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Katrina, a 32-year-old female who presented to the clinic with back pain and depression in 2017. She was treated with celecoxib 200 mg/day and eperisone hydrochloride 150 mg/day, but the persistent pain limited her mobility. She had a medical history of epilepsy from 15 to 23 years of age, a WPI (widespread pain index) of 16, and SS (symptom severity scale) scale score of 22. Laboratory tests did not reveal any evidence of rheumatoid arthritis or collagen disease. She was diagnosed with fibromyalgia and was started on 150 mg/day of pregabalin. Her pregabalin dose was increased to 175 mg/day, but because of the resulting dizziness, this was reduced to 150 mg/day. Her symptoms improved when she was started on duloxetine. At the same time, she received psychological counseling at our hospital. Her symptoms improved and the pregabalin dose was gradually tapered off. Describe the pathophysiology of fibromyalgia and what are some psychiatric comorbid issues you could see with the disease?
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