The Body Bears the Burden by Scaer Robert;

Author:Scaer, Robert; [Robert Scaer]
Language: eng
Format: epub
ISBN: 9781136175770
Publisher: Taylor and Francis

Fibromyalgia/Chronic Fatigue Syndrome

Another common chronic pain syndrome that may have its roots in trauma physiology is fibromyalgia. First described by Gowers in 1904,45 it has been exhaustively investigated in numerous, generally flawed studies. It has remained as controversial as one might expect of a syndrome with remarkably uniform and reproducible symptoms, but with few if any objective physical or laboratory findings. Clinical criteria for the diagnosis are generally based on consistency of symptoms and the presence of at least seven “tender points” in specific areas over the surface of the body. Typical symptoms include multiple regional or diffuse sites of soft tissue pain, poor and nonrestorative sleep, chronic fatigue, stiffness, headaches, irritable bowel syndrome, anxiety, cognitive dysfunction, and variable neurological symptoms, especially numbness and paresthesias. These symptoms typically are aggravated by stress, weather changes, and physical activity.

Chronic fatigue syndrome (CFS) is another syndrome closely linked to fibromyalgia, with similar symptoms except for the absence of soft tissue pain. In addition to many other similar symptoms, fibromyalgia and CFS share similar sleep disturbances. The electroencephalography (EEG) pattern during sleep in fibromyalgia and CFS is characterized by abnormal presence of alpha (7.5 to 11 Hz) wave activity seen during deeper non-REM cycles of sleep. This EEG pattern is consistent with a recurrent nonphysiological arousal disturbance, and coincides with the repeated nocturnal awakening characteristic of fibromyalgia and CFS. Interestingly, this unusual EEG pattern is also typical of the arousal disturbance seen in myofascial pain, PTSD, ambient nocturnal noise, and painful joint disease in rheumatoid arthritis.46

The clinical syndromes of fibromyalgia and CFS have remarkable similarities to those symptoms affecting whiplash victims with delayed recovery, and the later symptom complex of chronic PTSD (see Chapter 3). I have followed several whiplash patients who over several years have eventually progressed from regional myofascial pain to clinically consistent criteria-specific generalized fibromyalgia. All members of this group of patients had experienced childhood trauma except for one rape victim. Posttraumatic fibromyalgia has been reported in numerous studies, and generally follows soft tissue injuries. One study of 176 cases of posttraumatic fibromyalgia documented that 60.7 percent occurred after MVAs, 12.5 percent after work-related injuries, 7.1 percent after surgery, 5.4 percent after sports-related injury, and 14.3 percent after miscellaneous traumatic events.47 The majority of these events represent substantial trauma in the face of helplessness.

Neuroendocrine changes in fibromyalgia also suggest a traumatic link. Studies of the HPA axis in fibromyalgia and CFS show remarkably similar aberrations to those seen in late PTSD. These changes include low basal twenty-four-hour urine cortisol excretion, blunted cortisol circadian rhythms, exaggerated ACTH response to CRH, and a blunted cortisol response to increased ACTH.48 The HPA axis in CFS also reveals lowered basal cortisol levels, and an attenuated ACTH response to CRH, as seen in late PTSD.46 Depressed pituitary insulin-like growth factor (IGF-I) has been documented in those patients with fibromyalgia, and gives further evidence for HPA dysfunction.49,50 Finally, hypervigilance to a variety of external and internal noxious sensations, including pain, has been documented in fibromyalgia.51,52 Hypervigilance and nonspecific stimulus sensitivity, of course, are intrinsic to the diagnosis of PTSD.

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