Serotonin Mechanisms in Pain and Functional Syndromes: Management
Implications in Comorbid Fibromyalgia, Headache, and Irritable Bowl
Syndrome: Case Study and Discussion.

J Pain Palliat Care Pharmacother. 2004;18(4):31-45

Smith NL, 3627 Canyon Way, Salt Lake City, UT, 84106, smithnlee@aol.com.

PMID: 15760806


A young woman presented with multiple central hypersensitivity disorders,
including fibromyalgia, headache, pelvic pain and several smooth muscle
spasm disorders, including irritable bowel syndrome, irritable bladder and
Raynaud's phenomenon. She also had significant fatigue and sleep problems.

Her case illustrates the importance and surprising frequency of atypical
bipolar mood disorders in people with multiple central hypersensitivity
pain disorders, especially with depression and anxiety resistant to
antidepressant treatment.

Considering neurological mechanisms common to her overlapping disorders was
very helpful in guiding treatment choices. This experience illustrates the
value of serotonin receptor type 2 (5HT<sub>2</sub>) inhibition with
atypical neuroleptics, of neural cation channel and glutamate inhibition
with anticonvulsants, and the potential usefulness of antidepressants after
establishing 5HT<sub>2</sub> control to enhance downward inhibitory tracts.

Medications with combined usefulness for both bipolar mood and pain
disorders were highly effective for her multiple hypersensitivity problems.