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Post-traumatic Stress Disorder And Fibromyalgia

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Guest allanopie

Post-Traumatic Stress Disorder and Fibromyalgia

In this study, researchers assessed the tenderness, sensitivity to pain, and distribution of fibromyalgia syndrome (FS)-related symptoms (such as pain sensitivity, sleep disturbances, headaches, etc.) in 29 post-traumatic stress disorder (PTSD) patients as compared to a control group of 37 healthy subjects. The goal was to determine the prevalence of FS in patients with PTSD, and to compare the differences between PTSD patients with and without FS.

Predictably, the PTSD patients reported higher levels of tenderness, a lower quality of life, and a higher rate of physical impairment. PTSD subjects also reported a significantly higher percentage of FS-related symptoms than their matched controls.

The researchers found that 20% of the PTSD subjects met the diagnostic criteria for FS. Patients with both conditions did not differ from those with only PTSD in terms of the core PTSD symptoms (i.e. intrusion and avoidance), but patients with both conditions had significantly higher scores on the SCL-90R. Those areas with particularly high scores were paranoia, phobia, anxiety, and depression.

The authors explore the relationship between the two conditions:

“The prevalence of 20% fibromyalgia syndrome found here is far greater than in the general population (2%)…The finding that there is a correlation between pain and PTSD is in accordance with earlier studies. Kuch et al. found that, among 60 patients treated for fibromyalgia syndrome in a pain clinic, the prevalence of phobias and PTSD were 3.2 times more common in victims of minor road vehicle accidents than in subjects with non-vehicular-related onset of pain…The present study indicates that fibromyalgia syndrome has a substantial overlap with PTSD, which supports the psychological background of the disorder.”

“The results of our study raise the question of whether fibromyalgia syndrome is, in fact, a stress-related disease. Goldenberg states that fibromyalgia syndrome is not a psychiatric disease, however, he emphasizes the relationship to psychological stress.”

Amir M, Kaplan Z, Neumann L, Sharabani R, Shani N, and Buskila D. Posttraumatic stress disorder, tenderness, and fibromyalgia. Journal of Psychosomatic Research 1997;42(6):607-613.

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Posttraumatic Stress, Fibromyalgia Linked


07-12-2004 Chronic Pain Condition Seen in Half of Veterans With PTSD

By Salynn Boyles

WebMD Medical News

Reviewed By Brunilda Nazario, MD

The mysterious chronic pain condition fibromyalgia is widely thought of as a woman's disease, but new research suggests it is also common among men with posttraumatic stress disorder.

In a study of male Israeli war veterans, half of the men with combat-related PTSD also had the tenderness and pain characteristic of fibromyalgia. The findings were reported today in Berlin at a European rheumatology meeting.

There is a growing body of research linking posttraumatic stress and chronic pain, but the Israeli investigation is the first to limit its study population to males.

"A consistent relationship has been seen between PTSD and chronic pain conditions like fibromyalgia," says psychologist John D. Otis, PhD, who is also studying the link in veterans. "The fact that the pain is often independent of the traumatic event leads us to believe that there is something else going on."

Pain and Trauma

While the cause of fibromyalgia remains unknown, the condition often occurs following physical trauma -- such as an illness or injury -- which may act as a trigger. In 1990, the American College of Rheumatology developed a standardized diagnostic evaluation for fibromyalgia, which includes a history of widespread pain for a minimum of three months and pressure-associated pain at 11 of 18 specific sites on the body.

The ACR standards were used in the Israeli study to evaluate 55 war veterans with severe PTSD, along with 20 veterans with major depression and 49 veterans with neither condition.

About half -- 49% -- of the PTSD patients met the criteria for fibromyalgia, but only 5% of the patients with major depression did. None of the men who had neither condition had fibromyalgia.

In his presentation to the European League Against Rheumatism, lead investigator Howard Amital, MD, notes the fibromyalgia-PTSD link was much stronger than that for PTSD and major depression, despite the fact that the severity of the two psychiatric conditions was similar.

"Psychiatric illness is (not) necessarily correlated with fibromyalgia, but PTSD certainly is," he notes. "The symptoms may overlap, but the degree and the intensity of these disorders are so closely related that it cannot be just a coincidence."

Integrating Treatment

Peter Roy-Byrne, MD, who is chief of psychiatry at Seattle's Harborview Medical Center, has also studied the association between posttraumatic stress and chronic pain and fatigue. He tells WebMD that patients with fibromyalgia should be evaluated for PTSD, and PTSD patients should be evaluated for the chronic pain condition. Roy-Byrne is also professor and vice chairman of the department of psychiatry at the University of Washington School of Medicine.

"Even though the pharmacological treatment of these conditions may be similar, the behavioral and cognitive approaches to treatment may differ in patients with both," he says.

Otis says his own VA experience also suggests a very high incidence of unexplained chronic pain among veterans with PTSD. He is evaluating the effectiveness of cognitive behavioral therapy for the treatment of patients with both conditions.

"Our thinking is that that we will do a better job of treating both conditions using an integrated, behavioral approach," he says.

SOURCES: Annual European Congress of the European League Against Rheumatism, Berlin, June 9-12, 2004. Howard Amital, MD, Hadassah-Hebrew University School of Medicine, Jerusalem. Peter P. Roy-Byrne, MD, professor and vice chairman, department of psychiatry and behavioral sciences, University of Washington School of Medicine; chief of psychiatry, Harborview Medical Center, Seattle. John D. Otis, PhD, director of psychology pain management, VA Boston Healthcare System.

Article source: WebMD.

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Abstract: Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies



Ann N Y Acad Sci. 2004 Dec;1032:141-53.

Boscarino JA.

Division of Health and Science Policy, Room 552, The New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029-5293. jboscarino@nyam.org.

Research indicates that exposure to traumatic stressors and psychological trauma is widespread. The association of such exposures with posttraumatic stress disorder (PTSD) and other mental health conditions is well known. However, epidemiologic research increasingly suggests that exposure to these events is related to increased health care utilization, adverse health outcomes, the onset of specific diseases, and premature death.

To date, studies have linked traumatic stress exposures and PTSD to such conditions as cardiovascular disease, diabetes, gastrointestinal disease, fibromyalgia, chronic fatigue syndrome, musculoskeletal disorders, and other diseases. Evidence linking cardiovascular disease and exposure to psychological trauma is particularly strong and has been found consistently across different populations and stressor events.

In addition, clinical studies have suggested the biological pathways through which stressor-induced diseases may be pathologically expressed. In particular, recent studies have implicated the hypothalamic-pituitary-adrenal (HPA) and the sympathetic-adrenal-medullary (SAM) stress axes as key in this pathogenic process, although genetic and behavioral/psychological risk factors cannot be ruled out. Recent findings, indicating that victims of PTSD have higher circulating T-cell lymphocytes and lower cortisol levels, are intriguing and suggest that chronic sufferers of PTSD may be at risk for autoimmune diseases.

To test this hypothesis, we assessed the association between chronic PTSD in a national sample of 2,490 Vietnam veterans and the prevalence of common autoimmune diseases, including rheumatoid arthritis, psoriasis, insulin-dependent diabetes, and thyroid disease. Our analyses suggest that chronic PTSD, particularly comorbid PTSD or complex PTSD, is associated with all of these conditions.

In addition, veterans with comorbid PTSD were more likely to have clinically higher T-cell counts, hyperreactive immune responses on standardized delayed cutaneous hypersensitivity tests, clinically higher immunogolobulin-M levels, and clinically lower dehydroepiandrosterone levels. The latter clinical evidence confirms the presence of biological markers consistent with a broad range of inflammatory disorders, including both cardiovascular and autoimmune diseases.

PMID: 15677401 [PubMed - in process]

*Posttraumatic Stress Disorder and Physical Illness: Results from Clinical and Epidemiologic Studies

Joseph A. Boscarino, PhD, MPH http://mailer.fsu.edu/~cfigley/vets/ANYAS%...04_ver%2010.pdf

Edited by Wings
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