Professor James Baraniuk returned to IiME with a presentation that was typically provocative, idiosyncratic, and peppered with amusing asides. He started with a look at the historical “drift” of diagnostic criteria in fibrositis (later known as fibromyalgia, and “stripped down” by Wolfe in 1990), benign myalgic encephalomyelitis (later, ME/CFS), and Gulf War Illness.
Baraniuk has suggested before that the distinction between fibromyalgia and ME/CFS is fuzzy at best, and he drew attention to the criteria he still thinks are the best:
RM Bennett’s 1981 definition of ‘fibrositis‘.
He also applied his dry humour to the
Pain Catastrophising Scale (PCS), on which, if you score above 16, you’re deemed to be catastrophising – “Thank you, thank you very much.”
The PCS had been applied to fibromyalgia in particular as the diagnostic criteria “drifted,” and he wryly highlighted the downregulated and upregulated genes shown to be associated with high levels of “catastrophising” in fibromyalgia sufferers.
As his slide illustrating the PCS scale “failed to reproduce” very well on the projector, Baraniuk mused: “maybe the fuzziness is telling you something.”
Regarding the name “myalgic encephalomyelitis,” which goes back to epidemics of nurses caring for polio patients, he noted that five epidemics from the 1920s and 1930s had been re-evaluated as hysteria — “an unfortunate link that is a legacy … an asterisk tagged on to the ME name … I can only hope that we do justice to you by re-evaluating this link and getting away from ‘hysteria.’”
He added that it was Carruthers who had brought the title back, and praised his contribution of identifying post-exertional malaise as the key factor, and emphasising
autonomic dysfunction. Regarding Gulf War Illness (a major focus of his research), he drew gasps from the audience when he asserted that between 25 and 32% of those deployed are now affected — “if there were a similar attack rate on the House of Commons, maybe there’d be some funding for it” — and described some of the notable chemical exposures suffered by the troops.
Between FM, ME, CFS and GWI, there are a number of overlapping conditions here. Can we separate them, he asked?
Looking at frequency analyses in women of systemic hyperalgesia (the classical diagnostic criteria for fibromyalgia: striking tenderness measurable by a significant pain response to a small amount of pressure that would not normally cause pain, and which can now be tracked through to the brain) presented a confusing picture when comparing the distribution of responses in patients with these different diagnoses.
Women with fibromyalgia stood out on the graph, but this was not surprising given that they had been diagnosed on that very basis. Baraniuk had expected that women with CFS would also be very sensitive, but the results here were fairly equivocal in comparison with controls. The one group for whom the measure seemed useful was women with GWI: their pain sensitivity was extreme.
Turning to his own recent research, Baraniuk mentioned his ongoing study of brain MRI before and after a
submaximal exercise test.
Their stressor is not enough to see the 15% drop in VO2 max on Day 2, as reported in maximal exercise tests, but it’s enough to see changes in the blood flow in the brain, especially after a cognitive test.
A few more participants are required for the study, and can contact
baraniuklab@georgetown.edu if interested — they’ll even throw in a
lumbar puncture for free!
About half of the CFS subjects he has tested — and none of the controls — exhibit Baraniuk’s
Stress Test Activated Reversible Tachycardia (START): postural tachycardia following exercise challenge.
They are now assessing the details of heart rate variability in this group, but so far they see greater activation of the
sympathetic nervous system in this group. They enter “fight or flight” mode just because they stand up.
START is contrasted with STOPP (Stress Test Originated Phantom Pain) in Baraniuk’s terminology … but as he ran out of time, and Dr. Gibson demanded that he “climax,” Baraniuk hastily summarised: the ‘tenderness’ in fibromyalgia may turn out to be an artefact; in Gulf War Illness, it may prove to be more significant; GWI patients have many symptoms distinguishing them from ME patients; and START is telling us that there is something wrong with the brain stem in these patients.
