Topic: Medical Care
Theorists and Theories Collide, With Patients Caught In the Middle- Part One
All the differing theories and ideas regarding what Fibromyalgia and Chronic Fatigue Syndrome are and what causes these illnesses, which are put out by the 'top experts', are often vague and conflicting. Some experts have created less complex, yet nebulous theories; while others have created an entire mythos surrounding these illnesses.
Ockham's Razor- the principle that the simplest theory is often the best- appears to never crossed the minds of these medical researchers and practitioners.
The Fibromyalgia Spectrum
The Fibromyalgia Spectrum theory was first proposed by Dr. Muhammad Yunus, and has been continued by Dr. Mark Pellegrino (a physician who has been diagnosed with fibromyalgia). Under this theory Fibromyalgia is a part of Dysregulation Spectrum Syndrome, under which Fibromyalgia falls into an area of illness that is broken down into eight subsets.
As a senior resident at The Ohio State University in 1988, I gave a lecture on Fibromyalgia at the Physical Medicine Grand Rounds. One of my lecture slides was entitled “Fibromyalgia, A Spectrum of Conditions?” I discussed how Fibromyalgia appears to be a “broader” condition with specific subsets. Fibromyalgia was in that area between normal and disease – the “gray” area.
Some of the subsets were closer to normal, involving regional pain only, or milder symptoms without numerous associated conditions. Some subsets were closer to abnormal, with some features of connective tissue or rheumatic diseases, but were not quite “there.”
Today I’m convinced Fibromyalgia is indeed a “broader” condition with various subsets. I believe this information is helpful in explaining why everyone’s symptoms are different even though they all have Fibromyalgia. This chapter addresses how the Fibromyalgia spectrum is part of the big picture in understanding Fibromyalgia.
Fibromyalgia Is a Distinct Medical Entity, and Appropriately So
We have long recognized, however, that many conditions overlap it, and various conditions exist that can lead to secondary Fibromyalgia. Dr. Muhammad Yunus, MD, [a professor and FM specialist at the University of Illinois College of Medicine] has developed the concept of Dysregulation Spectrum Syndrome (DSS) to describe how conditions overlap.1
Dr. Yunus describes DSS as representing various associated conditions that share similar clinical characteristics and pathologic mechanisms with Fibromyalgia. Ten conditions are in the DSS umbrella: Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, tension headaches, migraine headaches, primary dysmenorrhea, periodic limb movement disorder, restless leg syndrome, temporomandibular pain syndrome, and myofascial pain syndrome. He predicts other entities will be added to this list in the future. ("The Fibromyalgia Spectrum- Part of the Big Picture in Understanding Fibromyalgia", Mark J. Pellegrino, MD http://www.fmscommunity.org/spectrum.htm )
The eight subsets range from being completely asymsptomatic to having severe symptoms of illness, which is indicative of disease. Details regarding these subsets and how they fit into the overall 'big picture' can be found on the FMS Community "spectrum" webpage link in the paragraph above.
The Trauma Related Illness and Symptoms theory:
Patricia D. McClendon, a Clinical Social Worker with psychiatric experience approaches the subject of Fibromyalgia and Chronic Fatigue Syndrome from the viewpoint that these conditions are Trauma Illnesses, not true Somatoform (Psychosomatic) illnesses, which are related to Dissociative Disorders/Multiple Personality Disorder, and Post Traumatic Stress Disorder.
Explaining Dissociative Disorders, from the Mayo Clinic website:
http://www.mayoclinic.com/health/dissociative-disorders/DS00574
Some excerpts from Patricia McClendon's article:
Many trauma survivors meet DSM-IV criteria for PSTD and/or dissociative disorders. Many also are diagnosed as having somatoform conditions which in my mind are conditions like fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, pain disorders, etc., (maybe MS and RA, etc.). It's only normal to have physical symptoms after enduring significant trauma because the trauma, I believe, permanently alters the survivors' neurochemistries....
"Long-standing somatic symptoms often reflect deeply dissociated visceral memories of traumas, long-standing interpersonality conflicts, and chronic self-destructive behavior." (Frank W. Putnam, 1989, Diagnosis & Treatment of MPD, p.293). I agree with the first part of the sentence, but since trust is so damaged, mutual loving relationship are difficult for many survivors, then the last part goes like this ... I was a bad little girl (or boy) ... that's why daddy hurt me and the reason I have fibromyalgia is because I am bad and should hurt ... and, if that doesn't cause enough pain, I must inflict it, so I can finally be punished enough for being bad ... then I can have a "good" time until the next time. Or, if I don't have pain today that means something is going to happen to cause me pain ("waiting for the other shoe to drop", so, it is safer to stay in pain).
I would imagine that you would find raging workaholic suffering with fibromyalgia and the like ... because, they can never do enough to erase their badness, so they push their bodies past the limits. Likewise for the chronic fatiguers. I think the hyperviligance of trauma survivors can be emotionally and physically exhausting, they are never safe, never accomplished enough, etc...
FMS may be the presenting manifestation in patients with PTSD. The diagnosis of PTSD should be considered in ANY, ANY patient with symptoms of FMS and a history of significant trauma, whether in childhood (physical, sexual, and/or extreme emotional abuse) or in adulthood (rape, battering, car wrecks, combat in the military).. (Patricia D. McClendon, MSSW http://www.clinicalsocialwork.com/trauma.html)
