Patients presenting with severe pain as can be seen with IBS, chronic abdominal pain and overlapping conditions such as fibromyalgia, migraine headaches can be challenging to treat. For this presentation, Dr. Douglas Drossman presents the case of a female patient with these severe, chronic abdominal pain with overlapping conditions. This challenge relates to the patient’s sense of frustration and urgency for rapid treatment and this is compounded when the patient requests opioids to treat their abdominal pain and is reluctant to use a central neuromodulator. Dr. Drossman uses both lecture and patient role paly video to exemplify how to manage this type of patient interaction effectively and explains how management of this condition can be done effectively and provide satisfaction for both patient and doctor. Also discussed is the pathophysiology of centrally mediated abdominal pain and the adverse effects of opioids on GI pain and constipation.