title: Refractory Depression, Fatigue, Irritable Bowel Syndrome, and Chronic Pain: A Functional Medicine Case Report.
abstract: Single-disorder or single-organ-system clinical practice guidelines are often of limited usefulness in guiding effective management of patients with chronic multidimensional signs and symptoms. The presence of multiple long-standing medical problems in a given patient despite intensive medical effort suggests that addressing systemic core imbalances could complement more narrowly focused approaches.
  
  
  
  A 72-year-old man experiencing longstanding depression, fatigue, irritable bowel syndrome, and chronic pain in the context of additional refractory illnesses was assessed and treated, guided by a system-oriented approach to underlying core imbalances termed functional medicine. This patient was referred from a team of clinicians representing primary care, cardiology, gastroenterology, hematology, and psychology. Prior treatment had been unsuccessful in managing multiple chronic comorbidities. Diagnostic assessment included comprehensive stool and nutritional/metabolic laboratory testing.
  
  
  
  The blood-, urine-, or stool-based measurements of relevant markers for multiple systemic issues, including digestion/absorption, inflammation, oxidative stress, and methylation, identified previously unrecognized root causes of his constellation of symptoms. These functional measurements guided rational recommendations for dietary choices and supplementation. The patient experienced steady and significant improvement in his mental health, fatigue, chronic pain, and irritable bowel syndrome-as well as the unexpected resolution of his chronic idiopathic pancytopenia.
  
  
  
  The success in this case suggests that other patients with chronic, complex, and treatment-refractory illness may benefit from a system-oriented assessment of core imbalances guided by specialized nutritional/metabolic and digestive laboratory testing.
authors: Senior Consultant for Minnesota Personalized Medicine in Minneapolis. gregory.plotnikoff@gmail.com.
authors: Gregory
authors: G
authors: Plotnikoff
authors: Research Associate at the Integrative Medicine Institute in Portland, OR. msbarber@integrativemed.org.
authors: Melissa
authors: M
authors: Barber
mesh_terms: D000368:Aged; D015415:Biomarkers; D059350:Chronic Pain / Q000209:etiology / Q000628:therapy*; D015897:Comorbidity; D061218:Depressive Disorder, Treatment-Resistant / Q000209:etiology / Q000628:therapy*; D004032:Diet; D019587:Dietary Supplements; D004063:Digestion; D005221:Fatigue / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007249:Inflammation; D007408:Intestinal Absorption; D043183:Irritable Bowel Syndrome / Q000209:etiology / Q000628:therapy*; D008297:Male; D008745:Methylation; D018384:Oxidative Stress
chemical_list: D015415:Biomarkers