Friday, February 17, 2012

Fibro: Mass Hysteria? Part 2

In my last post (2/16/2012 - Fibro: Mass Hysteria? ), I shared a letter from a doctor in New York City. In this letter, Dr. Kaddoch states,  "Disorders like chronic back pain, fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome have spread in epidemic proportions despite little consensus among physicians as to their etiology or to an optimal management and treatment approach. These are the telltale features of psychosomatic disease."

Let's take a moment to compare the symptoms and diagnosis of conversion disorder versus fibromyalgia as shown on the Mayo Clinic's website.

Conversion Disorder (Mass Hysteria)
Conversion disorder symptoms usually appear suddenly after a stressful event. Common symptoms can include:
·    Poor coordination or balance
·    Paralysis in an arm or leg
·    Difficulty swallowing or "a lump in the throat"
·    Inability to speak
·    Vision problems, including double vision and blindness
·    Deafness
·    Seizures or convulsions
Other conversion disorder symptoms include:
·      Loss of balance
·      Numbness or loss of the touch sensation
·      Inability to feel pain
·      Hallucinations
·      Difficulty with walking
·      Urinary retention
The pain associated with fibromyalgia often is described as a constant dull ache, typically arising from muscles. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.

Fibromyalgia is characterized by additional pain when firm pressure is applied to specific areas of your body, called tender points. Tender point locations include:

·    Back of the head
·    Between shoulder blades
·    Top of shoulders
·    Front sides of neck
·    Upper chest
·    Outer elbows
·    Upper hips
·    Sides of hips
·    Inner knees

Fatigue and sleep disturbances:
People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is frequently disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea, that further worsen symptoms.

Coexisting conditions:
Many people who have fibromyalgia also may have:

·    Fatigue
·    Anxiety
·    Depression
·    Endometriosis
·    Headaches
·    Irritable bowel syndrome
You must have one or more symptoms you can't control that affect movement of part of your body or your senses. These symptoms must seem as if they could be caused by a neurological or other medical condition.
·    Your symptoms must have occurred after a stressful event.
·    You're not producing symptoms on purpose.
·    Your symptoms aren't fully explained by a general medical condition, drug use or a culturally accepted behavior, such as experiencing visions at a religious ritual.
·    Your symptoms must cause significant stress or difficulty in social, work or other settings.
·    Your symptoms aren't limited to pain or sexual problems, and aren't better accounted for by another mental health problem.
·    Widespread pain lasting at least three months
·    No other underlying condition that might be causing the pain
·    At least 11 positive tender points — out of a total possible of 18 (1990 criteria)

The biggest contrast between the two disorders is that conversion disorder comes on suddenly, and usually resolves itself in weeks. Wide-spread pain has to be experienced for three months or more before a diagnosis of fibromyalgia is even considered. I cannot even see the sense in lumping these two disorders together.

In my last post I defined many of the terms in Dr. Kaddoch's letter. I would like to take a closer look at psychosomatic.
"Psychosomatic: pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin."

Many illnesses can be related to the mind. The mind is very powerful, and under the right conditions, can cause stress to manifest in very physical ways. A very simple example of this is experiencing some sort of digestive problem in an unpleasant situation. A friend of mine, used to break out in hives before giving presentations. Although this might be considered psychosomatic, it certainly isn't conversion disorder. Nor in most cases, does it require medical intervention.

I will not disagree that fibromyalgia can have psychosomatic links, but so can arthritis, or a broken leg, or anything else that causes stress or discomfort in your life. By the same token, just as a stomachache can be brought on by stress, so can the symptoms of fibromyalgia. Does this mean that stomachaches, fibromyalgia, and conversion disorder all originate in the mind? To make this leap is irrational and irresponsible.

It is very possible that fibromyalgia is over-diagnosed. After all, a doctor is frustrated by someone who is always in pain, to which no direct cause can be found, such as a broken bone. How do you treat this? Label it. If you place a label like fibromyalgia on something frustrating, then you've made a diagnosis, and you can move on. It's simple, the doctor can now say there are treatments but no cures, and if the doctor's really lucky, maybe the patient will be unhappy with her treatment and diagnosis and take her business elsewhere.

Then there are the disbelievers. Your fibromyalgia is in your head. It will go away on it's own. Or you could try engaging in some talk therapy. That should solve the problem. I could talk until I am blue in the face, and my fibro is not going to suddenly resolve itself. It may be less pervasive because I addressed the stress, but I have not treated the physical, which I strongly believe exists.

This is not fair to all doctors, but people are human, and it is readily believable that there are a few who behave in this way. Just because a doctor cannot find a cause for symptoms, doesn't mean there isn't one. Science is still evolving. Doctors and scientists do not know everything. If they did, there would be cures for cancer and diabetes. The body is a very complicated piece of machinery. The day that science can explain everything that happens is the day that scientists become equal with God. We are not even close to that point. It is arrogant to assume that because you can't trace a symptom to something tangible, that the tangible cause does not exist. It just means you don't know enough yet.

Thursday, February 16, 2012

Fibro: Mass Hysteria?

I am not drawing any conclusions about the illnesses in Le Roy, NY, but the following is a letter that appeared recently in Rochester, NY's hometown paper:
“I have read with interest about the case of mass hysteria in Le Roy, Genesee County. The truth is that this phenomenon is far more common than presently realized.
Psychosomatic illnesses tend to spread in epidemic fashion, similar to infectious outbreaks. A survey of medical history demonstrates this concept quite nicely. Hysterical symptoms like paralysis and blindness were extremely common in the days of Freud and Breuer. Only after we learned that these disorders were a form of neurosis did the cases finally begin to disappear.
Psychogenic illnesses permeate the current medical landscape and are a tremendous source of health care expenditure. Disorders like chronic back pain, fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome have spread in epidemic proportions despite little consensus among physicians as to their etiology or to an optimal management and treatment approach. These are the telltale features of psychosomatic disease.
We have a lot to learn from the recent outbreak in Le Roy. It is far from an isolated incident.”
Dr. Michael A. Kaddoch
New York City
Kaddoch, M. (2012, February 15). Historical context for the Le Roy outbreak.  Democrat  and  Chronicle, pp. 7A.
Before I even comment on this letter, let’s define some terms:
Mass hysteria: an episode of psychogenic illness affecting a large group of individuals at the same time. Examples include the witchcraft trials of the 17th century and the irrational mass reaction to the 1938 radio show based on H.G. Wells' science-fiction novel, War of the Worlds. Also called collective hysteria, epidemic hysteria, major hysteria, mass panic, mass psychogenic illness.
Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.
Conversion disorder: (Although this term was not used in the letter, it has been used in the media as a synonym for mass hysteria.)
Conversion disorder is a condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.
Psychosomatic: pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin.
Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

Neurosis: a mental and emotional disorder that affects only part of the personality, is accompanied by a less distorted perception of reality than in a psychosis, does not result in disturbance of the use of language, and is accompanied by various physical, physiological, and mental disturbances (as visceral symptoms, anxieties, or phobias)
1 originating within the mind.
2 referring to any physical symptom, disease process, or emotional state that is of psychologic rather than physical origin. Also called psychogenetic. See also psychosomatic.
Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.
Now that we are familiar with the terms used in Dr. Kadoch's letter. I will continue in my next post to contrast his opinion against that of someone who has suffered from both fibromyalgia and chronic back pain.