FM Patient Case Study: Mrs C

Applying multimodal therapy: part 2

It is now several weeks later, and Mrs C is in the office for her scheduled follow-up visit. She reports improved pain, which is a 4 on a 10-point scale. However, her fatigue is only slightly better, decreasing from an 8 previously to a 7. You remark on all the good progress and ask how she's doing with increasing her physical activity and caring for her children.

Mrs C notes that she is tolerating her medication well and believes that much of her improvement is related to medication use.

In general, she feels better but admits that she has not been exercising because she has been experiencing fatigue. At this point, you emphasize that there is not an expectation for her to exercise excessively; she should start with gentle physical activity and then increase her activity level as she feels able. You also mention that she may want to consider a buddy system for exercise. She may find it enjoyable to exercise with a friend. Also, if she knows that someone is depending on her, she may be more motivated to keep the exercise appointment. You also talk with her about what types of physical activities would be fun for her.

Mrs C notes that her functional abilities at work have extended beyond just the morning. She now feels that her energy levels persist through the middle of the day, at which time they start to wane.

During all subsequent visits, it will be very important to track all aspects of Mrs C's progress to determine whether her condition is improving.

patient picture

Improvements on NRS (0-10) at follow-up

  • Pain: 4

  • Sleep quality: 4

  • Fatigue: 7


  • Well tolerated

  • Patient's perception is that
    much of her improvement is
    related to her medication

Functional improvement

  • Functions well at work
    through midday

Physical activity status at follow-up

  • Patient feels better, but
    admits to not exercising
    because of fatigue