Psychology Today blog platform: "It's All in Your Head - The relationship between contested illnesses and psychiatric illnesses"

Good.

 

Nor the IOM 2015 ME/CFS Report. I won't be Tweeting this blog post - I don't want to drive traffic to it.

 

And this is the root cause of my dissatisfaction with treatment of contested illnesses. Doctors so often assume that contested illnesses have no physical basis, and the only treatment the patient needs is anti-depressants, anti-anxiolytics and a therapist. The pain they suffer isn't considered real so they don't need pain killers.

The other root cause of my dissatisfaction is the frequent reversal of cause and effect. Someone who has chronic pain is assumed to have created that pain in their heads because they are depressed. There is rarely any acceptance that being in chronic pain causes depression. Instead, the depression is assumed to cause the chronic pain.

I have read in a couple of places recently that some researchers in the US have said that chronic pain which is still being felt more than three months after surgery (I can't remember what kind of surgery they were referring to) is an artefact of the brain and isn't real because healing is always over by the end of three months. These researchers want to stop giving pain relief to people with chronic pain and treat them as psychiatric cases instead. This situation is all tied up with the opioid pain killer issue in the US.

 

My emphasis

And if the patient does have an abnormality in their brain how long will it take for it to be found if the treatment for contested illnesses is talking therapy and anti-depressants?

 

I think the author(s) are keeping up with this thread. There is a reference to myalgic encephalomyelitis in the post now.

 

@Arnie Pye

ICD-11 includes a new category block within Chapter 21 Symptoms, signs etc. for Chronic pain.

This includes a number of new categories under: Chronic primary pain.

https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/1326332835

(Open up the small grey arrow in front of Chronic primary pain to display around 25 "child categories".)


It is under Chronic primary pain > Chronic widespread pain that Fibromyalgia was relocated in May 2015.

Fibromyalgia is now an inclusion under Chronic widespread pain (originally proposed to be called "Chronic widespread primary pain") and takes the MG30.01 Chronic widespread pain code (ie there will be no discrete code for Fibromyalgia in the ICD-11 equivalent of ICD-10's Tabular List).

Though Fibromyalgia does have a Description in the Foundation Component:
https://icd.who.int/dev11/f/en#http://id.who.int/icd/entity/236601102


There is conceptual overlap between these new ICD-11 Chronic primary pain codes and ICD-10's F45.4 Persistent somatoform pain disorder and also overlap with ICD-11's new Bodily distress disorder.

The IASP Chronic pain Task Force developed this category block in collaboration with WHO/ICD Revision and has asked for Bodily distress disorder (BDD) to be crosslinked [sic] ie secondary parented to Chronic primary pain. This has not been formally submitted for and thus far, has not been approved or implemented by WHO.

The IASP had also requested (in a formal proposal in 2017) for IBS to be relocated as a child category under Chronic primary visceral pain:

https://icd.who.int/dev11/proposals...lGroupId=fa098a92-153d-45b6-b433-44ce40214642

This was also rejected by WHO and IBS remains located under its legacy chapter:

https://icd.who.int/dev11/f/en#/http://id.who.int/icd/entity/1158238623

After this submission was rejected, IASP then asked (in 2018) for IBS to be linked [sic] ie secondary parented under Chronic primary visceral pain. That has not been approved by WHO.

The 2015 position paper by the IASP Task Force on the development of these new categories had also proposed locating FM and IBS and a number of other so-called FSSs under these new Symptoms, signs chapter category blocks [1].


A detailed description of these new codes was published in January 2019 in a series of review articles in the journal, PAIN:
https://journals.lww.com/pain/toc/2019/01000


1 A classification of chronic pain for ICD-11
Treede, Rolf-Detlefa; Rief, Winfriedb; Barke, Antoniab,*; Aziz, Qasimc; Bennett, Michael I.d; Benoliel, Rafaele; Cohen, Miltonf; Evers, Stefang; Finnerup, Nanna B.h; First, Michael B.i; Giamberardino, Maria Adelej; Kaasa, Steink; Kosek, Eval; Lavand'homme, Patriciam; Nicholas, Michaeln; Perrot, Sergeo; Scholz, Joachimp; Schug, Stephanq; Smith, Blair H.r; Svensson, Peters,t; Vlaeyen, Johan W.S.u,v; Wang, Shuu-Jiunw
PAIN: June 2015 - Volume 156 - Issue 6 - p 1003–1007
doi: 10.1097/j.pain.0000000000000160

Full text: https://journals.lww.com/pain/Fulltext/2015/06000/A_classification_of_chronic_pain_for_ICD_11.6.aspx

 

"...nor do we have objective tests that make diagnoses secure for any of these conditions."

a) Actually, there are three FDA-approved objective Lyme tests that can be - and are being - used to diagnose late stage Lyme refractory to antibiotics, aka chronic Lyme. So there are objective tests. The problem is that they're not very good, despite claims their proponents have been hawking for decades. But they DO exist, and they ARE being used to diagnose chronic Lyme.

b) "Conditions"? Not diseases? Ick. Why not just plug in a neon sign and blast your biases for everyone to see?

 

@Dx Revision Watch

I don't have fibromyalgia and as far as I know I'm not diagnosed with it. I know the cause of a lot of the pain I suffer from. I have adhesions and scarring from previous surgeries. These adhesions were described to me as being "very extensive, very deep and very, very dense" when they were first found. The surgery I had which discovered and treated this problem for the first time is described in my medical notes, with the date, as "Laparoscopy". The findings are not mentioned. When I tell doctors I suffer from very severe adhesions they scowl at me, roll their eyes, and then offer me anti-depressants or just tell me they can do nothing for me. This is just one reason (amongst many) that I am so angry with doctors all the time. The notes they write are often obfuscated or just straightforward lies by omission. The only thing that seems to be recorded clearly is that I'm assumed to be depressed, anxious and a drug-seeker. The fact that a person in pain will seek pain relief is ignored and assumed to be a psychiatric symptom. One of my main symptoms is actually fury, rather than depression.

 

The new Chronic pain categories include:

https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/302680255

MG30.21 Chronic postsurgical pain

for postsurgical pain extending beyond 3 months.

"Chronic postsurgical pain is chronic pain developing after a surgical procedure and persisting beyond the healing process, i.e. at least 3 months after surgery. The pain is either localized to the surgical field, projected to the innervation territory of a nerve situated in this area, or referred to a dermatome (after surgery/injury to deep somatic or visceral tissues). Other causes of pain including infection, malignancy etc. need to be excluded as well as pain continuing from a pre-existing pain problem. The postsurgical etiology of the pain should be highly probable; if it is vague, consider using codes in the section of chronic primary pain. Dependent on type of surgery, chronic postsurgical pain often may be neuropathic pain. Even if neuropathic mechanisms are crucial, this type of pain should be diagnosed here."


However "...if it is vague, consider using codes in the section of chronic primary pain."

I know from the experience of a family member that formation of adhesions and also nerve pain beneath and in the region of scars can result in considerable pain - in my husband's case following laparoscopic-assisted resection of a 9 inch length of colon to remove a malignant tumour.
Clinicians, generally, should be more aware of post operative adhesions, nerve pain and visceral tissue pain in the months/years following surgery.


Edited to add: Patients complaining of chronic postsurgical pain might also be potentially assigned a diagnosis of Bodily distress disorder (or Somatic symptom disorder):

https://icd.who.int/dev11/f/en#/http://id.who.int/icd/entity/767044268

"If another health condition is causing or contributing to the symptoms, the degree of attention is clearly excessive in relation to its nature and progression."

 

Oh, joy...

 

10 Comments up now.

 

A couple of commenters have mentioned Psychology Today's editorial responsibility, the lack of fact checking etc.

But, as I've posted in Post #8,

Terms of Use

https://www.psychologytoday.com/us/terms-use

Extract:

c) You are solely responsible for the content of any posting you make to the Site and any consequences arising from such posting. We assume no responsibility for materials posted by our users or any other actions, conduct or omissions of our users. We act as a service provider for users to distribute and publish their materials. We do not undertake responsibility for screening or monitoring our users’ materials.

d) Our bloggers who post articles to our Site are not employed by us or Sussex Publishers, LLC. Each blogger is solely responsible for the content of his or her articles. Each blogger owns the copyright to the articles they upload. We do not undertake responsibility for screening or monitoring our bloggers’ materials. The opinions expressed by the bloggers are their own and are not our opinions or endorsed by us.

e) Further, we explicitly disclaim any responsibility for the accuracy, content or availability of information found on a site that links to or from the Site (a "third-party site").

 

As per @Dx Revision Watch's comments, these authors don't appear to have noted the IOM/NAM report.

How and why should any respect this writing if the depth of their research on ME only goes as far as reading and quoting fashion magazine articles?

For some, this work will cast doubt on ME and the other diseases discussed, as legitimate physical conditions. They may try to look balanced, but really, the bias is towards all the diseases being effectively treated with CBT and things of similar ilk.

 

Thanks. I'll modify the title to try to clarify.

 

really? interesting. thanks for the heads up.

 

IMO more comments is not necessarily better. They're becoming less a cogent argument and more an opportunity to vent. People reading all of them will be more confused.

 

There are several and they mostly are excellent.

I particularly liked that one:

While deniers argue over what to call it, people are dying and millions of lives are wasted. Whatever the nature of this disease, this is deeply shameful and has been fully in the realm of criminal negligence for a while. The whole discussion even seems amusing to some, as if it were of no serious consequences. The time for this debate is well over and rehashing this old trope is a massive failure.

 

Your comment was excellent. Likely to fall on deaf ears but it hit every point. If only ME deniers could exercise the same open-mindedness they demand of us to their own ideas.

 

The same can be said of depression, which is used in the post as a reference for an undisputed disease. This makes the point that the absence or existence of objective tests is not a genuine issue, rather an arbitrary cherry-picked excuse use for rhetorical purposes.

 

33 comments now.