Trouble Thinking

March 21, 2012

Fibromyalgia and PTSD

Filed under: Uncategorized — Tags: , , , , — Durandal @ 10:41 pm

So this is a question I got recently, and tried to find an answer to as best as I could:

Is there a connection between PTSD and the development of Fibromyalgia?

PTSD is a disorder characterized by intense anxiety and maladaptive anxious reactions to otherwise normal stimuli brought on by some instigating traumatic event, such as military combat. It also must involve some aspect of functioning loss tied directly to an inability to “process” the event that occurred, such as recurring dreams about the event or recurring flashbacks to the event. The prevalence of PTSD appears to be around 3.5% currently, and about 6.5% people are expected to experience it in their lifetime.

Fibromyalgia is characterized by intense pain sensations from otherwise innocuous stimuli, both widespread and in particular at about 11-18 “Tender Points” that are located near joints and along the back. Fibromyalgia appears to affect around 2.0% of the population in the US. Less emphasized, but consistently reported, are complaints of sleep disturbances, fatigue, and stress. Tender points seem to be linearly related to the intensity of these other disturbances, even in sub-clinical populations (those with fewer than 11 tender points).

So why would these two seemingly disparate disorders be related at all?

Although Fibromyalgia is a disorder causing physical pain, there’s not yet any evidence linking it to a distinct physical root cause. There’s no evidence of nerves being damaged, and no gross physical malformity at the tender points. Some studies have determined that it’s possible Fibromyalgia may be caused by stress reactions similar to those found in PTSD. Fibromyalgia co-occurs frequently with disorders across the stress spectrum, but most often with PTSD. Several studies have shown that persons experiencing PTSD have a significantly increased rate of Fibromyalgia, and that it seems to coincide with a more intense experience of PTSD. Both PTSD and Fibromyalgia sufferers frequently show evidence of hypocorticism, or lowered levels of the stress hormone Cortisol.

Many Fibromyalgia symptoms are also extremely similar to those reported by patients with Chronic Fatigue Syndrome and Multiple Chemical Sensitivities, including the painful tenderness. One study even suggested that classifying these disorders as separate was no longer tenable, as 70% of Fibromyalgia sufferers could be classed as CFS or MCS sufferers. Both of these disorders are also strongly linked to other stress disorders.

So why would this be the case? It seems as though there’s a very sharply defined connection between purely mental disorders and a purely physical disorder.

The answer is that there isn’t any such thing as a purely mental disorder, there are only physical disorders.

There are some highly stupid studies using fMRI to try to “prove” pain by showing some area of the brain receiving an increase in bloodflow several seconds after the pain is reported, but those are incredibly foolish. These studies serve to reveal the startling fact that when someone says they are in pain, a part of their body behaves differently. Super great if you want to check whether someone you know is a robot designed to deceive you, but not actually a very useful metric. It’s an elaborate way to check if someone flinches when you poke them.

The reason we do this sort of ridiculous study, though, is to reassure sufferers (or perhaps the doctors) that their problem is definitively and only physical by finding some aspect of the physical body that responds to their pain without requiring them to report it. The undercurrent to these fMRI studies is that we must test, because simply taking people at their word that they are in pain might mix in some mental patients with the “real” sick. Because the mental is inherently embarrassing and vulnerable and to a large extent considered your own damn fault. Persons with mental disorders are either dangerous or pitiable or contemptible. Persons with physical disorders are sympathetic and treatable. This is not just wrongheaded and insulting, it’s useless.

The reason Fibromyalgia co-occurs with stress-related disorders is because Fibromyalgia is a stress-related disorder. The reason it co-occurs with Multiple Chemical Sensitivities and Chronic Fatigue is because those too are stress-related disorders.

But then, so is lower back pain.

I get intense lower back pain with reasonable regularity. But I get it most often and most severely when I am intensely stressed. Is this considered a physical symptom or a mental one? Is it physical because tensing of my muscles causes the pain? My nervousness causes that tensing which causes the pain, so if we’re looking at root causes it’s sure as hell not my actual back. I can do physical exercises and take drugs which reduce inflammation to both relieve the current pain and lessen future pain, but neither of these actions “prove” it’s a purely physical condition any more than dressing the wounds of someone who cuts themselves proves it has nothing to do with their mental state. People experience this brain-body interaction almost identically when suffering from Irritable Bowel Syndrome or tension headaches or dozens of other disorders that because they are easily treated using physical methods are considered not just primarily but only traditionally “physical” rather than “mental”. There is no such separation.

Your brain is a part of your body. It is not separate in any manner whatsoever, whether regarded as a physical object or as a philosophical one. The difference between disordered functioning of your peripheral nerves and disordered functioning of your central nerves is exactly zilch. We don’t feel that, though. We feel like a whole being inside of a physical shell. I mean to use an offensively dumb analogy, all those body-switching family comedies exist because we believe on an intuitive level that “we” can be put into any physical form and still be entirely ourselves. So when we feel pain, we look for a cause that is intrinsically “physical”, which makes sense if you believe that your nervous system is separated between “you” (The central nervous system) and “your body” (the peripheral nervous system). But the only real separation is one we developed to conveniently subdivide areas of interest. Pain in the periphery could indicate something about the center, because they aren’t actually different systems, they’re a single integrated part.

We look to the physical first and foremost because it’s less disturbing to our sense of self, less embarrassing to discuss socially, and more likely to be solvable without changing who we are. Fibromyalgia is a disorder that causes intense physical pain, which understandably is the primary focus due to the intensity of the sensation. And if we can find ways of reducing the pain experienced then by all means we should be as soon as fucking possible. But several studies have pointed to the fact that tender points seem to be most useful as indicators of other underlying effects rather than as treatable objects. The connection between PTSD and Fibromyalgia suggests that it’s entirely possible that as salient as the pain is, it’s only a small part of a more complex disorder.

1 Comment »

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    Comment by dayawane.ihep.ac.cn — August 4, 2013 @ 8:38 am


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