Dystonic pattern in a fibromyalgia patient: Relevance of a biopsychosocial rehabilitation approach

Abstract

We present the complex case of a 49-year-old woman who worked as a cook in a school cafeteria and has been suffering from widespread pain since 2002. This patient showed a very particular gait pattern with hips adduction, flexed hips and knees and bilateral equinus foot deformity. Clinical examinations conducted by various clinicians, such as physical medicine and rehabilitation (PM&R) physicians and neurologists, yielded very different diagnostic hypotheses, each being nevertheless quite "logical": fibromyalgia syndrome with dystonia, CNS injury, Little's disease, intramedullary spinal cord tumor or multiple sclerosis. The only abnormalities observed occurred during the quantitative sensory test presenting as severe widespread allodynia to cold and hot temperatures and during Laser Evoked Potentials shown as a dysfunctional pattern for central processing of nociceptive data. Gait analysis showed that parameters were in the norms. Considering these different tests and the excellent progression of the patient's gait and general posture, we must envision that the fibromyalgia syndrome hypothesis remained the most likely one. The generalized dystonia was probably due to the patient's analgesic protective attitude. The actual therapy is still based on the biopsychosocial approach.