“Doctor, I hurt all over... Please help me!”One of the more challenging problems is what to do about the patient who hurts all over. The first distinction to be made is to decide whether the pain is in the joints or the muscles... or both. A search for signs and symptoms indicating serious systemic illness is mandatory. For example, is there a history of documented fevers, weight loss, or night sweats that might suggest an infectious problem? Does the pain persist at night or does the patient have trouble getting to sleep because the pain doesn’t quit? This suggests malignancy. Have any new drugs such as antibiotics, vitamin supplements, vaccines, cholesterol-lowering medicines, or heart medicines been started. All of these drugs have been associated with generalized aches and pains. Different endocrine and metabolic disorders such as under active thyroid, overactive parathyroid, and under active adrenal function may be culprits. Withdrawal of steroid therapy can also do it. Among the arthritic conditions most commonly associated with pain all over are systemic lupus erythematosus, polymyalgia rheumatica, polymyositis, and fibromyalgia. Depression, hyper mobility syndrome, and chronic fatigue syndrome are also causes. The history and physical examination are critical. Enlarged lymph nodes may suggest infection or malignancy. Thyroid gland enlargement can point to thyroid disease. Abnormal liver or spleen size can also suggest serious problems. Laboratory testing should include complete blood cell count, chemistry panel, erythrocyte sedimentation rate (ESR), thyroid function tests, creatine phosphokinase (a muscle enzyme), antinuclear antibody, and rheumatoid factor. Imaging studies are generally not helpful. Further workup will depend on the results of the history, physical examination, and laboratory testing.
|
