I was doing some searching online yesterday for new fibromyalgia and chronic fatigue syndrome (ME/CFS) articles for the site and stumbled across a few blogs and sites maintained by psychiatrists (I will not provide links as I am not one for personal attacks).
These sites and blogs had pages dedicated to fibromyalgia and ME/CFS and I was disappointed (but not surprised) that these individuals and the speciality of psychiatry as a whole still dismiss an organic basis for these illnesses almost out of hand. If I were a cynic I might say it is almost like they are trying to hang on to patients who would be better served by other professionals and forms of treatment.
One psychiatrist writing on fibromyalgia seemed to have a fondness for pointing out there are NO (his emphasis) lab tests to diagnose the condition. He used this point to bolster his position that fibromyalgia may not even exist and that patients might actually be suffering from depression and should be treated by individuals from his profession with therapy and antidepressant medications.
It is certainly true that there are currently no lab tests to diagnose fibromyalgia. This is a fact. On the other hand there is available a large body of research that when taken into consideration clearly indicates that fibromyalgia is an organic disease that, while having certain characteristics in common with depression, is almost certainly a distinct condition.
It has become clear that in fibromyalgia there is 'central sensitization' of the nervous system so that nerve cells in the entire body become overexcitable. The differences are clear between fibromyalgia patients, healthy individuals, and importantly, patients geniunely suffering solely from depression and other psychiatric disorders. According to Dr. Rodger Murphree , a doctor who aims to treat the underlying causes of fibromyalgia, current knowledge tells us that "Fibromyalgia patients have a reduction in their pain threshold (allodynia), an increased response to painful stimuli (hyperalgesia) and an increase in the duration of pain after nociceptor stimulation (persistent pain)."
Studies have shown that those with fibromyalgia have levels of a chemical called nerve growth factor (NGF) that are four times higher than normal. This increased NGF results in an increase in levels of another chemical called substance P. It is substance P that increases the sensitivity of nerves to stimuli which heightens patients' awareness of pain. Interestingly recent research has also shown that this heightened sensitivity in fibromyalgia isn't restricted to the sense of touch but that patients are also hypersensitive to noise and it is likely this extends to all senses.
It is very common for fibromyalgia and ME/CFS patients to complain of being sensitive to bright light and noise and that these exacerbate symptoms. This is not something that is associated with depression.
These psychiatrist authored websites also like to point out that those doctors that disagree with their position on fibromyalgia are making good money out of treating patients. On this point I would say this; if you are a fibromyalgia patient who has had little or no relief from the therapy and antidepressants you've been offered wouldn't it be natural to seek out the relatively few doctors who see the condition for what it is and offer more meaningful treatment. It's no wonder those few doctors who treat fibromyalgia as the physical illness it is have long waiting lists and make good money when the treatment on offer elsewhere is so inadequate.
Besides, can psychiatrists really have a beef over money? They get paid handsomely for doing very little in a profession that has very little solid ground to stand on. The mainstays of psychiatric treatment are antidepressant drugs and talking therapy. Antidepressant medications were recently shown by researchers from Hull University in the UK to be no more effective than placebo for the vast majority of patients when all studies were included. The researchers used the US Freedom of Information laws to reveal that drug companies had only been presenting the results of studies that gave a positive view of their products. Talking therapies have historically been based more in philosophy than science, although newer approaches have at least addressed this to some degree.
Psychiatrists tell us that antidepressant drugs such as the selective serotonin reuptake inhibitors (SSRIs) such as Prozac/Paxil/Seroxat and old tricyclic antidepressants such as amitriptyline are very helpful in fibromyalgia and ME/CFS. The evidence for this is far from convincing. On a personal note I saw a psychiatrist for a couple of years (I have ME/CFS) and was prescribed three different SSRIs, amitryptaline, and an antipsychotic called respiridone. None of them helped at all. All three SSRIs and respiridone appeared to be completely inert, not helping any of my symptoms and at the same time not giving me any side-effects. Amitriptyline certainly knocked me out (so I guess that's classed as a successful sleep treatment) but left me extremely groggy in the morning even at very low doses and also resulted in worsening of memory function and concentration. These side-effects are common as this class of drugs blocks the action of acetylcholine, an important neurotransmitter.
The blogs and websites of psychiatrists I was reading also liked to repeat the standard line that cognitive behavioural therapy (CBT) and graded exercise therapy (GET) are the most effective treatments for fibromyalgia and ME/CFS. It may be true that there are clinical studies suggesting these therapies are helpful. In the real world however the evidence against them is damning. In the UK this summer patients and medical researchers aware of the biochemical basis of these illnesses went to court to make a stand against national guidelines advocating CBT and GET.
At the time Dr. Charles Shepherd, Medical Director of the M.E. Association, pointed out that the evidence for the effectiveness of these treatments remains weak and inconsistent, especially for group CBT sessions. Additionally, based on evidence submitted by CFS/ME patients themselves, the government's chief medical officer's report concluded that CBT produced "no change" in 67% of cases and actually made the patients' condition "worse" in 26% of cases. In addition, around half of the patients reported that inappropriate exercise therapy had also made their condition worse.
On a personal level I have tried both of these therapies. CBT made a lot of sense in theory but did not provide me with any significant improvement in my condition. It occurs to me that the positive studies on CBT may be due to the short term hope it may give patients. It is uplifting when you feel you can make positive changes to your life and this may bring about improvement in symptoms on its own but when lasting improvements fail to materialise symptoms worsen again. With regards to GET. It just doesn't work in my experience. Biochemical research shows that fibromyalgia and ME/CFS patients have problems with energy production at the cellular level. Patients can't increase their activity according to a GET schedule because the mitochondria in their cells are simply incapable of producing any more energy!
It's my personal experience as an ME/CFS sufferer that my illness is most certainly physical in origin. I have various lab tests (both conventional and those used in functional/integrative medicine) showing as much and with a passing knowledge of the symptoms of depression it is obvious to any fibromyalgia or ME/CFS patient that that is not what they are suffering from. I have gained no benefit from antidepressant drugs, CBT or GET. On the other hand I have gained a lot of benefit from treatments recommended by doctors working from the starting point of these illnesses being physical in origin (the same doctors psychiatrists seem to be accusing of "cashing in" on my suffering).
It is my hope that in the near future patients like myself will not be subjected to ignorance and useless 'therapies' recommended by psychiatrists, especially early in the disease process when the chances of more appropriate biochemical based treatments being successful are at their highest.
About: Matthew Hogg ("Maff")
Diagnosed with M.E./chronic fatigue syndrome aged only 11 years old and subsequently associated illnesses including irritable bowel syndrome (IBS) and multiple chemical sensitivity (MCS). Despite his own struggles he has constantly sought to educate and support others suffering from such "invisible illnesses" through his website, The Environmental Illness Resource. He fully recovered from MCS using his own approach and holds a Bachelor of Science Degree in Nutritional Health.