
1) Thyroid-stimulating hormone
2) 25-Hydroxy vitamin D level: Low levels can cause muscle pain and tenderness
3) Vitamin B-12 level: Very low levels can cause pain.
4) Iron studies including iron, total iron binding capacity, percent saturation, and serum ferritin
5) Magnesium: Low levels can lead to muscle spasms, which are common in fibromyalgia; magnesium supplementation can also improve symptoms in some fibromyalgia.
6) The erythrocyte sedimentation rate (ESR)
7) Antinuclear antibody (ANA)
8) Rheumatoid factor
9) Sleep studies
10) Antipolymer antibody assay; present in approximately 50% of patients with fibromyalgia. This biologic marker may provide conclusive evidence for a subgroup with fibromyalgia.
The treatment of fibromyalgia is comprehensive and a single guideline for an individual is difficult to make. The treatment has to be individually tailored;
1) Aerobic exercise; low-impact aerobics, walking, water aerobics, stationary bicycle.
2) Heat, massage, and other treatments like sauna, hot baths and showers, hot mud, and massage.
3) Trigger-point injections,
5) Chiropractic manipulation,
6) Myofascial release
7) Neural pulse stimulation (CNP) device
8) Cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT)
9) Relaxation training and biofeedback
10) Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen
11) Opioid analgesics (hydrocodone, oxycodone, fentanyl, morphine),
13) Estrogen receptor modulator raloxifene
14) St. John's wort, ginseng, valerian, botanical oil, melatonin, magnesium, dehydroepiandrosterone
A combination of above is tried for an individual to relieve the symptoms.
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