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D’Amuri A, Greco S, Pagani M, Presciuttini B, Ciaffi J, Ursini F. Common Non-Rheumatic Medical Conditions Mimicking Fibromyalgia: A Simple Framework for Differential Diagnosis. Diagnostics (Basel) 2024; 14:1758. [PMID: 39202246 PMCID: PMC11354086 DOI: 10.3390/diagnostics14161758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 08/06/2024] [Accepted: 08/10/2024] [Indexed: 09/03/2024] Open
Abstract
Fibromyalgia (FM) is a chronic non-inflammatory disorder mainly characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and a constellation of other symptoms. For this reason, delineating a clear distinction between pure FM and FM-like picture attributable to other common diseases can be extremely challenging. Physicians must identify the most significant confounders in individual patients and implement an appropriate diagnostic workflow, carefully choosing a minimal (but sufficient) set of tests to be used for identifying the most plausible diseases in the specific case. This article discusses prevalent non-rheumatological conditions commonly observed in the general population that can manifest with clinical features similar to primary FM. Given their frequent inclusion in the differential diagnosis of FM patients, the focus will be on elucidating the distinctive clinical characteristics of each condition. Additionally, the most cost-effective and efficient diagnostic methodologies for accurately discerning these conditions will be examined.
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Affiliation(s)
- Andrea D’Amuri
- General Medicine Unit, Medical Department, ASST Mantova, Ospedale Carlo Poma, Str. Lago Paiolo 10, 46100 Mantova, Italy; (A.D.); (M.P.); (B.P.)
| | - Salvatore Greco
- Internal Medicine Unit, Medical Department, Ospedale del Delta, Via Valle Oppio 2, Lagosanto, 44023 Ferrara, Italy;
| | - Mauro Pagani
- General Medicine Unit, Medical Department, ASST Mantova, Ospedale Carlo Poma, Str. Lago Paiolo 10, 46100 Mantova, Italy; (A.D.); (M.P.); (B.P.)
| | - Barbara Presciuttini
- General Medicine Unit, Medical Department, ASST Mantova, Ospedale Carlo Poma, Str. Lago Paiolo 10, 46100 Mantova, Italy; (A.D.); (M.P.); (B.P.)
| | - Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy
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Leslie EA, Byrne J, Mesarwi P, Edmonds KP, Hirst JM, Atayee RS. Descriptive Analysis of Dexmedetomidine's Utility in a Palliative Care Unit at the End of Life. J Palliat Med 2024. [PMID: 38916782 DOI: 10.1089/jpm.2024.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Context: Pain and symptom management at the end of life (EoL) can pose unique challenges, particularly when symptoms are refractory to conventional methods. Dexmedetomidine, originally approved for sedation in ventilated patients, has been demonstrated to be beneficial in pain management and palliative care settings by functioning as an alpha-2 agonist. Methods: A retrospective review of inpatient palliative care unit (IPU) records from January 2020 to December 2023 was conducted. Twenty-five adult patients receiving continuous dexmedetomidine for refractory pain at the EoL were identified. These patients were further evaluated for concurrent opioid, benzodiazepine, and chlorpromazine usage. Results: Patients experienced predominantly cancer-related pain, and had a median infusion duration of 5 days. Dexmedetomidine's initial dosing differed between the intensive care unit (ICU) and IPU settings. There was a trend toward a decreased opioid requirement 24 hours after initiation. Patients transferred from the ICU showed a progressive increase in opioid use. Conclusion: This study contributes to understanding dexmedetomidine's role in managing refractory symptoms at the EoL in the palliative care setting.
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Affiliation(s)
- Eric A Leslie
- UC San Diego & Scripps Health Joint Fellowship in Hospice & Palliative Medicine, Department of Family Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jennifer Byrne
- Section of Palliative Care, Division of Geriatrics, Gerontology, & Palliative Care, Department of Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Palliative Care Program, UC San Diego Health, University of California San Diego, La Jolla, California, USA
| | - Paula Mesarwi
- Section of Palliative Care, Division of Geriatrics, Gerontology, & Palliative Care, Department of Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Palliative Care Program, UC San Diego Health, University of California San Diego, La Jolla, California, USA
| | - Kyle P Edmonds
- Section of Palliative Care, Division of Geriatrics, Gerontology, & Palliative Care, Department of Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Palliative Care Program, UC San Diego Health, University of California San Diego, La Jolla, California, USA
| | - Jeremy M Hirst
- Section of Palliative Care, Division of Geriatrics, Gerontology, & Palliative Care, Department of Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Palliative Care Program, UC San Diego Health, University of California San Diego, La Jolla, California, USA
| | - Rabia S Atayee
- Section of Palliative Care, Division of Geriatrics, Gerontology, & Palliative Care, Department of Medicine, UC San Diego Health Sciences, La Jolla, California, USA
- Palliative Care Program, UC San Diego Health, University of California San Diego, La Jolla, California, USA
- Department of Pharmacy, UC San Diego Health, San Diego, California, USA
- Skaggs School of Pharmacy & Pharmaceutical Sciences, UC San Diego Health, San Diego, California, USA
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Pain knowledge of patients and family caregivers as predictors of pain management outcomes in cancer patients: a multicenter study in China. Support Care Cancer 2021; 30:575-584. [PMID: 34347180 DOI: 10.1007/s00520-021-06457-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purposes of this study were to evaluate the current situation of pain management outcomes, patients' pain knowledge, and family caregivers' pain knowledge in China and explore the impact of pain knowledge of patients and family caregivers on pain management outcomes. METHODS A total of 410 patient-family caregiver dyads were assessed by Brief Pain Inventory (BPI), the Pain Knowledge subscales of Patient Pain Questionnaire (PPQ), and Family Pain Questionnaire (FPQ). The difference in pain management outcomes was analyzed using bivariate analysis first, and then variables with statistical significance in bivariate analysis were included in multivariable linear regression analysis. RESULTS The average patient pain score in the last 24 h was 3.23 (SD = 2.16). The total average scores on pain knowledge of 410 patients and family caregivers were 3.60 ± 1.90 and 3.57 ± 1.76. Multivariable linear regression analysis showed taking strong opioids, patients' perceived moderate health status, patients' pain knowledge, and family caregivers' pain knowledge were the main factors influencing the pain management outcomes. CONCLUSION Pain knowledge of patients and family caregivers were important indicators of pain management outcomes, indicating tailored cancer pain education program should be developed.
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