Quantitative Sensory Testing in Patients with Multisomatoform Disorder with Chronic Pain as the Leading Bodily Symptom, 2019, Tran et al

[Andy]

Chronic pain is a debilitating condition of multifactorial origin, often without physical findings to explain the presenting symptoms. Of the possible etiologies of persisting painful symptoms, somatoform disorders and functional somatic syndromes (FSS) are among the most challenging, with a prevalence of 8–20%. Many different somatoform disorders and FSS have overlapping symptoms, with pain being the most prevalent one. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We hypothesized that the concept of MSD will be reflected in a distinct sensory profile of patients compared with healthy controls and possibly provide insight into the type and pathophysiology of the pain commonly experienced by patients.

Design
We performed comprehensive quantitative sensory testing (QST) in 151 patients and 149 matched controls.

Results
There were significant differences in the sensory profiles of patients compared with controls. Patients with MSD showed a combination of tactile and thermal hypesthesia combined with mechanical and cold hyperalgesia. This was true for measurements at test and control sites, with the exception of vibration detection threshold and mechanical pain threshold. Among the observed changes, a marked sensory loss of function, as evidenced by an increase in cold detection threshold, and a marked gain of function, as evidenced by a decrease of pressure pain threshold, were most notable. There was no evidence of concurrent medication influencing QST results.

Conclusions
The observed somatosensory profile of patients with MSD resembles that of patients suffering from neuropathic pain with evidence of central sensitization.

Paywall, https://academic.oup.com/painmedicine/article-abstract/doi/10.1093/pm/pnz195/5580374/
Scihub, not available at time of posting.

 

[Cheshire]

compared with healthy controls

Wouldn't it be more instructive to compare to people having painful conditions?

 

[Mithriel]

I am not sure but I think they must mean physical disease when they talk about somatoform disorders if they are distinguishing them from functional somatic disorders.

Which means they found that "imaginary" diseases have the same problems as physical ones. Then again who knows what these people find.

 

[Dx Revision Watch]

I am not sure but I think they must mean physical disease when they talk about somatoform disorders if they are distinguishing them from functional somatic disorders.

Which means they found that "imaginary" diseases have the same problems as physical ones. Then again who knows what these people find.

I don't have access to the full paper, but I would imagine what the authors are referring to are the ICD-10 Somatoform disorders:

https://icd.who.int/browse10/2016/en#/F45

F45 Somatoform disorders
F45.0 Somatization disorder
F45.1 Undifferentiated somatoform disorder
F45.2 Hypochondriacal disorder
F45.3 Somatoform autonomic dysfunction
F45.4 Persistent somatoform pain disorder
F45.8 Other somatoform disorders


For expanded disorder description texts, see also:

https://www.who.int/classifications/icd/en/bluebook.pdf

The ICD-10 Classification of Mental and Behavioural Disorders, Clinical descriptions and diagnostic guidelines, World Health Organization

aka the ICD-10 "Blue Book"

(Expanded description texts from Page 129)


See also:

https://www.who.int/classifications/icd/en/GRNBOOK.pdf

The ICD-10 Classification of Mental and Behavioural Disorders, Diagnostic criteria for research, World Health Organization

aka the ICD-10 "Green Book" (Research criteria)

(Diagnostic criteria from Page 127)

-----------------------

If you look at the research criteria (from page 127 onwards) for the ICD-10 Somatoform disorders, particularly for:

F45.0 Somatization disorder,
F45.1 Undifferentiated somatoform disorder,
F45.3 Somatoform autonomic dysfunction, and
F45.4 Persistent somatoform pain disorder

there is potential "overlap" with the so-called "FSSs" and for assigning a diagnosis of one of the ICD-10 Somatoform disorders to patients with symptoms of one or more of the so-called "FSSs".



As you know, DSM-5 replaced DSM-IV's Somatoform disorders categories with Somatic symptom disorder (SSD) in May 2013. I think it unlikely that the paper would be referring to the now deprecated DSM-IV TR Somatoform disorders, though you do still see occasional references to the disorder descriptions and criteria for the now obsolete DSM-IV Somatoform disorders categories in contemporary studies, rather than the DSM-5's SSD criteria which replaced them.

Comparison Table: Criteria for DSM-IV Somatization disorder v ICD-10 Somatization disorder

(You can see how IBS, FM and other of the so-called "FSSs" might, in some cases, meet a diagnosis of Somatization disorder or Persistent somatoform pain disorder.)

[Edited to insert comparison table]