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A 54-year-old woman has widespread pain, fatigue, nonrestorative sleep, and cognitive fog for 1 year. Exam shows diffuse tenderness without synovitis or weakness. ESR, CK, TSH, CBC, and metabolic panel are normal. Which management is best?
High-dose opioids for chronic centralized pain
Long-term prednisone
Repeated Lyme serologies until positive
Graded aerobic exercise, sleep optimization, education, and selected nonopioid medications
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