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The following is my letter from the pain clinic to my G.P
Please can I have all your thoughts....
Dear Dr foster
Thanks for askng us to see Marc. He comes complaining of widespread pain for the past year or so. He said he began attending yourselves about the pain around four or five months ago. He describes pain in the hips, knees, thighs, and ankles, the neck to the shoulders and from the elbows down to the wrists, low back and buttock bilaterally. He described the pain as "tight" and "tense". He says he is currently in a situation where he cant cope with the pain.
He fatigues easily, even after low exercise rate and has a poor sleep parttern and says he wakes unrefreshed.
He has quite a limited lifestyle. He lives with his mum. He gets up between 0630 and 0900 and then tidied the house if he has the energy and his pain allows. He then goes to get his daily prescription and spends the rest of the day "doing nothing" which usually involves watching television or surfing on the laptop. He goes out very little.
He says he has tried various forms of excercise including swimming in the last couple of weeks but he finds that when he exercises he is much worse for several days afterwards.
I note that you have done bloods and inflammatory markers which have come back reassuringly normal.
He has a previous history of mental health problems and I understand he has a diagnosis of borderline personality disorder for which he saw Dr Hayward in the past but is now discharged from his service.he is on the waiting list for Dialectical behavioural therapy which I understand to be a varient of CBT.
In the past there have concerns around codeine misuse which I understand had been in relation to buying over the counter codeine. He days he has not used any other illicit medication in particular and has never bought street drugs.
In the past he has held down a job initially as a health care care assistant in the stroke unit here, then as an office worker with allied health care organising care rotas. I understand he had to leave paid work because of mental health issues because of mental health issues.
I agree the diagnoses here is Fybromyalgia. Betty Little and I saw him together and spent a considerable amount of time going through the evidence base and also our experience of treating fybromyalgia. He is already on correct therapy with pregabalin, naproxen and paracetemol. It is doubtful that his codeine and nefopam are significantly helping his fybromyalgia. He is also on propranolol for anxiety and omeprazole for mild GORD.
As you know the mainstay treatment in fibromyalgia are anti-neuropathics, which he is on, and then psychological apprroaches such as CBT or other behavioural therapy and graded exercise. We discussed other drugs including tramadol, MST and oxycontin. Duloxetine and amitryptyline. I explained that the evidence does not favour opioids in fybromyalgia and our own clinical experience is very similar.
Marc has been on the fybromyalgia forums and brought various suggestions to the table including accupuncture, which we have found to be 50/50 successful in fibromyalgia and we had a somewhat difficult discussion around the fact that there is no cure for fybromyalgia which he found rather bleak and we were unable to offer any cure or significant medicines change.
He id already a member of live active but doesn't seem to make much use of it, and he is on the waiting list for behavioural therapy which I understand to be aimed at his borderline pErsonality disorder, but which is bound to have some general amelierating effect on quality of life and ability on quality of life and ability to cope with pain if successful.
I am afraid the pain service has anything else to offer this gentleman. However he did ask for a second opinion. I am happy to arrange that and he was content to see one of my colleagues here in Perth.
I feel his Dr has neglected his duty of care towards me and eould really appreciate feedback. Thanks
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