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Chemobrain (& CFS): critical review & causal hypothesis [=somatoform via biomed]

barbc56

Senior Member
Messages
3,657
According to this it's under Diseases of the musculoskeletal system and connective tissue.

I think it's a great improvement. Not perfect but headed in the right direction. It does mention exercise but fails to mention it needs to be weight bearing like walking and warm water therapy. However, certainly not as intense nor as long in duration for those who are not sick. Tender points aren't as prominent. I think if poked with the least bit of pressure just about anywhere on my body, it would hurt followed by the intense, breathtaking aching that makes you feel like you are runnung a temperature of 106 and your bone marrow is being sucked out, followed by exhaustion. I would not be able to tolerate a massage which I used to love. This is in addition to IBS, RLS and severe sleep issues which are usually comorbid with FM.

FM is now considered by many to be neurological. But it may be this, as well as some the above which I think are inaccuracies, has to do with lack of research to say this is definitive.

FM often starts with a physical injury, possibly a long standing health condition, but not always. I had a complicated broken arm. Whiplash is often mentioned as one of the leading events that precipitate FM. But of course not everyone gets FM after a physical injury, so there is some underlying process. Again, this may not be definitive but what my neurologist and PCP report. Some doctors now refer you to a neurologist. I've also seen a physical therapist who specializes in FM and MS. I love the warm water therapy but the problem, like most of us, is actually having the energy to get there or participate.
http://www.icd10data.com/ICD10CM/Codes/M00-M99/M70-M79/M79-/M79.7
 
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barbc56

Senior Member
Messages
3,657
The NIH has already conducted extensive research on chronic fatigue, fibromyalgia, chronic pain, cancer and ms fatigue. They found no abnormalities that would be classsified as biological pathophysiology. This is not only with Wallit but Catherine Bushnell postions as well. The interpretation of the results is the key. Biomedical reductionism is a huge concern

I highlighted above as its an important point. Emphasis on interpretation. Other conditions such as migraines are recognized as physical conditions, yet no biological abnormalities.
 

Hip

Senior Member
Messages
17,824
It is worth pointing out that the concepts of somatoform and psychosomatic are not the same thing, even though in this paper, Brian Walitt et al seem to use these terms interchangeably.


Psychosomatic disorders have objectively-measurable physiological symptoms (such as blood pressure) that are affected and aggravated by psychological factors such as emotional state.

To give an example from ME/CFS: neurally mediated hypotension, which can be triggered by an unpleasant emotional shock, can be classed as psychosomatic.

Somatoform disorders have subjectively sensed symptoms that appear to come from the body (such as pain with no apparent physical cause) that are objectively unobservable and unmeasurable by any means or medical instruments (at least with present medical technology). Somatoform symptoms can only be sensed and felt by the patient in their mind, but cannot be seen by other observers or detected by medical instruments.

Somatoform disorders are associated with psychological symptoms such as stress and anxiety, and there is often the suggestion that these psychological states may cause the somatoform symptoms the patient experiences in their body.
Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) definition of somatoform disorder:
"The occurrence of one or more physical complaints for which appropriate medical evaluation reveals no explanatory physical pathology or pathophysiologic mechanism, or, when pathology is present, the physical complaints or resulting impairment are grossly in excess of what would be expected from the physical findings." Ref: 1

Lower back pain with no apparent cause is an example of a somatoform symptom. Of course, this notion of "no apparent cause" just relates to the current state of medical knowledge. No cause may be known today, but may be discovered in the future. And indeed, for such inexplicable lower back pain, new evidence is now emerging that it may be cause by spinal disc infection with anaerobic bacteria. Refs: 1 2

In ME/CFS, I guess you could attempt to classify symptoms such as stomach or muscular pain as somatoform; but since studies have found significant enterovirus infections in the stomach and muscles of ME/CFS, I don't think this classification would hold, since a somatoform classification requires that there are no detectable major physical abnormalities, and a chronic infection is such a physical abnormality.

This is always the flaw in the somatoform concept: somatoform seems more a marker of medical ignorance that an indication any real medical phenomenon. When, using today's medical knowledge, you cannot find a cause for subjectively sensed symptoms that appear to come from the body, somatoform psychiatrists will class these as somatoform. But if tomorrow some causes for the symptoms are found, then the symptoms will no longer be categorized as somatoform. So tagging symptoms as somatoform is really more a marker of the current state of medical ignorance.

Another important definition: a quackery /kwækəri/ — the collective noun for a group of somatoform psychiatrists (OK, OK, so I invented this definition myself).


The only area of somatoform research that I think might have legitimacy is the work on central sensitization: the idea that the volume control (gain control) on the nervous system has been turned up, so that very minor inputs become greatly amplified to produce pain signals, or overwhelming signals of sensation. But I think the cause of any central sensitization will be a physical one, not a psychological one.
 
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Hip

Senior Member
Messages
17,824
Got a source on that?

Well, for example, this paper:
Vasovagal syncope can be caused by acute stress or fear and is therefore implicated in anxiety, panic, and major depressive disorders.

Or this book:
Neurally mediated syncope/vasovagal syncope is associated with pain, fear, and unpleasant sight, smell, or sound.

Note that NMH is also called neurally mediated syncope, neurocardiogenic syncope, vasovagal syncope, and vasodepressor syncope.
 
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JayS

Senior Member
Messages
195
Weak. What are they basing those quotes on anyway? Surely there's an actual study on fear/anxiety-induced NMH?

One paper from 2000 and a brief mention in a book?

I reject the assertion that NMH 'can be classed as psychosomatic.' I'd keep an open mind if this is even remotely prominent in the literature, but I'd want to see better examples.
 

Hip

Senior Member
Messages
17,824
One paper from 2000 and a brief mention in a book?

I reject the assertion that NMH 'can be classed as psychosomatic.' I'd keep an open mind if this is even remotely prominent in the literature, but I'd want to see better examples.

Those refs took me 60 seconds to find on Google, just for your benefit. If you want more, do you own research.

From my past reading about NMH, I read that stress or emotional shock can trigger or exacerbate NMH (in addition to the orthostatic trigger of standing up). I am surprised this is news to anyone, and that you had not previously come across this. Even in the general population, it's not as if the concept of fainting through shock or fright is unheard of.

I am not surprised that you are rejecting it though, as lots of ME/CFS patients have a strong negative reaction when they see words like "psychosomatic".

But in some circumstances, such as in this one, psychosomatic is the correct term, as NMH does have a psychosomatic component (which does not mean the whole of NMH is due to psychological factors; it just means that NMH can be influenced and triggered by emotional state).
 
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wastwater

Senior Member
Messages
1,271
Location
uk
Is chemo brain similar to me/cfs
IL-2 side effects could for example cover all me/cfs symptoms
 
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Hip

Senior Member
Messages
17,824
What? People who make the claims provide the evidence. Not the other way around.

Not when the facts are fairly established and accepted, and easy to find by typing in Google. Do I need to prove that the common cold exists every time I mention I caught one?

If you want references, start with the Wikipedia article on the vasovagal response (a synonym for NMH). You can see in that article that all sorts of triggers can lead to a vasovagal attack, starting with the orthostatic triggers, but including such intriguing triggers as your "funny bone" being hit.
 

Bob

Senior Member
Messages
16,455
Location
England (south coast)
I've re-read the chemobrain paper, and perhaps I slightly misinterpreted it the first time around. I'm still confused both by their semantics and by their hypothesis.

They are definitely hypothesising that chemobrain is a somatoform disorder but they're using the term 'somatoform' in a way that I'm unfamiliar with; They say that the chemobrain patients are perceiving cognitive impairment, but because their perceived (subjective) cognitive impairment doesn't match what can be objectively measured in cognitive tests (i.e. cognitive tests are normal), it means that the symptoms are a false interpretation of reality (i.e. patients are perceiving impairment that doesn't exist), and so it is a somatoform disorder, despite other measurable biological abnormalities. They seem to be suggesting that the false perceptions have a legitimate biological basis (it's very confusing); they seem to blame the distorted perception of reality on cytokine and epigenetic changes. The authors accept that cytokine and epigenetic (biologic) changes may cause the (supposedly inaccurate) subjective cognitive impairment, so it surprises me that they still refer to it as a somatoform disorder. It seems bizarre and convoluted to me that they are proposing that there is an (alleged) false perception of cognitive impairment and the false perception has a biologic basis, and that this amounts to a somatoform disorder.

I would never have used 'somatoform' to describe an illness that has a biological basis (e.g. if there were demonstrable immunological, neurological, genetic, or epigenetic abnormalities). But the authors seem to be using the 'somatoform' to describe a specific type of manifestation of cognitive symptoms whether or not there are demonstrable biological abnormalities. They use it simply to indicate that normal results of the cognitive tests do not match the perceived subjective impairment.

But to conclude that the cognitive impairment isn't real seems like quite a jump in reasoning to me, as there could be a number of reasons why subjective experience doesn't match objective tests (e.g. the tests could be inadequate or they could be measuring the wrong thing. They acknowledge that cognitive studies have been small and underpowered.)

Much of the confusion for me stems from the definition of 'somatoform'. I've never seen it used in quite this way before. I didn't know that it was used to define a biologically based illness in which subjective experiences do not match objective tests.

Some types of cognitive testing for ME patients have normal results, but researchers have now found that ME patients do have measurable differences in some specific cognitive tasks especially related to multi-tasking. (In some simple tasks we have no measurable differences.)

ME patients know that they have short and long term memory issues which fluctuate with the severity of the illness. When I'm at my worst, my (usually) vivid imagination and ability to visualise are diminished. I also struggle to recall words. And even simple tasks can become confusing because of working memory problems. But all of this clears up (i.e. my memory returns in full) when the illness is in a good patch. So I know there's no structural damage. And I think that's not an entirely unhelpful hypothesis to make in terms of chemobrain. i.e. that the impairment is not due to structural or cell damage from toxicity, but is reversible if they find the right intervention. If that's what they're trying to say, they've gone a long way about it!
 
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Large Donner

Senior Member
Messages
866
I've re-read the chemobrain paper, and perhaps I slightly misinterpreted it the first time around. I'm still confused both by their semantics and by their hypothesis.

They are definitely hypothesising that chemobrain is a somatoform disorder but they're using the term in a way that I'm unfamiliar with. They say that the patients are perceiving cognitive impairment, but because their perceived (subjective) cognitive impairment doesn't match what can be objectively measured in cognitive tests (i.e. cognitive tests are normal), it means that the symptoms are a false interpretation of reality (i.e. patients are perceiving impairment that doesn't exist), and so it is a somatoform disorder, despite other measurable biological abnormalities.

Ah ha, now we have a real conclusion!!!! They need to stop using crap cognitive tests and understand PEM.

Should we email them to let them know?
 

Hip

Senior Member
Messages
17,824
What was I thinking. Of course, psychosomatic NMH is as well established as the existence of the common cold. Silly me.

It is probably far better established than the causal role of viruses in ME/CFS, yet I bet if posted up a new study that found a link between enterovirus or herpes viruses and ME/CFS, people here would not say "I reject the assertion that ME/CFS can be caused by viruses".

So there is a bias there. I can understand why so many ME/CFS are biased against concepts like "psychosomatic", given how those concepts have been abused by psychiatrists in the Wessely school. The bias of ME/CFS patients is for political expediency. But political expediency is not scientific. I prefer to keep scientific. That's not to say I think ME/CFS is in general psychosomatic; I don't. But if one aspect of one symptom of ME/CFS such as NMH has a psychosomatic component, I am not going to "reject" it just purely for political reasons. Doing so gives a bad name to ME/CFS patients, in my view.
 
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Bob

Senior Member
Messages
16,455
Location
England (south coast)
Most types of cognitive testing for ME patients has normal results, but researchers have now found that ME patients do have measurable differences in some specific cognitive tasks related to multi-tasking. (In simple tasks we have no measurable differences.)
Does anyone happen to have handy references for this research? Not sure if my records are systematic enough.
 

Scarecrow

Revolting Peasant
Messages
1,904
Location
Scotland
To give an example from ME/CFS: neurally mediated hypotension, which can be triggered by an unpleasant emotional shock, can be classed as psychosomatic.
My brother, who is notoriously squeamish, fainted in a bar once because someone was relating a particularly gory story. It almost started a fight - his friend hadn't seen him fall and assumed that the man standing next to my brother had hit him.

The problem with your statement is the sleight of hand involved. You've equated my brother's vasovagal syncope due to being upset just at the thought of blood with the reaction that I get when I've been standing in a queue for too long. It isn't really "an example from ME/CFS" is it?
 
Messages
15,786
Much of the confusion for me stems from the definition of 'somatoform'. I've never seen it used in quite this way before. I didn't know that it was used to define a biologically based illness in which subjective experiences do not match objective tests.
I think he's using the term to create a chasm between biomedical findings (even causative ones like genes) and symptoms. So the conclusion is that the biomedical abnormalities are not causing the symptoms ... but they are causing the patient to falsely believe they have symptoms. The symptoms and disorder (never "disease") are psychosomatic, but the psychosomatism can have a biological contribution.

It's not a rational model. It creates complex relationships between multiple factors, when it can be explained in much simpler terms as a direct relationship between a biological cause and the symptoms. There's no need or basis for inserting an unproven intermediary in the form of psychosomatism.
 

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
Much of the confusion for me stems from the definition of 'somatoform'. I've never seen it used in quite this way before. I didn't know that it was used to define a biologically based illness in which subjective experiences do not match objective tests.
I'm not sure I quite agree with that: the same paper argues that everything we perceive as humans is an experience created by biology in the brain. They have chosen - without explaining why, as far as I can see - to categorise mecfs as a non-pathological biological process, as opposed to a pathological one.

They have also rejected a hypothesis with limited evidence (pathological microglial activation) with one with much less: essentialy "epigenetics makes stuff happen", which is true, and even more so gene expression does too, but they haven't explained how and why the initial cytokine spike (in periphery, and then the brain) causes symptoms. Whereas the microglia hypothesis says due to immune-over-reaction, microglia get activated long-term (good evidence for this in some diseases, that small PET study was some evidence specific to mecfs), spew out cytokines long-term and these cytokines cause symptoms as per sickness response. It might be wrong, but there's no obvious reason to discard it for a hypothesis with weaker evidence.
 
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