Fibromyalgia and opioid-induced hyperalgesia

A 45-year-old woman was referred to a pain management center from her primary care doctor’s office for evaluation and treatment of her fibromyalgia. Per history, patient complains of worsening fatigue, headache, and widespread and migrating pain all over her body. She relates that the pain is most bothersome in her shoulders and lower back but is also present in her thoracic spine, neck, right elbow, and bilaterally in her knees. She remembers having diffuse body pain since age 25 when she got into a motor vehicle accident in which her car was wrecked even though she did not have any fractures or hospitalization from that accident. On further evaluation, she has also been dealing with depression and insomnia. She does not think that she has fibromyalgia and she would like to have a different diagnosis and be cured of her pain. She also would like to increase her opioid dosage as her pain has worsened since her son had gone to college. 1. What is the differential diagnosis? Some differential diagnoses for widespread body pain include: Fibromyalgia Polymyalgia rheumatica Myositis/myopathies Myofascial pain syndrome Rheumatoid arthritis Systemic lupus erythematosis Sjogren’s syndrome Ankylosing spondylitis Hypothyroidism Somatoform disorder Cervical spinal stenosis Systemic vasculitis.