Thermal pulse durations (PDs) of 0.7sec were delivered at an interstimulus interval (ISI) of 2.5sec. == 4.2. stimuli of deep and superficial tissues [1]. The magnitude, distribution, and frequency of the clinical pain and the responses to experimental stimuli vary widely [2,3] suggesting to some: (1) that FMS represents the upper portion of the normal distribution of pain sensitivity [4], (2) that individuals with FMS are predisposed by their genetic makeup and psychological history to exhibit exaggerated pain effect (catastrophize) [4,5] and therefore (3) that chronic FMS represents a psychological pain state. According to these suppositions, the widespread hypersensitivity characteristic of FMS would be associated with excessive activation of cortical levels involved in affective interpretation of pain [6,7], without abnormal processing within pain pathways extending from the periphery to the initial stages of cortical somatosensory processing. The FMS patient presented here drew our attention because of Kobe2602 the clinical severity of her disease and an abnormal sensitivity to cutaneous thermal stimulation. This prompted us to thoroughly evaluate her pain sensitivity with psychophysical methods that can reveal abnormal processing within primary pain pathways. This patient’s high sensitivity to thermal stimulation reveals pathophysiogical pain processing. The studies were conducted with informed consent and approval by the IRB of the University of Florida. == 2. Clinical Description == The patient initially presented with complaint of hurting all over and being extremely fatigued. She met the ACR criteria for FMS with typical symptoms, as well as physical findings [8]. These symptoms included severe headaches, nonrestorative sleep without other findings of a primary sleep disorder, sensations of weakness in her upper and lower extremities, profound fatigue, hypotensive/fainting episodes, Reynaud’s phenomenon with cold and clammy feet and hands, and TMJ disorder. Her past history was significant for migraine headache disorder with aura since childhood. She denied any previous trauma except a right hand fracture in 1998 without residuals. There was no history of sexual/verbal/physical abuse, mental health problems, or drug abuse. She noted slow but steadily increasing, generalized pain since her adolescence and reported that her headaches were largely uncontrolled during her childhood. Better control of pain was achieved with a Kobe2602 variety of medications in her later years; however, she noted extreme generalized pain in 2001 as she was trying to come off medications. She has been on medroxyprogesterone (Depo Provera) for birth control. Generalized pain and associated symptoms continue, despite Kobe2602 a variety of treatments. In general, they have slowly worsened, and she has experienced increasing problems staying functional. She has not developed significant mental health comorbidities. She underwent neuropsychological evaluation twice, and there was no diagnosis of somatization disorder, depression, or anxiety disorder. She was found to have a learning disability (reading disorder). There have been no signs of connective tissue disease: that is, synovitis, joint effusions, or deformities. Her joints reveal some hypermobility, which has always been present. She has developed some osteoarthritis of the knees, lower back and shoulders. She has FMS tender points ranging from 13/1818/18, irritation to the occipital nerves, and ongoing myofascial pain (MFP) trigger point areas. Of note, she has developed more sympathetic nervous system signs, with diffuse skin Kobe2602 mottling and cold and clammy hands and feet. Her vital signs, including blood pressure, respiratory rate, and weight have all remained stable and normal. However, her heart rate is elevated (102120) and felt to be secondary to her medications, particularly cyclobenzaprine (Flexeril). Her laboratory studies were and have remained normal, including CBC, chemistry profile, sedimentation rate, antinuclear antibody, rheumatoid factor, highly sensitive C-reactive profile, Vitamin B12, and thyroid studies. Treatments have been multidisciplinary, including pharmacological and nonpharmacological procedures. Her current regimen has kept her functioning with regular activities of daily living (ADLs). She is taking: topiramate TP53 (Topamax) 50 mg bid, cyclobenzaprine (Flexeril) 20 mg qhs, hydrocodone/acetaminophen 10/500 12 q68 hours, zolpidem (Ambien CR) 12.5 qhs,.