Event 3: Evaluating Sarah's Treatment Response

Follow-up Visit with Physical Therapist: Part I

Sarah returns to Mike Schneider’s office to participate in therapy and discusses her progress as well as frustration.

She has followed with her PCP and further testing has been completed and is negative. She has been screened for depression and is agreed to see a psychologist to address her low mood. She is planning to see the occupational therapist.

Test Your Knowledge

What is the best response to Sarah’s concern that her pain is not improving?


Reassure the patient that fibromyalgia treatment takes time at this moment, in order for pain to decrease the function of the tissues need to improve first. As the tissues are able to do more pain, flares occur less frequently, and the patient ultimately achieves a long lasting pain reduction.

The misconception many patients have is the pain should be treated with rest and pain medication. In reality, this approach causes a decrease in functional status and increases the likelihood that pain will increase with daily activities. The main focus should be to improve function, fatigue, and quality of life.

Ultimately pain will improve, but it will take some time. Mike describes the importance of pacing and patients and reinforcing treatment goals.

Follow-up Visit with Physical Therapist: Part II

Mike explains to Sarah that with treatment pain will ultimately improve, but only with time.

Follow-up Visit with Physician

Sarah returns to Dr. Bernstein after two months of treatment.

Sarah returns to her primary physician. After two months of treatment, she is exercising five days a week and maintaining healthy lifestyle habits, including getting regular sleep. She is working with the psychologist and the occupational therapist has made modifications to improve her workspace. She tells her physician, she still has periods of increased pain.

A friend told her she should ask for some oxycodone pills.

Test Your Knowledge

What is the best recommendation for Sarah when she has a flare of her pain?


Mike should work with Sarah on flare management techniques, flare management techniques are useful to decrease pain flares. These techniques may include applying ice and heat and trigger point release and massage. Some patients report pain relief when using transcutaneous electrical stimulation, activities should be modified if pain is severe, but complete rest is not advised.

There is evidence that acupuncture may be helpful for fibromyalgia pain as well. This is a good option for patients who may want to avoid medication use for your education. We provide a link to an article about complimentary and alternative medicine. Epidural injections are not effective for myofascial pain.

Opioids are not indicated for fibromyalgia pain. Recent studies demonstrate that opioids are less effective in fibromyalgia patients. And may increase pain, sensitivity.

Flare Techniques

  • Identify and limit flare triggers
  • Pace daily activities and avoid overexertion
  • Modify exercise and continue stretching
  • Regulate sleep
  • Consider adding massage, transcutaneous electrical stimulation, biofeedback, craniosacral release and acupuncture to reduce pain.
  • Rescue medications may be appropriate 

Patients with fibromyalgia are likely to experience pain flares while it may be difficult. Patients should try to identify those factors, which trigger pain flares during a flare. It is important to pace daily activities and avoid overexertion stretching and exercise may be modified during a pain flare to improve comfort.

Sleep should be regulated, massage, relaxation techniques, transcutaneous electrical nerve stimulation, chiropractic and acupuncture may be helpful during a flare. Some patients develop with physicians, a plan to use rescue medications. These may include over the counter medications or prescription analgesics, such as Tramadol.

Widespread Pain and Fibromyalgia

Wrap Up

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