FM Patient Case Study: Mrs C

Setting Treatment Goals

While reviewing Mrs C's history, you ask her to rate her recent levels of pain, sleep quality, and fatigue on a 0-10 (best-worst) scale. She rates pain and sleep quality at 7 and fatigue at 8.

You ask, "What bothers you the most about the effect FM has had on you?" Mrs C becomes emotional and says the worst thing is the impact that the pain and fatigue have had on her ability to care for her children. Her symptoms limit her ability to cook meals, do household chores, and interact with her kids. She states that she still functions reasonably well at work early in the day, but that she "drops out at home." Her husband has had to take over many family chores, especially in the evenings, to meet the children's needs.

You ask Mrs C what she would like to be doing that she cannot do right now. She describes simple things, such as hosting a sleepover for her daughter, cooking, and going to the movies with her husband. When asked, she says the most important thing to her is the sleepover. Based on this dialogue, you and Mrs C decide on 2 goals that she will try to accomplish before her next visit. You suggest that, for now, a play date rather than a sleepover might be more realistic. She agrees. You and she also decide that it is realistic for her to try to cook dinner 2 evenings a week.

To help Mrs C attain these goals, you and she brainstorm to identify potential barriers to achieving these milestones. Since she functions best in the morning, you suggest that she schedule her daughter's play date for the morning, when her energy levels are highest and her pain is at its lowest. So that she does not feel overwhelmed by the many steps needed to make dinner, you suggest she split up the steps. Mrs C comes up with the idea to prep the ingredients one night and cook the next night as a way to conserve her energy.

Although helping Mrs C attain these goals is important to her, 
as her physician, you will evaluate her treatment success 
clinically by documenting functional improvement and
symptom improvement.

Now that you and Mrs C have identified and set some goals, it is time to employ a comprehensive, multimodal treatment plan (ie, pharmacologic and nonpharmacologic strategies) to better help her attain these goals.

patient picture

Patient ratings on NRS (0-10)

  • Pain: 7

  • Sleep quality: 7

  • Fatigue: 8

Most troubling effect of FM

  • Inability to care for her children

  • Pain and fatigue limit her ability to cook meals, do household chores, interact with kids

Effect on daily routine

  • Functions reasonably well at work, early in the day

Desired goals discussed

  • Host a sleepover for her daughter

  • Cook meals (dinner 2 nights/week)

  • Go to a movie with her husband

Identification of potential barriers

  • Schedule play date for the morning, when she feels best

  • Prep dinner ingredients one night, cook the next night to conserve energy

Clinical evaluation of success

  • Functional improvement

  • Symptom improvement