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SSD-Christopher Bass & MaxHenderson: Fibromyalgia: unhelpful diagnosis for both patients and doctors

Discussion in 'Fibromyalgia' started by Esther12, Mar 8, 2014.

  1. Esther12

    Esther12 Senior Member

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    C Bass wrote a piece for Pulse that was commented on here: http://forums.phoenixrising.me/inde...-archive-somatoform-disorders-in-pulse.14253/

    Henderson did a piece on CFS and personality disorder that had no control group with physical health problems.

    This is their new comment on the BMJ promoting SSD.


    Fibromyalgia: an unhelpful diagnosis for both patients and doctors
    6 March 2014
    The review by Rahman et al on fibromyalgia [1] describes the disorder as if it is a disease entity characterised by, for example, a certain number of tender points. This is misleading, as tender point counts merely reflect levels of distress. [2] Whilst, indeed because, we recognise the difficulties encountered by this patient group, we suggest that the term fibromyalgia be abandoned for the following reasons:

    1] Fibromyalgia is a dimensional or “continuum disorder” and not a “disease” [3]

    2] FM is strongly associated with other non-musculoskeletal complaints and emotional distress, which are at least as disabling as the somatic symptoms; it is more appropriately described in terms of “polysymptomatic distress”[3]

    3] In our clinical experience assigning a person a label of FM has a negative and disempowering effect on the patient and many of their doctors; once a person ascribes a complaint to, for example, “fibrofog” it suggests that it is external and unalterable. This may transform a person with distress into “a patient with fibromyalgia.”

    4] Because FM overlaps with numerous other disorders with medically unexplained symptoms such as irritable bowel syndrome and chronic fatigue syndrome [3] it is more appropriate to treat them within the same specialised service in the general hospital. Experience in Europe suggests that such specialised units for patients with these disorders can be established with multidisciplinary teams

    Polysymptomatic distress has been recognised as a somatoform disorder, specifically as a somatic symptom disorder or SSD. [4] Of people with fibromyalgia in the general population 40% satisfy criteria for somatic symptom disorder, prompting Wolfe to remark that – “the idea that fibromyalgia is primarily a somatic symptom disorder is well accepted in the pain and psychological literature, but not in the rheumatology, where the dominant idea is central sensitisation”. [3] People with these diverse complaints present to doctors in all branches of medicine, in particular in primary care. A greater awareness of the psychosocial determinants of musculoskeletal complaints would benefit all doctors by helping them to identify these people earlier in their “patient journey” and prevent the medicalisation and potential for iatrogenic harm that accompanies a diagnosis of fibromyalgia. [5]

    [1] Rahman A, Underwood M, Carnes D. Fibromyalgia Br Med J 2014;] 24th February]

    [2] McBeth J, MacFarlane G, Benjamin S, Morris S, Silman A. The association between tender points, psychological distress, and adverse childhood experiences. Arthitis Rheum 1999; 42:1397-1404.

    [3] Wolfe F, Brahler E, Hinz A, Hauser W. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care Res 2013; 65: 777-785.

    [4] Somatic symptom and related disorders. In: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. American Psychiatric Association. Washington DC, 2013:309-327.

    [5] Kouyanou K, Pither C, Wessely S. Iatrogenic factors and chronic pain. Psychosom Med 1997; 57:597-604.

    http://www.bmj.com/content/348/bmj.g1224/rr/689294
     
    Last edited: Mar 9, 2014
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  2. alex3619

    alex3619 Senior Member

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    Shudder ... replace something with objective research with something with only subjective hypothesis? Is this science? Is this evidence-based? I think not.
     
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  3. barbc56

    barbc56 Senior Member

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    Fibromyalgia is now recognized by the American College of Rheumatology. However the tender point test has been rather controversial.

    For myself, if I was poked just about any place on my body, it would hurt.

    While the AAR, does mention gentle exercise and CBT, it appears as more of an adjunct therapy. I'm still not happy about this part but at least it is recognized.

    http://www.fibromyalgiapedia.com/fibromyalgia-causes/

    However, it is now thought that Fibromyalgia is more neurological usually percipated by some kind of bodily injury such as whiplash, arthritis, as a trigger. ME/CFS may also be a triggering event.

    I see a neurologist, however my PCP is also very knowledgeable about Fibromyalgia and its co-morbid conditions, so I quite fortunate.

    I have found that the following site has been the most helpful dealing with fibromyalgia.. Note there are links to other information on the site.

    http://fmaware.org/site/PageServerccdf.html?pagename=fibromyalgia_science


    Barb
     
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  4. Esther12

    Esther12 Senior Member

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    I don't know much about FMS, so can't comment much.

    I was just reading this 2005 Wessely paper that shows little, but is a bit relevant to concerns about the "iatrogenic harm that accompanies a diagnosis of fibromyalgia." (Which cited a 1997 Wessely paper).

    http://onlinelibrary.wiley.com/doi/10.1002/art.21545/full

     
  5. peggy-sue

    peggy-sue

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    Never, ever considering for one moment that this is exactly how somebody who had a real, but ignored, condition would behave.
     
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  6. barbc56

    barbc56 Senior Member

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    You would think they would get that, wouldn't you?

    If I remember correctly, years ago there was a study of patients with a chronic condition, I think it might have been MS, where many of the patients had shown some type of depression/anxiety symptoms within the prior two years of diagnosis. The conclusion was that the depression was possibly from the illness starting but not at a level where it would be detected.

    I have a family member who is an oncologist/hematologist. He has often said that the old adage that positive thinking will increase a cancer patient's life span is not proven and is too simplistic as you also have to consider that a person's outlook may also be a reflection of how sick a patient is.

    Barb
     
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  7. peggy-sue

    peggy-sue

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    I seem to remember recently reading a study on Medline which showed that positive thinking has absolutely no effect on survival rate with cancer.

    However, I would think that having a positive attitude helps a great deal with making the time that is survived, of far better quality.
    I'm not sure it's something that should be put out to the public (says she, having just made it very public indeed).

    As an old saying goes; "'Tis better to travel in hope, than it is to arrive."
     
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  8. barbc56

    barbc56 Senior Member

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    Absolutely. That's an important point.

    @peggy-sue Thanks for adding this.:thumbsup:

    Barb
     
  9. Esther12

    Esther12 Senior Member

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