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Fibromyalgia - A Case Report Of Serotonin Syndrome Masked By Fibromyalgia


A disorder known as fibromyalgia is characterized by widespread myalgia, exhaustion, and hyperesthesia. Mood swings, insomnia, and memory problems are additional symptoms that it may show.

It affects roughly 3.94 million people in the US and has a prevalence of 1.75 %. Although the full pathophysiology is unknown, it is believed to be due to a lower pain threshold in the central nervous system ("central sensitization").

By turning on the pain modulatory circuit of the CNS3, this hyperactivity can be reduced.

The most likely participants in this circuit are selective serotonin reuptake inhibitors (SSRIs), which have demonstrated effectiveness in the management of fibromyalgia-related pain.

This effect is unrelated to its antidepressant activity, so people without depression or fibromyalgia can also use these medications.

COPYRIGHT_SZ: Published on https://stationzilla.com/fibromyalgia/ by Dr. Cooney Blades on 2022-07-20T12:53:17.965Z

What Is Fibromyalgia?

Widespread musculoskeletal pain coupled with issues with memory, mood, sleep, and fatigue are the hallmarks of the disorder known as fibromyalgia. According to researchers, fibromyalgia alters how your brain and spinal cord process painful and non-painful signals, amplifying painful sensations.

Symptoms frequently appear following an incident, such as a physical injury, surgery, infection, or intense psychological stress. In other instances, symptoms develop gradually over time without a specific cause.

When it comes to fibromyalgia, women are more likely than men to develop it. Many fibromyalgia patients have tension headaches, temporomandibular (TMJ) disorders, IBS, anxiety, and depression.

Numerous drugs can help control symptoms of fibromyalgia, even though there is no known cure for it. Exercise, rest, and techniques for reducing stress may also be beneficial.

A lady wearing a grey tank top holding the back of her neck that is red
A lady wearing a grey tank top holding the back of her neck that is red

Some Causes Of Fibromyalgia

Many researchers believe repeated nerve stimulation causes fibromyalgia brain and spinal cord changes. This change raises brain chemicals that signal pain.

The brain's pain receptors seem to remember the pain and become sensitized, overreacting to painful and non-painful signals.

These shifts are probably caused by a wide variety of factors, including the following:

Genetics: Because fibromyalgia often runs in families, there may be particular genetic mutations that make you more likely to develop the disorder if you have a family history of it.

Infections: There are some conditions that seem to cause fibromyalgia, or to make it worse.

Physical or emotional events: An actual occurrence, such as a car accident, may occasionally cause fibromyalgia to manifest. In addition, the condition may be brought on by persistent psychological stress.

Some Symptoms Of Fibromyalgia

The following are some of the most prominent signs and symptoms of fibromyalgia:

Widespread Pain: A constant dull ache that has been present for at least three months is a common way to describe the pain that is associated with fibromyalgia. In order for the pain to be described as widespread, it must be experienced on both sides of the body, as well as above and below the waist.

Fatigue: Even though they claim to sleep for long periods of time, people with fibromyalgia frequently wake up feeling exhausted. Pain frequently keeps people from sleeping, and many people with fibromyalgia also suffer from sleep apnea and restless legs syndrome.

Cognitive Difficulties: The inability to focus, pay attention, and concentrate on mental tasks is a common symptom of fibromyalgia and is commonly referred to as "fibro fog."

Many different conditions can co-exist with fibromyalgia, including the following:

  • Postural tachycardia syndrome
  • Depression
  • Anxiety
  • Temporomandibular joint disorders
  • Interstitial cystitis or painful bladder syndrome
  • Migraine and other types of headaches
  • Chronic fatigue syndrome
  • Irritable bowel syndrome

Serotonin Syndrome - Causes, Symptoms, and Treatment

What Is Serotonin Syndrome?

The central and peripheral nervous systems' excessive serotonergic activity is referred to as serotonin syndrome. Classic symptoms are mental status changes, autonomic instability, and neuromuscular hyperactivity. The degree of serotonin toxicity is indicated by the intensity of the clinical findings. The severe end of the toxicity spectrum is typically referred to as "serotonin syndrome."

Any increase in serotonergic neurotransmission can result in serotonin syndrome. Synergistic medication use causes most cases, but intentional self-poisoning with serotonergic agents also occurs. Serotonin syndrome can also be caused by adding drugs that inhibit cytochrome P450 2D6 and/or 3A4 (CYP3A4) to SSRI therapy.

Causes Of Serotonin Syndrome

Serotonin syndrome, or serotonin toxicity, is caused by serotonergic drugs, which affect serotonin levels. Several things can cause it, including:

Taking one serotonergic medication: One serotonergic medication alone is unlikely to cause serotonin syndrome, but it can happen in serotonin-sensitive people, especially when the dose is increased.

Overdosing: Serotonin syndrome can result from an accidental or intentional overdose of serotonergic medications.

Taking two serotonergic medications together: The vast majority of serotonin syndrome cases are caused by a person taking two or more serotonergic drugs at the same time, frequently without even being aware that they are doing so.

Symptoms Of Serotonin Syndrome

The symptoms of serotonin syndrome can range from mild to severe, indicating anything from a slight excess of serotonin to a dangerous imbalance in the neurotransmitter's levels. The following are the most frequently occurring symptoms:

  • Tremor
  • Sudden jerky or shock-like movements
  • Slow or fast pulse
  • Shivering
  • Restlessness
  • Rapid breathing
  • Profuse sweating
  • Poor coordination
  • Muscle rigidity
  • Irregular heartbeat
  • High blood pressure
  • Headache
  • Flushing or paleness
  • Fever
  • Dilated pupils
  • Confusion
  • Anxiety

If your condition worsens to the point where it poses a serious risk to your life, you may exhibit symptoms such as the following:

  • Sudden swings in your blood pressure or pulse
  • Seizures
  • Losing consciousness
  • High fever

A Case Description

A 56-year-old woman with hypertension, asthma, and fibromyalgia came to the clinic for management. Within the clinic, the patient was well-known. Her syndrome was treated with milnacipran, zolpidem, pregabalin, and vitamins (B complex daily, C 500 mg daily). Throughout her ten-year course, the patient's fibromyalgia was well-controlled. However, her symptoms at the clinic were different from those at baseline. She complained of hot flashes, headaches, and pain.

Her primary care physician prescribed tramadol, according to her medical history. Physical exam revealed a tachycardic, flushed patient. She had no long tract signs, hyperthermia, dilated pupils, or clonus but was mildly agitated and fatigued.

A lady wearing a white underwear holding the back of her neck and waist that is red
A lady wearing a white underwear holding the back of her neck and waist that is red

Looking At The Effects Of Serotonin Syndrome Masked By Fibromyalgia

When a fibromyalgia patient presents with changed symptoms, a thorough history and physical exam are needed to rule out other systemic problems that can mimic fibromyalgia. Multiple medications are often prescribed for pain, cognitive, and psychiatric disorders. This puts them at risk for drug interactions that make it difficult to distinguish fibromyalgia exacerbations from serotonin syndrome. Serotonin syndrome is caused by 5-HT receptor stimulation that increases serotonin in the CNS.

This can happen with a single serotonergic overdose or two drugs working synergistically to release serotonin. Serotonin syndrome can present with anything from mild to severe symptoms. Tachycardia, diaphoresis, myoclonus, hypertension, and hyperthermia are mild to moderate signs and symptoms. Patients with more severe conditions might exhibit shock, seizures, renal failure, or metabolic acidosis. In a patient exhibiting atypical fibromyalgia symptoms, a high level of clinical suspicion for serotonin syndrome must be maintained.

People Also Ask

Will Serotonin Help Fibromyalgia?

Serotonin is a potent chemical in the brain, and researchers believe that low serotonin levels contribute significantly to fibromyalgia pain. Serotonin levels are also associated with depression and sleep. It's possible that 5-HTP can help those with fibromyalgia get deeper sleep and feel less pain overall.

Why Do Doctors Not Believe In Fibromyalgia?

"Physicians do not have sufficient and consistent knowledge of the fibromyalgia diagnostic criteria," the article states. The majority of doctors—about 50%—did not follow the requirements. Misdiagnoses and delays in diagnosis may increase due to inadequate knowledge and adherence.

What Part Of The Brain Is Affected By Fibromyalgia?

Our structural covariance network analysis discovered more connections in the frontal lobe for healthy controls and more connections in the cerebellum for fibromyalgia patients.

What Happens If Serotonin Syndrome Goes Untreated?

Once serotonin levels return to normal, the symptoms of serotonin syndrome typically go away. Serotonin syndrome that is too severe to treat can cause unconsciousness and even death.


The acute and potentially fatal illness known as serotonin syndrome is almost always brought on by taking multiple medications at once. Patients diagnosed with chronic fibromyalgia whose symptoms have developed since their initial presentation require an intensive diagnostic workup. In this particular case, the symptoms of serotonin syndrome and fibromyalgia can be seen to overlap with one another. When a patient presents with fibromyalgia, it is imperative that a comprehensive review of all of their medications be performed. When dealing with patients like these, a high clinical suspicion of serotonin syndrome is warranted, particularly when the patients are being heavily medicated.

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About The Authors

Dr. Cooney Blades

Dr. Cooney Blades

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