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The concern is that both agents affect CNS serotonin tone simultaneously, and adding exogenous serotonin precursor load on top of a drug that disrupts normal serotonin signaling creates an unpredictable net effect

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In FM, central sensitization is thought to be caused by changes in the function of pain-processing pathways in the central nervous system, including alterations in neurotransmitter function and abnormal sensory processing 10,11