Thursday, June 20, 2013

FMS and PTSD are comorbid conditions?

“A link between fibromyalgia syndrome (FMS) and posttraumatic stress disorder (PTSD) has been suggested because both conditions share some similar symptoms. The temporal relationships between traumatic experiences and the onset of PTSD and FMS symptoms have not been studied until now. All consecutive FMS patients in 8 study centres of different specialties were assessed from February 1 to July 31, 2012. Data on duration of chronic widespread pain (CWP) were based on patients' self-reports. Potential traumatic experiences and year of most burdensome traumatic experience were assessed by the trauma list of the Munich Composite International Diagnostic Interview. PTSD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders IV symptom criteria by the Posttraumatic Diagnostic Scale. Age- and sex-matched persons of a general population sample were selected for controls. Three hundred ninety-five of 529 patients screened for eligibility were analysed (93.9% women, mean age 52.3years, mean duration since chronic widespread pain 12.8years); 45.3% of FMS patients and 3.0% of population controls met the criteria for PTSD. Most burdensome traumatic experience and PTSD symptoms antedated the onset of CWP in 66.5% of patients. In 29.5% of patients, most burdensome traumatic experience and PTSD symptoms followed the onset of CWP. In 4.0% of patients' most burdensome traumatic experience, PTSD and FMS symptoms occurred in the same year. FMS and PTSD are linked in several ways: PTSD is a potential risk factor of FMS and vice versa. FMS and PTSD are comorbid conditions because they are associated with common antecedent traumatic experiences.”

The rope is frayed. My comment:
I am uncertain as to why these researchers are suggesting that PTSD is a comorbid (overlapping) condition to fibromyalgia.  Fibromyalgia has been thought to be initiated by some traumatic emotional or physical event. However, Traumatic initiating events are not limited to emotional trauma; physical trauma is just as significant.  There was also a recent study that dismissed this all together. [Gonzalez, et al., 2013]. 

If the researchers are studying comorbid disorders, why are they not also considering hypothyroidism, bladder and bowel dysfunction, myofascial pain syndrome, lupus (SLE), ankylosing spondylitis, Raynaud’s, etc.?  Many fibromyalgia patients have no history of mental health disparities. So why does Dr. Hauser, and those who associate with him, keep wasting valuable research money on such ill fated endeavors? 

See Fibromyalgianess is ALL in Our Head? My Correspondence with Dr Frederick Wolfe here

Dr Hauser and Dr Wolfe co-authored another survey type study suggesting fibromyalgia meets the DSM-5 (American Psychiatric Assoscition diagnostiic manual) criteria.  I am not the only one with concerns.  See  Huffington Post article, Don't People in Chronic Pain Have Enough to Deal With? here.

Hypothesis = suggested probable cause to be proved or disproved.

If one is going to study a possible connection of comorbidity in fibromyalgia, they must at least consider ALL the suggested comorbid disorders, and they should conduct an extensive literature review before positing their hypothesis. It seems these researchers are bent on constructing studies to prove there is no other possibility. This is not research, at least not what I learned in college.  Study results are often unparalleled to the hypotheses. Researchers generally expect when they do not get the results they expect, they will need to form a new unexpected hypothesis. 

This study makes about as much sense as saying heart disease, which also has a degree of psychological stress,  is the result of post traumatic stress disorder (PTSD).   To suggest that disorders with many accompanying symptoms and comorbid disorders is nothing less than ludicrous. After all, heart disease can cause peripheral circulation symptoms, fatigue, blood pressure irregularities, heart arrhythmia, cold hands and feet, chest pain, exertional malaise, etc. Polysymptomatic, right?  

Post traumatic stress disorder (PTSD) is a very serious illness. "PTSD is a potential risk factor of FMS and vice versa." Is this to say that FM is a risk factor for PTSD? I am sorry, I do not make this connection. Am I alone in my thinking?


Unknown said...

When you don't really have a clue waste money? It is interesting that the rhuematologist treating me for fibromyalgia is a researcher that does clinical studies on meds such as Lyrica. I am grateful that he does not treat me as having conditions such PTSD or other emotional problems. He does see frustration which is expected.

RevNana said...

Well said, Celeste!

I have lived almost 18 years with a diagnosis of fibromyalgia and I have been through the years when many medical folks did not recognize the existence of FM, when many who were forced to recognize its reality decided that it had to be either psychosomatic or some form of mental illness and on and on. I have been so very fortunate in my doctors for the most part. Initially, my doctor recognized it before I had a major flare-up and was ready to move into formal diagnosis when that happened -- and she was Chief of Staff at the oldest most prestigious hospital in a city with 3!

When I was forced into early retirement and moved to another geographical area -- one which prides itself on its medical community! -- I was passed from one doctor to another, each one refusing to take on a chronic pain condition! -- until I found my current doctor who told me that while he knew very little about FM, he was willing to learn. It has been a good relationship for the most part.

After all of those years of the put-downs and denials of the reality of our condition, after NIH established diagnostic criteria, why do we still have to put up with this kind of nonsense? And because it is in a peer-review journal and the "researchers" have degrees after their names, some people will believe that it is valid! These folks have damaged people who already live with more stress than we need.

Sorry for the rant -- I guess it made me as angry as it seems to have made you!

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