After years of treating pain patients with treatments best directed at localized pain, I increasingly saw more patients with diffuse pain often accompanied by other symptoms such as fatigue, sleep disturbance, bowel symptoms, brain fog, anxiety, depression and others. Many times they had been worked up for autoimmune disease, but often the tests were negative or mildly positive, not warranting expensive biological treatments that suppress the immune system.
My approach is look for the underlying cause of these symptoms. Many people have genetic predispositions for chronic disease because of impairments of methylation or detoxification pathways. These people accumulate toxic metabolites, setting off chronic inflammatory pathways. Some people have genetic impairments of the inflammatory pathways themselves, either turning on inflammation too easily or not turning off inflammation easily enough.
Some are exposed to toxins from the environment, such as pesticides or mycotoxins, and lack the genetic means to sufficiently turn off those inflammatory pathways. I will get a good history, counsel patients regarding food and supplements, perform genetic testing or organic acid or mycotoxin testing. Hopefully we can help the patient's own detoxification pathways, control the out of control inflammation, and help resolve the patient's constellation of symptoms.