Síndrome de amplificação dolorosa no idoso: relato de caso e revisão da literatura

Abstract

BACKGROUND AND OBJECTIVES: There are very few publications on pain amplification syndrome in the elderly (PAS), in spite of its importance for them, because it may have multiple consequences during aging. This study aimed at reporting a case of PAS in the elderly represented by fibromyalgia (FM), describing its diagnostic approach and therapeutic management, and at presenting a literature review on the subject. CASE REPORT: Female patient, 73 years old, with moderate diffuse muscle pain, fleeting morning stiffness, anhedonia, sadness, anxiety, major fatigue and sleep disorders for four years. She was initially diagnosed as rheumatic polymyalgia and was under regular prednisone in spite of the progressive worsening of her functional capacity and quality of life (QL). One year ago her diagnosis was reviewed by our service and we confirmed it was PAS, spectrum of FM. Prednisone was then withdrawn and non-pharmacological therapy was indicated with pain self-management program; multi-176 modal pharmacological therapy was also instituted with non-opioid (lysine clonixinate) and opioid (tramadol) analgesics and a pain modulator (duloxetine). Six months later there has been major pain, sleep, depression, anxiety, functional capacity and QL improvement. CONCLUSION: Accurate diagnosis and adequate therapeutic intervention are paramount for PAS cases, especially in the elderly population with FM, which has unique characteristics in such population. There are major probabilities of symptomatic, functional and QL improvement in the elderly with PAS if we pay attention to differential diagnoses and introduce adequate therapies.