A29-year-old woman complains to her physician that she hasn’t felt well since having the flu several months ago. she is extremely tired but often doesn’t sleep well at night and complains of generalized aching and pain. she has experienced frequent migraines and is often incapacitated for days. her bowel movements are irregular and fluctuate between constipation and diarrhea. physical exam reveals pain to the touch at the base of her neck, muscles in her upper back, upper muscles of her buttocks, knee joints, and sides of her elbows. laboratory tests are unremarkable with normal chemistry. cbc, and thyroid functions. esr is within the normal range and ana, ra, and rapid mono (mono spot) are negative.