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EP is a twenty-five-year-old African American female who has just moved to town and comes to the clinic for her first visit. She has been diagnosed with fibromyalgia. She reports that her previous primary care physician (PCP) was treating her with opiates only. She has been taking hydrocodone/ibuprofen 7.5 mg/200 mg four times daily but notes that this is not helping her. She is asking you for a refill of this medication and any additional treatment you can advise. On physical exam, she is in moderate distress and reports pain when being touched. Answer the following questions:
•How would you validate the diagnosis of fibromyalgia?
•How would you handle EP’s request for ongoing hydrocodone? Locate any evidence of the efficacy of this treatment for fibromyalgia.
•Assuming that the diagnosis is correct, what would your treatment plan be?
•Would you recommend any nontraditional therapies?
For medications, include dosages and schedules. Include highlights of patient teaching and/or lifestyle alterations. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.