This patient has fibromyalgia, one type of central pain syndrome. Central pain results from dysregulation of sensory processing pathways within the nervous system. This dysregulation amplifies sensory input, resulting in the increased perception of pain. Central pain can be classically neuropathic, such as poststroke pain or post–spinal cord injury pain, or it can be more indistinct, such as in fibromyalgia. The pain is usually constant, with bursts of more severe pain, often exacerbated by cough, temperature changes, movement, or emotions. Central pain syndromes can also evolve out of unrelenting chronic pain when persistent stimulation of peripheral pain receptors results in the upregulation of central pain modulators. It is important to recognize patients who have pain as a result of central mechanisms, as these conditions respond particularly well to multimodal pain management, and neuromodulating medications are more effective for this type of pain than opioids.

The hallmarks of neuropathic pain are stinging, burning, or tingling sensations, none of which are present in this patient. Furthermore, neuropathic pain follows the distribution of the nerves affected. This patient describes widespread pain all over her body that is not compatible with an anatomic nerve distribution.

Nociceptive pain is dull, aching, or throbbing pain caused by tissue injury. It is localized to the site of the injury. This patient has no evidence of tissue injury, and her pain is not localized.

Although psychological conditions can impact how patients experience their pain or can perpetuate pain, they are not thought to be a mechanism of pain generation in and of themselves. Additionally, this patient has no evidence of psychological comorbidity.