Goldman S I, Krings M S
Total Rehabilitation and Athletic Conditioning Center, Botsford General Hospital, Farmington Hills, Mich, USA.
J Am Osteopath Assoc. 1995 Aug;95(8):487-90.
A female swimming instructor was seen with chronic bilateral shoulder pain and loss of range of motion. Intensive physical therapy significantly improved the range of motion but did not alleviate the pain. Osteopathic manipulative treatment produced no further improvement in pain or function. Results of laboratory tests were all within normal limits. Four months after the initial consultation, the patient, who was taking medication for tonic/clonic seizures, recalled that her symptoms began after her anticonvulsant medication was switched from hydantoin sodium to phenobarbital. Therefore, phenobarbital-induced fibromyalgia was diagnosed. In 4 months, pain had completely disappeared. The authors discuss several theories regarding the cause of fibromyalgia and the mechanism of action of phenobarbital, including its relationship to sleep disturbance, a probable contributor to pain and dysfunction in the patient described.
一名女性游泳教练出现双侧肩部慢性疼痛及活动范围受限。强化物理治疗显著改善了活动范围，但并未减轻疼痛。整骨手法治疗在疼痛或功能方面未带来进一步改善。实验室检查结果均在正常范围内。初次会诊四个月后，正在服用抗强直阵挛性癫痫药物的患者回忆起她的症状在抗惊厥药物从苯妥英钠换成苯巴比妥后开始出现。因此，诊断为苯巴比妥诱发的纤维肌痛。四个月内，疼痛完全消失。作者讨论了关于纤维肌痛病因及苯巴比妥作用机制的几种理论，包括其与睡眠障碍的关系，睡眠障碍可能是所描述患者疼痛和功能障碍的一个促成因素。
