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Central Sensitivity and Fibromyalgia, 2021, Mezhov et al

Discussion in 'Psychosomatic research - ME/CFS and Long Covid' started by Andy, Jun 22, 2021.

  1. Andy

    Andy Committee Member

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    [My bolding]

    Abstract

    Fibromyalgia presents with symptoms of widespread pain, fatigue, sleeping and cognitive disturbances as well as other somatic symptoms. It often overlaps with other conditions termed ‘central sensitivity syndromes’ such as irritable bowel syndrome, chronic fatigue syndrome and temporomandibular disorder. Central sensitisation, mediated by amplified processing in the central nervous system, has been identified as the key pathogenic mechanism in these disorders. The term ‘central sensitivity’ can be used to collectively describe the clinical presentation of these disorders. Fibromyalgia is highly prevalent in most rheumatic diseases as well as non-rheumatic chronic diseases and if unrecognised results in high morbidity. It is diagnosed clinically after excluding important differential diagnoses. Diagnostic criteria have been developed as tools to help identify and diagnose fibromyalgia. Such tools can fulfill an important need when managing patients with rheumatic disease and other chronic diseases as a way to identify fibromyalgia and improve patient outcomes. Treatment involves an integrated approach including education, exercise, stress reduction and pharmacological therapies targeting the central nervous system. This approach is suitable for all presentations of central sensitivity and some central sensitivity syndromes have additional treatment options specific to the clinical presentation.


    Paywall, https://onlinelibrary.wiley.com/doi/10.1111/imj.15430
     
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  2. petrichor

    petrichor Senior Member (Voting Rights)

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    Central sensitivity seems to be another one of these grand unifying theories that seem to appeal to people in medicine a lot. Vague enough that it can accommodate all sorts of different viewpoints and fit people's agendas and anything can count as evidence for it, and broadly enough applied that you can get a lot of citations.

    Nobody knows what causes ME and fibromyalgia. It may be central sensitivity (probably only because the term is so vague it could mean anything). Shoehorning in a theory like central sensitivity with such certainty is both putting the cart before the horse, and gives cover for people to insert their own theories of the conditions and pretend they're evidence based when they're not.

    The article isn't terrible, but why people feel the need to go around making labels like "central sensitivity" just doesn't make any sense to me. It comes across as pseudoscience.
     
  3. Trish

    Trish Moderator Staff Member

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    How would this be detected and measured biologically?
     
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  4. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

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  5. rvallee

    rvallee Senior Member (Voting Rights)

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    Those things are mutually exclusive. Something cannot be a metadescription of a group of somethings while at the same time their core process. Just ending the word differently to describe either changes nothing, this is an alleged process that has never been shown and is as compelling as "this is probably warmer because it probably holds more heat" even though an objective measurement shows no change in temperature.

    That's just weak. Clearly it's possible to make it through a graduate program related to health with rote memorization alone because these people don't think for a single minute about what they do.
     
  6. DigitalDrifter

    DigitalDrifter Senior Member (Voting Rights)

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    I think "Central sensitivity" is another euphemism for mental illness, like "Functional". The problem is once you psychologize physical symptoms they become inconsequential.
     
  7. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    I've never understood why temporomandibular disorder is considered to be a "central sensitivity" issue or a "functional pain syndrome". Why are jaw and facial muscles and nerves not allowed to become inflamed without blaming the patient in some way?
     
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  8. petrichor

    petrichor Senior Member (Voting Rights)

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    This article features this diagram, if anyone finds it of interest: E4JU6aFVUAUhdLs.png
     
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  9. Amw66

    Amw66 Senior Member (Voting Rights)

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    What a useful diagram .... the bottom box can be replaced with buzz words/ condition of choice , endlessly applicable and no sell by date ...
     
  10. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

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    They forgot the *magic happens here* bit.
     
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  11. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Worth remembering that the first author is a newly qualified doctor doing a master's degree.
    This is not a paper. It is an essay for filling the CV. Do not expect it to be saying anything informed.
     
  12. chrisb

    chrisb Senior Member (Voting Rights)

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    Does that not say it all? Weren't Wessely and Chalder studying for master's degrees in 1988?
     
  13. Trish

    Trish Moderator Staff Member

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    I don't understand why journals publish student essays as if they are scientific papers. Similarly a lot of the so called systematic reviews are just the literature search and summary done as an initial part of a post grad degree.
     
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  14. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    This is the medical journal of the Australian RoyalCollege of Physicians.In the blurb it says:

    The Journal also plays a major role in continuing medical education through review articles relevant to physician education.

    The journal exists to oil the wheels of physicians careers, nothing else. Within the profession that is understood. Unfortunately people outside the profession don't necessarily realise this. That includes patient citizen scientists but also scientists working in the pharmaceutical industry, or research labs, or maybe clinical psychologists, who think they are reading something authoritative.
     
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  15. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    When are the proponents of central sensitisation going to actually propose objectively measurable signs of their belief system? If they are arguing this is a feature of brain/nerves biology, albeit it triggered environmentally/socially/psychologically there must be some measurable change in the nerve or brain cells.

    Which of these theorists are going to suggest specific mechanisms that reveal themselves in thresholds for neurones firing, axon transmission rates, levels of specific neurotransmitters, etc, etc? Actually predict things that could me measured in our neurochemistry, our brain scans, our autopsies, etc, etc.

    Instead it seems that they postulate that particular behaviour patterns or syndromes are caused by central sensitisation, and then use questionnaires supposedly indicative of those behaviours or syndromes to demonstrate the existence of central sensitisation.

    This no different to saying people go to Church because God exists, so we know God definitely exists because when we observe churches people visit them.
     
    Last edited by a moderator: Jun 23, 2021
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  16. petrichor

    petrichor Senior Member (Voting Rights)

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    This paper says "The process underlying central sensitivity is thought to be central sensitisation (CS).3 The definition and understanding of CS has evolved over time. Initially it described the process of “activity-dependent synaptic plasticity in the spinal cord that generates post-injury pain hypersensitivity”2 and now the meaning of the term has broadened to include increased responsiveness and signaling within the CNS involving both nociceptors and low threshold mechanoreceptors.15 The potential pathways leading to this are explained below but currently there is no method to either measure nor define the exact neurophysiological processes in central sensitisation."

    I think in pain research there may be some specific mechanisms identified in the CNS that lead to increased pain sensitivity, but in the context of fibromyalgia and other "central sensitivity" disorders as explained above there doesn't seem to be any kind of firm definition of it at all. As far as I can tell Nocicepters and Mechanoreceptors are simply mechanisms by which pain is expressed in the CNS. So if there's increased responsiveness from them that really only tells you that the subject is feeling pain - it doesn't tell you much about the mechanism by which that pain is coming about.

    So by similar logic, you could diagnose someone with a stubbed toe and has more pain when walking on it as having "central sensitivity", because obviously you'll see more pain expressed in the CNS, and it'll look more sensitive. (I'm not an expert on this stuff obviously, so happy to be corrected about any of this.)
     
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  17. Dolphin

    Dolphin Senior Member (Voting Rights)

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