A 77 year old man was seen in the pain clinic, complaining of pain in his neck, lower back (L3/L4 region), and areas over his trapezius muscles of the shoulders. He also had some difficulty in swallowing and was taking small quantities of food. The pain was described as a dull ache with an average score of 5/10. The pain came and went. It was very localised with no radiations and no pins and needles. It was aggravated by eating, by the movement of his arm, and relieved by lying flat. Of note, in the past since 1985 he has had Spondylosis (narrowing) of the cervical spine.
Drug History: Paracetamol or Paracetamol and Codeine combinations.
Past Medical History:
- Temporal arthritis
- Cervical spondylosis
- Insulin dependant diabetes
- Intermittent shortness of breath.
On Examination, his head was held in an extremely flexed position with a fixed cervical flexion deformity noted, flexed at the C7/T1 level. On palpation there were multiple trigger points in the neck, in the trapezius muscles, the rhomboid muscles and over the shoulders and back area. These trigger points gave pain on deep palpation. The impression was of Fibromyalgia (Myofacial Pain Syndrome), secondary to Chronic Cervical Spondylolysthesis.
Conservative Management: At that time, the plan for the gentleman to start with conservative management with Deep Tissue Massage and a course of 6-10 acupuncture sessions.
Medication: Amitriptyline in small doses or Gabapentin in small doses.More Invasive Treatments: Local anaesthetic and steroid injections to local trigger points or Botulinum Toxin injections to local trigger points. Rehabilitation: Physiotherapy in order to change the posture and training about posture. The gentleman was not keen on medication. Over the course of 2 weeks he received daily acupuncture for 10 days and local injections (wet needling) to trigger points with local anaesthesia and steroid. During the treatment his symptoms subsided, after which he returned to his home abroad.
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