1
|
Pinto AM, Luís M, Geenen R, Palavra F, Lumley MA, Ablin JN, Amris K, Branco J, Buskila D, Castelhano J, Castelo-Branco M, Crofford LJ, Fitzcharles MA, Häuser W, Kosek E, López-Solà M, Mease P, Marques TR, Jacobs JWG, Castilho P, da Silva JAP. Neurophysiological and Psychosocial Mechanisms of Fibromyalgia: A Comprehensive Review and Call for An Integrative Model. Neurosci Biobehav Rev 2023:105235. [PMID: 37207842 DOI: 10.1016/j.neubiorev.2023.105235] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 05/21/2023]
Abstract
Research into the neurobiological and psychosocial mechanisms involved in fibromyalgia has progressed remarkably in recent years. Despite this, current accounts of fibromyalgia fail to capture the complex, dynamic, and mutual crosstalk between neurophysiological and psychosocial domains. We conducted a comprehensive review of the existing literature in order to: a) synthesize current knowledge on fibromyalgia; b) explore and highlight multi-level links and pathways between different systems; and c) build bridges connecting disparate perspectives. An extensive panel of international experts in neurophysiological and psychosocial aspects of fibromyalgia discussed the collected evidence and progressively refined and conceptualized its interpretation. This work constitutes an essential step towards the development of a model capable of integrating the main factors implicated in fibromyalgia into a single, unified construct which appears indispensable to foster the understanding, assessment, and intervention for fibromyalgia.
Collapse
Affiliation(s)
- Ana Margarida Pinto
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal; University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; University of Coimbra, Psychological Medicine Institute, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal.
| | - Mariana Luís
- Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal.
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Martinus J. Langeveldgebouw, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, the Netherlands.
| | - Filipe Palavra
- Centre for Child Development, Neuropediatric Unit. Pediatric Hospital, Coimbra Hospital and University Centre, Avenida Afonso Romão, 3000-602 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Suite 7908, Detroit, MI 48202, USA.
| | - Jacob N Ablin
- Internal Medicine H, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel.
| | - Kirstine Amris
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Jaime Branco
- Rheumatology Department, Egas Moniz Hospital - Lisboa Ocidental Hospital Centre (CHLO-EPE), R. da Junqueira 126, 1349-019 Lisbon, Portugal; Comprehensive Health Research Center (CHRC), Chronic Diseases Research Centre (CEDOC), NOVA Medical School, NOVA University Lisbon (NMS/UNL), Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal.
| | - Dan Buskila
- Ben Gurion University of the Negev Beer-Sheba, Israel.
| | - João Castelhano
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Miguel Castelo-Branco
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Mary-Ann Fitzcharles
- Division of Rheumatology, Department of Medicine, McGill University, 1650 Cedar Ave, Montreal, Quebec, Canada, H3G 1A4.
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm 171 77, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Marina López-Solà
- Serra Hunter Programme, Department of Medicine and Health Sciences, University of Barcelona.
| | - Philip Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA.
| | - Tiago Reis Marques
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences (LMS), Hammersmith Hospital, Imperial College London, South Kensington, London SW7 2BU, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Strand, London WC2R 2LS, UK.
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
| | - Paula Castilho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal.
| | - José A P da Silva
- University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal
| |
Collapse
|
2
|
Gardoki-Souto I, Redolar-Ripoll D, Fontana M, Hogg B, Castro MJ, Blanch JM, Ojeda F, Solanes A, Radua J, Valiente-Gómez A, Cirici R, Pérez V, Amann BL, Moreno-Alcázar A. Prevalence and Characterization of Psychological Trauma in Patients with Fibromyalgia: A Cross-Sectional Study. Pain Res Manag 2022; 2022:2114451. [PMID: 36504759 PMCID: PMC9729049 DOI: 10.1155/2022/2114451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/22/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022]
Abstract
Background Preliminary evidence suggests that psychological trauma, especially childhood trauma, is a risk factor for the onset of fibromyalgia (FM). Objective The main objective of this study consisted of evaluating the prevalence and detailed characteristics of psychological trauma in a sample of patients with FM, the chronology of trauma across the lifespan, and its clinical symptoms. We also calculated whether childhood trauma could predict the relationship with different clinical variables. Method Eighty-eight females underwent an interview to assess sociodemographic data, psychiatric comorbidities, level of pain, FM impact, clinical symptoms of anxiety, depression, insomnia, quality of life, and psychological trauma. Results The majority of participants (71.5%) met the diagnostic criteria for current post-traumatic stress disorder (PTSD). Participants reported having suffered traumatic events throughout their lifespan, especially in childhood and early adolescence, in the form of emotional abuse, emotional neglect, sexual abuse, and physical abuse. Traumatic events predict both poor quality of life and a level of pain in adulthood. All patients showed clinically relevant levels of anxiety, depression, insomnia, suicidal thoughts, and pain, as well as somatic comorbidities and poor quality of life. Pain levels predicted anxiety, depression, dissociation, and insomnia symptoms. 84% of the sample suffered one or more traumatic events prior to the onset of pain. Conclusions Our data highlight the clinical complexity of patients with FM and the role of childhood trauma in the onset and maintenance of FM, as well as the high comorbidity between anxiety, depression, somatic symptoms, and FM. Our data also supports FM patients experiencing further retraumatization as they age, with an extremely high prevalence of current PTSD in our sample. These findings underscore the need for multidisciplinary programs for FM patients to address their physical pain and their psychiatric and somatic conditions, pay special attention to the assessment of psychological trauma, and provide trauma-focused interventions. Trial registration: ClinicalTrials.gov NCT04476316. Registered on July 20th, 2020.
Collapse
Affiliation(s)
- Itxaso Gardoki-Souto
- Forum Center Research Unit, Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar (PSMAR), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous Universtiy of Barcelona (UAB), Barcelona, Spain
| | - Diego Redolar-Ripoll
- Cognitive NeuroLab, Open University of Catalonia (UOC), Barcelona, Spain
- Neuromodulation Unit, Brain 360 Institute, Barcelona, Spain
| | - Marta Fontana
- Forum Center Research Unit, Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar (PSMAR), Barcelona, Spain
| | - Bridget Hogg
- Forum Center Research Unit, Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar (PSMAR), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous Universtiy of Barcelona (UAB), Barcelona, Spain
- Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Mental Health Networking Biomedical Research Centre (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
| | | | - Josep M. Blanch
- Rheumatology Service, Parc de Salut Mar (PSMAR), Barcelona, Spain
| | - Fabiola Ojeda
- Rheumatology Service, Parc de Salut Mar (PSMAR), Barcelona, Spain
| | - Aleix Solanes
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Joaquim Radua
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Karolinska Institute (KI), Stockholm, Sweden
- King's College London, London, UK
| | - Alicia Valiente-Gómez
- Forum Center Research Unit, Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar (PSMAR), Barcelona, Spain
- Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Mental Health Networking Biomedical Research Centre (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Roser Cirici
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Víctor Pérez
- Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Mental Health Networking Biomedical Research Centre (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Benedikt L. Amann
- Forum Center Research Unit, Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar (PSMAR), Barcelona, Spain
- Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Mental Health Networking Biomedical Research Centre (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Hospital, Munich, Germany
| | - Ana Moreno-Alcázar
- Forum Center Research Unit, Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar (PSMAR), Barcelona, Spain
- Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Mental Health Networking Biomedical Research Centre (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
- ISOMAE Institute of Neurosciences and Psychosomatic Psychology, Sant Cugat Del Vallés, Barcelona, Spain
| |
Collapse
|
3
|
Westmore MR, Chakraborty P, Thomas LA, Jenkins L, Ohri F, Baiden P. BMI moderates the association between adverse childhood experiences and COPD. J Psychosom Res 2022; 160:110990. [PMID: 35878540 PMCID: PMC9531576 DOI: 10.1016/j.jpsychores.2022.110990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Cigarette smoking and obesity are leading risk factors for chronic obstructive pulmonary disease (COPD). Although studies have established an association between adverse childhood experiences (ACEs) and COPD, few studies have examined whether this association is moderated by cigarette smoking or body mass index (BMI). This cross-sectional study examined the association between ACEs and COPD, and whether cigarette smoking or BMI moderates this association. METHODS Data for this study came from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 75,700 adults aged 18-79 years (50.7% female) were analyzed using binary logistic regression. The outcome variable investigated was self-reported physician-diagnosed COPD, and the main explanatory variable was ACEs. RESULTS Of the 75,700 respondents examined, 8.1% had COPD. About one in three (33.6%) respondents had no ACEs, 23.1% had one ACE, and about one in five (20.2%) had four or more ACEs. In the multivariable binary logistic regression, we found that the association between ACEs and COPD differs by BMI status. Controlling for the effects of other factors, the association between ACEs and COPD is strongest for respondents who are obese (AOR = 1.41, 95% CI = 1.04-1.91). CONCLUSIONS The findings of this study demonstrate that ACEs are associated with COPD later in adulthood, and BMI moderated this association. The findings of this study add to the number of studies demonstrating the adverse impact of ACEs on chronic health outcomes among adults.
Collapse
Affiliation(s)
- Megan R Westmore
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX 76019, United States
| | - Priyanjali Chakraborty
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX 76019, United States
| | - LaTisha A Thomas
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX 76019, United States
| | - Lacey Jenkins
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX 76019, United States
| | - Faheem Ohri
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX 76019, United States
| | - Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX 76019, United States.
| |
Collapse
|
4
|
Löwe B, Andresen V, Van den Bergh O, Huber TB, von dem Knesebeck O, Lohse AW, Nestoriuc Y, Schneider G, Schneider SW, Schramm C, Ständer S, Vettorazzi E, Zapf A, Shedden-Mora M, Toussaint A. Persistent SOMAtic symptoms ACROSS diseases - from risk factors to modification: scientific framework and overarching protocol of the interdisciplinary SOMACROSS research unit (RU 5211). BMJ Open 2022; 12:e057596. [PMID: 35063961 PMCID: PMC8785206 DOI: 10.1136/bmjopen-2021-057596] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Persistent somatic symptoms (PSS) are highly prevalent in all areas of medicine; they are disabling for patients and costly for society. The subjective symptom burden often correlates poorly with the underlying disease severity, and patients' needs for effective treatment are far from being met. Initial evidence indicates that, in addition to disease-specific pathophysiological processes, psychological factors such as expectations, somatosensory amplification and prior illness experiences contribute to symptom persistence in functional as well as in somatic diseases. However, prospective studies investigating the transition from acute to chronic somatic symptoms, integrating pathophysiological, psychological and social factors, are scarce. A better understanding of the multifactorial mechanisms of symptom persistence is crucial for developing targeted mechanism-based interventions for effective prevention and treatment of PSS. Thus, the overall aim of the interdisciplinary SOMACROSS research unit is to identify generic and disease-specific risk factors and aetiological mechanisms of symptom persistence across a range of diseases. METHODS AND ANALYSIS Seven projects will investigate risk factors and mechanisms of symptom persistence in a total of 3916 patients across 10 medical conditions. All study designs are prospective and share common assessment points, core instruments and outcome variables to allow comparison and validation of results across projects and conditions. Research will focus on the identification of generic and disease-specific mechanisms associated with unfavourable symptom course. The development of a multivariate prediction model will facilitate the understanding of the course of PSS across diseases. ETHICS AND DISSEMINATION All individual SOMACROSS studies were approved by the ethics committees of the Medical Chambers Hamburg and Münster, Germany. Findings will be disseminated through peer-reviewed publications, scientific conferences and the involvement of relevant stakeholders, patients and the lay public. This interdisciplinary research unit will fundamentally contribute to earlier recognition of patients at risk, and to the development of prevention and tailored treatment concepts for PSS.
Collapse
Affiliation(s)
- Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Viola Andresen
- Department of Gastroenterology, Israelitic Hospital, Hamburg, Germany
| | - Omer Van den Bergh
- Research Group on Health Psychology, University of Leuven, Leuven, Belgium
| | - Tobias B Huber
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yvonne Nestoriuc
- Department of Psychology, Helmut-Schmidt-University/University of the Armed Forces Hamburg, Hamburg, Germany
- Institute of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gudrun Schneider
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Münster, Münster, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venerology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sonja Ständer
- Department of Dermatology, Medical University Center Münster, Münster, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Meike Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
5
|
Byrne EA. Understanding Long Covid: Nosology, social attitudes and stigma. Brain Behav Immun 2022; 99:17-24. [PMID: 34563621 DOI: 10.1016/j.bbi.2021.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 12/13/2022] Open
Abstract
The debate around Long Covid has so far shown resistance to accept parallels between Long Covid and a set of existing conditions which have historically been subject to stigma. This resistance risks endorsing the stigma associated with such existing conditions, and as such, these dynamics of stigma ought to be dismantled in order to facilitate the development of effective clinical resources for all such implicated conditions. As well as affecting proceedings at the structural level, I discuss how the aforementioned problems also risk affecting patients at the personal level by motivating the reconfiguration and restriction of patient illness narratives. The problems I identify therefore risk affecting both collective and individual understanding of Long Covid.
Collapse
Affiliation(s)
- Eleanor Alexandra Byrne
- University of York, Sally Baldwin Buildings Block A, Wentworth Way, Heslington, York YO10 5DD, United Kingdom.
| |
Collapse
|
6
|
Chandan JS, Thomas T, Raza K, Bradbury-Jones C, Taylor J, Bandyopadhyay S, Nirantharakumar K. Intimate Partner Violence and the Risk of Developing Fibromyalgia and Chronic Fatigue Syndrome. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP12279-NP12298. [PMID: 31805821 DOI: 10.1177/0886260519888515] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Intimate partner violence (IPV) is a global public health issue with a variety of ill health consequences associated with exposure. Due to the stimulation of chronic stress and inflammatory pathways, childhood abuse has been associated with the subsequent development of functional syndromes such as fibromyalgia and chronic fatigue syndrome (CFS). Although IPV in women appears to elicit similar biochemical responses, this association has not been tested thoroughly in IPV survivors. These functional syndromes are complex in etiology and any indication of their risk factors would benefit health care professionals managing this population. Therefore, we aimed to investigate the association between exposure to IPV with functional syndromes: fibromyalgia and CFS. We conducted a retrospective open cohort study using "The Heath Improvement Network" database between January 1, 1995 and December 1, 2017. A total of 18,547 women who were exposed to IPV were each matched by age to four controls who were not exposed (n = 74,188). The main outcome measures were the risk of developing fibromyalgia and CFS. These were presented as adjusted incidence rate ratios (aIRR) with 95% confidence intervals (CIs). We found that 97 women in the exposed group developed fibromyalgia (incidence rate [IR] = 1.63 per 1,000 person-years) compared to 239 women in the unexposed group (IR = 0.83 per 1,000 person-years). Following adjustment, this translated to an IRR of 1.73 (95% CI = [1.36, 2.22]). Similarly, 19 women developed CFS in the exposed group (IR = 0.32 per 1,000 person-years), compared to 53 in the unexposed group (0.18 per 1,000 person-years), which translates to an aIRR of 1.92 (95% CI = [1.11, 3.33]). Therefore, we have identified an association between a history of IPV in women and the development of these functional syndromes, which may provide more information to inform the biopsychosocial pathway precipitating the development of fibromyalgia and CFS.
Collapse
Affiliation(s)
| | | | - Karim Raza
- University of Birmingham, UK
- Sandwell and West Birmingham Hospitals NHS Trust, UK
| | | | - Julie Taylor
- University of Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, UK
| | | | | |
Collapse
|
7
|
Baiden P, Panisch LS, Onyeaka HK, LaBrenz CA, Kim Y. Association of childhood physical and sexual abuse with arthritis in adulthood: Findings from a population-based study. Prev Med Rep 2021; 23:101463. [PMID: 34258175 PMCID: PMC8259400 DOI: 10.1016/j.pmedr.2021.101463] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/26/2021] [Accepted: 06/17/2021] [Indexed: 12/19/2022] Open
Abstract
The objective of this cross-sectional study was to investigate childhood physical and sexual abuse as factors associated with arthritis among adults from selected states in the United States. Data for this study came from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 75,717 adults 18-75 years old (49.7% female) was analyzed using log-binomial regression. The outcome variable investigated in this study was arthritis, and the main explanatory variables were childhood physical and sexual abuse. Of the 75,717 respondents examined, 20,938 (representing 27.6%) had arthritis. A little over one in four respondents (25.5%) experienced childhood physical abuse and 5.6% experienced childhood sexual abuse by age 18. In the multivariable regression, respondents who experienced childhood physical abuse had 1.36 times the risk of having arthritis when compared to respondents who did not experience childhood physical abuse (ARR = 1.36, p < .001, 95% CI = 1.28-1.46). Respondents who experienced childhood sexual abuse had 1.60 times the risk of having arthritis when compared to respondents who did not experience childhood sexual abuse (ARR = 1.74, p < .001, 95% CI = 1.54-1.97). The findings of this study demonstrate that childhood physical and sexual abuse are associated with arthritis later in adulthood. The associations persisted even after adjusting for demographic, socioeconomic status, body mass index (BMI), current smoking status, and self-perceived physical health. The findings of this study add to the burgeoning number of studies demonstrating the adverse impact of childhood physical and sexual abuse on chronic health outcomes among adults.
Collapse
Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX 76019, United States
| | - Lisa S. Panisch
- University of Rochester Medical Center, Department of Psychiatry, Center for the Study and Prevention of Suicide, 300 Crittenden Blvd., Rochester, NY 14642, United States
| | - Henry K. Onyeaka
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital/McLean Hospital, Boston, MA 02115, United States
| | - Catherine A. LaBrenz
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX 76019, United States
| | - Yeonwoo Kim
- The University of Texas at Arlington, College of Nursing and Health Innovation, Department of Kinesiology, 500 W. Nedderman Dr., Arlington, TX 76019, United States
| |
Collapse
|
8
|
Pierce J, Hassett AL, Brummett CM, McAfee J, Sieberg C, Schrepf A, Harte SE. Characterizing Pain and Generalized Sensory Sensitivity According to Trauma History Among Patients With Knee Osteoarthritis. Ann Behav Med 2021; 55:853-869. [PMID: 33377478 PMCID: PMC8382144 DOI: 10.1093/abm/kaaa105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood trauma and adversity have been linked to chronic pain and pain sensitivity, particularly centralized pain. Yet, there remain numerous gaps in our understanding of this link. PURPOSE We explored the association between nonviolent and violent childhood trauma and a component of centralized pain (i.e., generalized sensory sensitivity) and pain sensitivity using self-report measures of centralized pain and quantitative sensory testing (QST). METHODS Patients scheduled for a total knee arthroplasty (n = 129) completed questionnaires and QST prior to surgery. RESULTS We found that self-report measures of centralized pain (i.e., widespread pain, somatic awareness, and sensory sensitivity) displayed a graded relationship across trauma groups, with patients with a history of violent trauma reporting the highest scores. Univariable multinomial logistic regression analyses showed that higher sensory sensitivity was associated with increased risk of being in the nonviolent trauma group compared to the no trauma group. Furthermore, higher widespread pain, higher somatic awareness, and higher sensory sensitivity distinguished the violent trauma group from the no trauma group. In multivariable analyses, sensory sensitivity is uniquely distinguished between the violent trauma group and the no trauma group. QST did not distinguish between groups. CONCLUSIONS The findings highlight the need for future research and interventions that reduce sensory sensitivity for chronic pain patients with a history of violent childhood trauma.
Collapse
Affiliation(s)
- Jennifer Pierce
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Christine Sieberg
- Center for Pain and the Brain, Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| |
Collapse
|
9
|
Kaleycheva N, Cullen AE, Evans R, Harris T, Nicholson T, Chalder T. The role of lifetime stressors in adult fibromyalgia: systematic review and meta-analysis of case-control studies. Psychol Med 2021; 51:177-193. [PMID: 33602373 DOI: 10.1017/s0033291720004547] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain. Although accumulating evidence suggests that exposure to stressful events increases the risk for this complex disorder, this is the first meta-analysis to compare the impact of a full range of lifetime stressors (e.g. physical trauma through to emotional neglect) on adult fibromyalgia. METHODS This review was performed in accordance with PRISMA guidelines. Random-effects models examined associations between different stressor exposures and fibromyalgia status with meta-regression investigating the effects of publication year and study quality on effect sizes. RESULTS Nineteen studies were included in the meta-analysis. Significant associations with fibromyalgia status were observed for all six exposure types examined: odds ratios (OR) were highest for physical abuse (OR 3.23, 95% confidence interval 1.99-5.23) and total abuse (3.06, 1.71-5.46); intermediate for sexual abuse (2.65, 1.85-3.79) and smaller for medical trauma (1.80, 1.19-2.71), other lifetime stressors (1.70, 1.31-2.20), and emotional abuse (1.52, 1.27-1.81). Results were not significantly changed when childhood, as opposed to adult, exposures were used in studies that reported both. Meta-regression analyses demonstrated no effect of publication year or study quality on effect sizes. CONCLUSIONS This study confirmed a significant association between stressor exposure and adult fibromyalgia with the strongest associations observed for physical abuse. Limitations related to current available literature were identified; we provide several suggestions for how these can be addressed in future studies. Stressors are likely to be one of many risk factors for fibromyalgia which we argue is best approached from a biopsychosocial perspective.
Collapse
Affiliation(s)
- Nia Kaleycheva
- School of Psychology, University of Surrey, Guildford, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, King's College London, London, UK
| | - Robyn Evans
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Tirril Harris
- Department of Health Service and Population Research, King's College London, London, UK
| | - Timothy Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London, London, UK
| |
Collapse
|
10
|
Chandan JS, Keerthy D, Zemedikun DT, Okoth K, Gokhale KM, Raza K, Bandyopadhyay S, Taylor J, Nirantharakumar K. The association between exposure to childhood maltreatment and the subsequent development of functional somatic and visceral pain syndromes. EClinicalMedicine 2020; 23:100392. [PMID: 32637892 PMCID: PMC7329705 DOI: 10.1016/j.eclinm.2020.100392] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Childhood maltreatment is a global public health issue linked to a vast mortality and morbidity burden. This study builds on current literature to explore the risk of developing central sensitivity syndromes (CSS) (consisting of somatic and visceral pain syndromes) subsequent to childhood maltreatment exposure. METHODS A retrospective population based open cohort study using the UK primary care database, 'The Health Improvement Network,' between 1st January 1995-31st December 2018. 80,657 adult patients who had experienced childhood maltreatment or maltreatment related concerns (exposed patients) were matched to 161,314 unexposed patients by age and sex. Outcomes of interest were the development of CSS: either somatic (Fibromyalgia, chronic fatigue syndrome, temporomandibular joint disorder, chronic lower back pain, chronic headache, myofascial pain syndrome and restless leg syndrome) or visceral (Interstitial cystitis, vulvodynia, chronic prostatitis and irritable bowel syndrome) in nature. Effect sizes are presented as adjusted incidence rate ratios (aIRR) with confidence intervals (CI). Models were adjusted for the following covariates at cohort entry: age, sex, deprivation, anxiety, depression and serious mental ill health. RESULTS The average age at cohort entry was 23.4 years and the median follow was 2.2 years. There was an increased risk of developing fibromyalgia (aIRR 2.06; 95% CI 1.71-2.48), chronic fatigue syndrome (1.47; 1.08-2.00), chronic lower back pain (1.99; 1.68-2.35), restless leg syndrome (1.82; 1.41-2.35) and irritable bowel syndrome (1.15; 1.08-1.22) when compared to the unexposed group, whereas no statistical association was seen with the development of temporomandibular joint disorder (1.00; 0.88-1.13), chronic headache (1.04; 0.59-1.86), interstitial cystitis (1.19; 0.51-2.74), vulvodynia (0.65; 0.34-1.26), chronic prostatitis (0.34; 0.07-1.77) and myofascial pain syndrome (0.88; 0.36-2.14). Outcome numbers were low, most likely, due to the rarity of visceral conditions (aside from irritable bowel syndrome). The association between a history of childhood maltreatment and CSS were mainly observed in somatic CSS. INTERPRETATION The debilitating effects of CSS carry a substantial physical, psychological and economic burden to both the individuals who are diagnosed with them and the health services who serve them. Primary prevention approaches targeting childhood maltreatment as well as secondary preventative approaches should be considered to minimise the associated burden of CSS.
Collapse
Affiliation(s)
- Joht Singh Chandan
- Warwick Medical School, University of Warwick, Coventry CV47HL, United Kingdom
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
| | - Deepiksana Keerthy
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
| | - Dawit Tefra Zemedikun
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
| | - Kelvin Okoth
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
| | - Krishna Margadhamane Gokhale
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
| | - Karim Raza
- Arthritis Research, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
| | - Siddhartha Bandyopadhyay
- Centre of Crime, Justice and Policing, The Department of Economics, University of Birmingham, B152TT, United Kingdom
| | - Julie Taylor
- Child Protection, School of Nursing, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
- Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, United Kingdom
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
- Midlands Health Data Research UK, University of Birmingham B152TT, United Kingdom
- Corresponding author at: Institute of Applied Health Research, College of Medical and Dental sciences, University of Birmingham, B152TT
| |
Collapse
|
11
|
Sweeting JA, Garfin DR, Holman EA, Silver RC. Associations between exposure to childhood bullying and abuse and adulthood outcomes in a representative national U.S. sample. CHILD ABUSE & NEGLECT 2020; 101:104048. [PMID: 31945515 DOI: 10.1016/j.chiabu.2019.104048] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/09/2019] [Accepted: 06/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Negative childhood experiences are associated with poor health and psychosocial outcomes throughout one's lifespan. OBJECTIVE We examined associations between childhood bullying and maltreatment and several adulthood outcomes: psychological distress, functional impairment, generalized fear, and physician-diagnosed mental and physical health ailments. The potential mediating role of recent negative life events was also explored. PARTICIPANTS AND SETTING Data were collected through web-based surveys of a U.S. representative national sample of adults. METHODS At Wave 1 (N = 3,598), participants reported exposure to negative childhood experiences; at Wave 2 (N = 3,497), physician-diagnosed mental and physical health ailments were provided; at Wave 3 (N = 2,906), participants reported exposure to recent negative life events and psychosocial outcomes. RESULTS Of the sample, 26.29% (weighted n = 946) reported childhood bullying, 15.02% (weighted n = 540) reported physical abuse, 15.56% (weighted n = 560) reported witnessing parental violence, 11.42% (weighted n = 411) reported sexual abuse, and 8.64% (weighted n = 311) reported parental neglect. Respondents who reported bullying, physical abuse, or sexual abuse during childhood reported greater distress, functional impairment, and fear of the future in adulthood, as mediated through recent negative life events, compared to those who did not (ßs: 0.04-.06). Those reporting bullying, neglect, physical abuse, or sexual abuse in childhood reported more mental health ailments in adulthood (IRRs: 1.44-1.66) compared to those who did not. Those reporting bullying or sexual abuse in childhood reported more physical health ailments (IRRs: 1.25-1.39). CONCLUSIONS Specific negative childhood experiences have unique links with poor outcomes in adulthood. Recent negative life events partially mediate these associations.
Collapse
Affiliation(s)
- Josiah A Sweeting
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Dana Rose Garfin
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - E Alison Holman
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Roxane Cohen Silver
- Department of Psychological Science, University of California, Irvine, CA, USA; Department of Medicine, University of California, Irvine, CA, USA; Program in Public Health, University of California, Irvine, CA, USA.
| |
Collapse
|
12
|
Chandan JS, Thomas T, Raza K, Bandyopadhyay S, Nirantharakumar K, Taylor J. Association between child maltreatment and central sensitivity syndromes: a systematic review protocol. BMJ Open 2019; 9:e025436. [PMID: 30782933 PMCID: PMC6368161 DOI: 10.1136/bmjopen-2018-025436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/19/2018] [Accepted: 12/05/2018] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION A growing body of evidence is identifying the link between a history of child maltreatment and a variety of adverse health outcomes ultimately leading to significant social and healthcare burden. Initial work has identified a potential association between child maltreatment and the development of a selection of somatic and visceral central sensitivity syndromes: fibromyalgia, chronic fatigue syndrome, temporomandibular joint disorder, chronic lower back pain, chronic neck pain, chronic pelvic pain, interstitial cystitis, vulvodynia, chronic prostatitis, tension-type headache, migraine, myofascial pain syndrome, irritable bowel syndrome and restless legs syndrome. METHODS AND ANALYSIS Primary electronic searches will be performed in the Embase, MEDLINE, PubMed, Scopus, PyscINFO, CINAHL and Cochrane Library databases and a number of Grey Literature sources including child protection and paediatric conference proceedings. Following independent screening of studies by two review authors, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses template will be used to aid extraction. A meta-analysis will be conducted on the included case-control and cohort studies. The Newcastle-Ottawa grading system will be used to assess the quality of included studies. Results will be expressed as pooled ORs for binary data and mean differences for continuous data. ETHICS AND DISSEMINATION Ethics approval will not be required. The final results of the review and meta-analysis will be submitted for peer-review publication and also disseminated at relevant conference presentations. PROSPERO REGISTRATION NUMBER CRD42018089258.
Collapse
Affiliation(s)
- Joht Singh Chandan
- Institute of Applied Health Research College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tom Thomas
- Institute of Applied Health Research College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Karim Raza
- Institute of Inflammation and Ageing College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Krishnarajah Nirantharakumar
- Public Health, Epidemiology and Biostatistics Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Julie Taylor
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
13
|
Russell A, Hepgul N, Nikkheslat N, Borsini A, Zajkowska Z, Moll N, Forton D, Agarwal K, Chalder T, Mondelli V, Hotopf M, Cleare A, Murphy G, Foster G, Wong T, Schütze GA, Schwarz MJ, Harrison N, Zunszain PA, Pariante CM. Persistent fatigue induced by interferon-alpha: a novel, inflammation-based, proxy model of chronic fatigue syndrome. Psychoneuroendocrinology 2019; 100:276-285. [PMID: 30567628 PMCID: PMC6350004 DOI: 10.1016/j.psyneuen.2018.11.032] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 11/23/2018] [Accepted: 11/23/2018] [Indexed: 12/21/2022]
Abstract
The role of immune or infective triggers in the pathogenesis of Chronic Fatigue Syndrome (CFS) is not yet fully understood. Barriers to obtaining immune measures at baseline (i.e., before the trigger) in CFS and post-infective fatigue model cohorts have prevented the study of pre-existing immune dysfunction and subsequent immune changes in response to the trigger. This study presents interferon-alpha (IFN-α)-induced persistent fatigue as a model of CFS. IFN-α, which is used in the treatment of chronic Hepatitis C Virus (HCV) infection, induces a persistent fatigue in some individuals, which does not abate post-treatment, that is, once there is no longer immune activation. This model allows for the assessment of patients before and during exposure to the immune trigger, and afterwards when the original trigger is no longer present. Fifty-five patients undergoing IFN-α treatment for chronic HCV were assessed at baseline, during the 6-12 months of IFN-α treatment, and at six-months post-treatment. Measures of fatigue, cytokines and kynurenine pathway metabolites were obtained. Fifty-four CFS patients and 57 healthy volunteers completed the same measures at a one-off assessment, which were compared with post-treatment follow-up measures from the HCV patients. Eighteen patients undergoing IFN-α treatment (33%) were subsequently defined as having 'persistent fatigue' (the proposed model for CFS), if their levels of fatigue were higher six-months post-treatment than at baseline; the other 67% were considered 'resolved fatigue'. Patients who went on to develop persistent fatigue experienced a greater increase in fatigue symptoms over the first four weeks of IFN-α, compared with patients who did not (Δ Treatment Week (TW)-0 vs. TW4; PF: 7.1 ± 1.5 vs. RF: 4.0 ± 0.8, p = 0.046). Moreover, there was a trend towards increased baseline interleukin (IL)-6, and significantly higher baseline IL-10 levels, as well as higher levels of these cytokines in response to IFN-α treatment, alongside concurrent increases in fatigue. Levels increased to more than double those of the other patients by Treatment Week (TW)4 (p = 0.011 for IL-6 and p = 0.001 for IL-10). There was no evidence of an association between persistent fatigue and peripheral inflammation six-months post-treatment, nor did we observe peripheral inflammation in the CFS cohort. While there were changes in kynurenine metabolites in response to IFN-α, there was no association with persistent fatigue. CFS patients had lower levels of the ratio of kynurenine to tryptophan and 3-hydroxykynurenine than controls. Future studies are needed to elucidate the mechanisms behind the initial exaggerated response of the immune system in those who go on to experience persistent fatigue even if the immune trigger is no longer present, and the change from acute to chronic fatigue in the absence of continued peripheral immune activation.
Collapse
Affiliation(s)
- Alice Russell
- Dept. of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Nilay Hepgul
- Dept. of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Naghmeh Nikkheslat
- Dept. of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Alessandra Borsini
- Dept. of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Zuzanna Zajkowska
- Dept. of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Natalie Moll
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Daniel Forton
- Gastroenterology & Hepatology Department, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Kosh Agarwal
- Institute of Liver Studies, Kings College Hospital NHS Foundation Trust, London, UK.
| | - Trudie Chalder
- Dept. of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Chronic Fatigue Service, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK.
| | - Valeria Mondelli
- Dept. of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Matthew Hotopf
- Dept. of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Anthony Cleare
- Dept. of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Gabrielle Murphy
- The Royal Free London Fatigue Service, Royal Free London NHS Foundation Trust, London, UK.
| | - Graham Foster
- Gastrointestinal and Liver services Department, Barts Health NHS Trust, London, UK.
| | - Terry Wong
- Gastroenterology & Hepatology Department, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
| | - Gregor A. Schütze
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Markus J. Schwarz
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Neil Harrison
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
| | - Patricia A. Zunszain
- Dept. of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Carmine M. Pariante
- Dept. of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| |
Collapse
|
14
|
Abstract
SummaryPatients with severe and enduring somatoform disorders (SESD) characteristically present with multiple, recurrent and frequently changing physical symptoms that have usually been present for several years before referral to a psychiatrist/psychologist. Many patients report long histories of contact with both primary and tertiary care services, have undergone repeated fruitless investigations and have high levels of disability. SESD are responsible for disproportionately high healthcare costs and are the third most common cause of workplace absence. Identification of patients with SESD by psychiatrists requires particular skills: collaboration with colleagues is vital and there are risks of iatrogenic harm. We describe the obstacles encountered in identifying these patients as well as methods of assessment and management. Treatment pathways best suited to managing this large and as yet untended group of patients are described.
Collapse
|
15
|
Clark JE, Davidson SL, Maclachlan L, Newton JL, Watson S. Rethinking childhood adversity in chronic fatigue syndrome. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2017; 6:20-29. [PMID: 29392095 PMCID: PMC5774185 DOI: 10.1080/21641846.2018.1384095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/20/2017] [Indexed: 11/23/2022]
Abstract
Background: Previous studies have consistently shown increased rates of childhood adversity in chronic fatigue syndrome (CFS). However, such aetiopathogenic studies of CFS are potentially confounded by co-morbidity and misdiagnosis particularly with depression. Purpose: We examined the relationship between rates of childhood adversity using two complimentary approaches (1) a sample of CFS patients who had no lifetime history of depression and (2) a modelling approach. Methods: Childhood trauma questionnaire (CTQ) administered to a sample of 52 participants with chronic fatigue syndrome and 19 controls who did not meet criteria for a psychiatric disorder (confirmed using the Structured Clinical Interview for DSM-IV). Subsequently, Mediation Analysis (Baye’s Rules) was used to establish the risk childhood adversity poses for CFS with and without depression. Results: In a cohort of CFS patients with depression comprehensively excluded, CTQ scores were markedly lower than in all previous studies and, in contrast to these previous studies, not increased compared with healthy controls. Post-hoc analysis showed that CTQ scores correlated with the number of depressive symptoms during the lifetime worst period of low mood. The probability of developing CFS given a history of childhood trauma is 4%, a two-fold increased risk compared to the general population. However, much of this risk is mediated by the concomitant development of major depression. Conclusions: The data suggests that previous studies showing a relationship between childhood adversity and CFS may be attributable to the confounding effects of co-morbid or misdiagnosed depressive disorder. Abbreviations: CFS: Chronic fatigue syndrome; CTQ: Childhood trauma questionnaire; MDD: Major depressive disorder; CA: Childhood adversity; P: Probability
Collapse
Affiliation(s)
- James E Clark
- Wolfson Research Unit, Newcastle University, Newcastle, UK
| | | | | | - Julia L Newton
- Newcastle Hospitals, NHS Foundation Trust and Newcastle University, Institute for Cellular Medicine, Newcastle, UK
| | - Stuart Watson
- Wolfson Research Unit, Newcastle University, Newcastle, UK.,NTW NHS Foundation Trust, Newcastle, UK
| |
Collapse
|
16
|
Taylor AG, Fischer-White TG, Anderson JG, Adelstein KE, Murugesan M, Lewis JE, Scott MM, Gaykema RPA, Goehler LE. Stress, Inflammation and Pain: A Potential Role for Monocytes in Fibromyalgia-related Symptom Severity. Stress Health 2016; 32:503-513. [PMID: 27925450 DOI: 10.1002/smi.2648] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 08/03/2015] [Accepted: 08/06/2015] [Indexed: 12/12/2022]
Abstract
The possibility that immunological changes might contribute to symptom severity in fibromyalgia (FM) prompted this proof-of-concept study to determine whether differences in monocyte subpopulations might be present in persons with FM compared with healthy controls. Relationships were assessed by comparing specific symptoms in those with FM (n = 20) and patterns of monocyte subpopulations with healthy age-matched and gender-matched controls (n = 20). Within the same time frame, all participants provided a blood sample and completed measures related to pain, fatigue, sleep disturbances, perceived stress, positive and negative affect and depressed mood (and the Fibromyalgia Impact Questionnaire for those with FM). Monocyte subpopulations were assessed using flow cytometry. No differences were observed in total percentages of circulating monocytes between the groups; however, pain was inversely correlated with percentages of circulating classical (r = -0.568, p = 0.011) and intermediate (r = -0.511, p = 0.025) monocytes in the FM group. Stress and pain were highly correlated (r = 0.608, p = 0.004) in the FM group. The emerging pattern of changes in the percentages of circulating monocyte subpopulations concomitant with higher ratings of perceived pain and the correlation between stress and pain found in the FM group warrant further investigation. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Ann Gill Taylor
- Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, VA, USA
| | | | - Joel G Anderson
- Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, VA, USA
| | | | - Maheswari Murugesan
- PhD Program, School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Janet E Lewis
- Division of Clinical Rheumatology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Michael M Scott
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ronald P A Gaykema
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Lisa E Goehler
- Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
17
|
Bansal AS. Investigating unexplained fatigue in general practice with a particular focus on CFS/ME. BMC FAMILY PRACTICE 2016; 17:81. [PMID: 27436349 PMCID: PMC4950776 DOI: 10.1186/s12875-016-0493-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/13/2016] [Indexed: 01/23/2023]
Abstract
Unexplained fatigue is not infrequent in the community. It presents a number of challenges to the primary care physician and particularly if the clinical examination and routine investigations are normal. However, while fatigue is a feature of many common illnesses, it is the main problem in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This is a poorly understood condition that is accompanied by several additional symptoms which suggest a subtle multisystem dysfunction. Not infrequently it is complicated by sleep disturbance and alterations in attention, memory and mood. Specialised services for the diagnosis and management of CFS/ME are markedly deficient in the UK and indeed in virtually all countries around the world. However, unexplained fatigue and CFS/ME may be confidently diagnosed on the basis of specific clinical criteria combined with the normality of routine blood tests. The latter include those that assess inflammation, autoimmunity, endocrine dysfunction and gluten sensitivity. Early diagnosis and intervention in general practice will do much to reduce patient anxiety, encourage improvement and prevent expensive unnecessary investigations. There is presently an on-going debate as to the precise criteria that best confirms CFS/ME to the exclusion of other medical and psychiatric/psychological causes of chronic fatigue. There is also some disagreement as to best means of investigating and managing this very challenging condition. Uncertainty here can contribute to patient stress which in some individuals can perpetuate and aggravate symptoms. A simple clinical scoring system and a short list of routine investigations should help discriminate CFS/ME from other causes of continued fatigue.
Collapse
Affiliation(s)
- Amolak S Bansal
- Department of Immunology and Allergy, St. Helier Hospital, Carshalton, Surrey, SM5 1AA, UK. .,The Sutton CFS Service, Sutton Hospital, Cotswold Rd, Sutton, SM2 5NF, UK.
| |
Collapse
|
18
|
Kempke S, Luyten P, De Coninck S, Van Houdenhove B, Mayes LC, Claes S. Effects of early childhood trauma on hypothalamic-pituitary-adrenal (HPA) axis function in patients with Chronic Fatigue Syndrome. Psychoneuroendocrinology 2015; 52:14-21. [PMID: 25459889 DOI: 10.1016/j.psyneuen.2014.10.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is a paucity of studies that have investigated the assumption that early childhood trauma is associated with hypothalamic-pituitary-adrenal (HPA) axis dysfunction in Chronic Fatigue Syndrome (CFS). The current study is the first to simultaneously investigate relationships among early childhood trauma, cortisol activity, and cortisol stress reactivity to psychosocial stress in a sample of well-screened CFS patients. We also examined whether self-critical perfectionism (SCP) plays a mediating role in the potential relationship between early trauma and neurobiological stress responses. METHODS A total of 40 female patients diagnosed with CFS were asked to provide morning saliva cortisol samples (after awakening, 30min later, and 1h later) for seven consecutive days as a measure of cortisol activity. In addition, patients were exposed to the Trier Social Stress Test, a well-validated stress test, to investigate the relationship between early childhood trauma and cortisol stress reactivity. Before the start of the study, patients completed the Childhood Trauma Questionnaire-Short form (CTQ-SF) as a measure of early childhood trauma (i.e. sexual, physical and emotional traumatic experiences). SCP was measured with the Depressive Experiences Questionnaire (DEQ). Data were analyzed by calculating several indices of cortisol secretion (i.e. Cortisol Awakening Response and Area Under the Curve). RESULTS There was no association between early childhood trauma and cortisol as measured over the 7-day period. However, emotional neglect was significantly negatively related to cortisol reactivity in the TSST. SCP did not significantly mediate this association. CONCLUSION Findings of this study suggest that emotional neglect is associated with blunted HPA axis reactivity, congruent with the assumption that CFS may reflect loss of adaptability of the neuroendocrine stress response system in at least a subgroup of patients.
Collapse
Affiliation(s)
- Stefan Kempke
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sarah De Coninck
- Biological Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Linda C Mayes
- Yale Child Study Center, Yale Medical School, Yale University, New Haven, USA
| | - Stephan Claes
- Department of Psychiatry, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| |
Collapse
|
19
|
McInnis OA, McQuaid RJ, Bombay A, Matheson K, Anisman H. Finding benefit in stressful uncertain circumstances: relations to social support and stigma among women with unexplained illnesses. Stress 2015; 18:169-77. [PMID: 25544022 DOI: 10.3109/10253890.2014.1001975] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Living with a chronic illness can be challenging, but the ability to derive benefits and grow from this experience may enhance well-being. However, the possibility of obtaining such benefits may be dependent on the levels of stigmatization and lack of social support experienced by an individual as a result of the illness. Chronic fatigue syndrome (CFS) and fibromyalgia are chronic conditions that remain largely unexplained and those with these conditions must often contend with stigma and skepticism from others. Individuals with CFS/fibromyalgia often display stress-related biological alterations and the experience of stressful life events has been associated with illness development. The present study demonstrated that women with CFS/fibromyalgia (n = 40) as well as community participants who were depressed/anxious (n = 37), reported higher stigma levels than healthy women (n = 33). Moreover, women with CFS/fibromyalgia and those with depression/anxiety also reported greater levels of stigma than women with a chronic yet more widely accepted condition (n = 35; rheumatoid arthritis, osteoarthritis and multiple sclerosis). Secrecy related to stigma among those with CFS/fibromyalgia declined with increased social support, but this was not apparent among those with other chronic conditions. In addition, posttraumatic growth was lower among women with CFS/fibromyalgia compared to those with other chronic conditions. Qualitative analysis examining both negative impacts and positive changes stemming from illness experience revealed many similarities between women with CFS/fibromyalgia and those with other chronic conditions, including elevated appreciation for life, personal growth and compassion for others. However, women with CFS/fibromyalgia tended to report less positive change regarding interpersonal relationships compared to women with other chronic conditions. In general, unexplained illnesses were also accompanied by stigmatization which might ultimately contribute to women's lower ability to derive positive growth from their illness experience.
Collapse
Affiliation(s)
- Opal A McInnis
- Department of Neuroscience, Carleton University , Ottawa, ON , Canada
| | | | | | | | | |
Collapse
|