Trauma – PTSD

Question:

"BaliKris" <balik…@aol.comzipspam> wrote in message

news:20020126035146.22762.00000387@mb-ml.aol.com… – Hide quoted text — Show quoted text -> Larry posted to a member here (me I think =) – thank you Larry! the following: > >>(PTSD masks a 21% incidence rate of FM. ) > So, the literature clearly shows a  ommonality, an overlap, or comorbidity > between the disorders. In fact, the medical community is beginning to consider > them to be manifestations of the same  underlying pathology.>>> > Thank you Larry, THIS is the thing I was asking about on the fibro group. You > worded this in a way that answered my questions very well and Risa’s follow up > (in light of my early onset abuse) gave me even more information to be armed > with for now and the future. > Thank you very much for the posts and I hope you can find what you read Risa. > Some of the muscular spasming is linked with the "bracing" people with PTSD > often do, kind of waiting for the next blow state. IT is horrible but I think > it is part of my own physical problems that lead to more pain. Good physical > therapy taught me (over a long time period) to check myself regularly for body > bracing. I know I’m sparing my muscles the lack of oxygen and overuse that goes > with the chemicals and oxygen involved with braced muscles. > All the information is much appreciated! > Kristine

Yes, it was for you, Kristine. And for everyone else, too. I didn’t want to name you specifically, until I saw that you yourself were comfortable with that. Doctors like to put us into diagnostic pigeon-holes, but we don’t always fit neatly into just one or another of those diagnoses. Moreover, the very definitions of each disease are artifical and arbitrary. Mother Nature doesn’t work like that. Seeing my IBS, fibromyalgia, PTSD, and major depression as expressions of one underlying disease state has helped me to find useful coping strategies that help all of them at the same time. You have to get your mind in the right place to do that. Best of luck, Kristine. Larry

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Thanks Larry =)

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Larry, I don’t know where the research is located to read about, but I do know that there is a high incidence of autoimmune disorders (Fibromyalgia, Rheumatoid Arthritis, Diabetes, Lupus) among people who were subjected to extreme, extended trauma during their early lives. It seems to be related to having the body on constant "alert" status for so long. I’ve read a few articles on this, but can’t remember where I got them from. If I find them again, I’ll post the link. Risa You should never say anything to a woman to even remotely suggest you think she’s pregnant unless you can see an actual baby emerging from her at that moment.

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Larry posted to a member here (me I think =) – thank you Larry! the following: >>(PTSD masks a 21% incidence rate of FM. )

So, the literature clearly shows a  ommonality, an overlap, or comorbidity between the disorders. In fact, the medical community is beginning to consider them to be manifestations of the same  underlying pathology.>>> Thank you Larry, THIS is the thing I was asking about on the fibro group. You worded this in a way that answered my questions very well and Risa’s follow up (in light of my early onset abuse) gave me even more information to be armed with for now and the future. Thank you very much for the posts and I hope you can find what you read Risa. Some of the muscular spasming is linked with the "bracing" people with PTSD often do, kind of waiting for the next blow state. IT is horrible but I think it is part of my own physical problems that lead to more pain. Good physical therapy taught me (over a long time period) to check myself regularly for body bracing. I know I’m sparing my muscles the lack of oxygen and overuse that goes with the chemicals and oxygen involved with braced muscles. All the information is much appreciated! Kristine

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I noticed one of our regulars posting on the fibromyalgia group, and asking about the relationship between these disorders. In my humble opinion, there is not clear line between the stress disorders. Symptoms are not that neatly arranged that we can say "this is this" and "that is that". The question arose on alt.med.fibromyalgia a couple months ago, and I dug up these papers to show that blurry distinction. Maybe it will help someone here to look at this a little bit. Regards, Larry Clin J Pain 2000 Jun;16(2):127-34 Prevalence and impact of posttraumatic stress disorder-like symptoms on patients with fibromyalgia syndrome. Sherman JJ, Turk DC, Okifuji A. Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA. jeffr…@u.washington.edu OBJECTIVE: Traumatic events can result in a set of symptoms including nightmares, recurrent and intrusive recollections, avoidance of thoughts or activities associated with the traumatic event, and symptoms of increased arousal such as insomnia and hypervigilance. These posttraumatic stress disorder (PTSD)-like symptoms are frequently observed in persons with chronic pain syndromes. Little is known about how these two phenomena interact with one another. The present study evaluated PTSD-like symptoms in patients with fibromyalgia syndrome (FMS) and examined the relation between PTSD-like symptoms and problems associated with FMS. DESIGN: Ninety-three consecutive patients underwent a comprehensive FMS evaluation and completed self-report questionnaires measuring PTSD-like symptoms, disability, and psychosocial responses to their pain condition. Subjects were divided in two groups based on level of self-reported PTSD-like symptoms. RESULTS: Approximately 56% of the sample reported clinically significant levels of PTSD-like symptoms (PTSD+). The PTSD+ patients reported significantly greater levels of pain (p < 0.01), emotional distress (p < 0.01), life interference (p < 0.01), and disability (p < 0.01) than did the patients without clinically significant levels of PTSD-like symptoms (PTSD-). Over 85% of the PTSD+ patients compared with 50% of the PTSD- patients demonstrated significant disability. Based on response to the Multidimensional Pain Inventory, a significantly smaller percentage of PTSD+ patients were classified as adaptive copers (15%) compared with the PTSD- group (48.2%). CONCLUSIONS: Results suggest that PTSD-like symptoms are prevalent in FMS patients and may influence adaptation to this chronic illness. Clinicians should assess the presence of these symptoms, as the failure to attend to them in treatment may impede successful outcomes. J Psychosom Res 1997 Jun;42(6):607-13 Posttraumatic stress disorder, tenderness and fibromyalgia. Amir M, Kaplan Z, Neumann L, Sharabani R, Shani N, Buskila D. Department of Behavioral Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Ma…@Bgumail.bgu.ac.il The aims of the present study were to inquire into the prevalence of fibromyalgia syndrome, to assess nonarticular tenderness, to measure fibromyalgia syndrome-related symptoms, quality of life, and functional impairment among posttraumatic stress disorder (PTSD) patients as compared with control subjects. Furthermore, the differences between the PTSD patients with and without fibromyalgia syndrome were studied. Twenty-nine PTSD patients and 37 control subjects were assessed as to the diagnosis of fibromyalgia syndrome according to the American College of Rheumatology. Tenderness was assessed manually and with a dolorimeter. Fibromyalgia syndrome-related symptoms, quality of life, physical functioning, PTSD symptomatology, and psychiatric features were assessed by valid and reliable self-report inventories. Results showed that the prevalence of fibromyalgia syndrome in the PTSD group was 21% vs. 0% in the control group. Furthermore, the PTSD group was more tender than the control group. PTSD subjects suffering from fibromyalgia syndrome were more tender, reported more pain, lower quality of life, higher functional impairment and suffered more psychological distress than the PTSD patients not having fibromyalgia syndrome. It is suggested that previous reports on diffuse pain in PTSD in fact described undiagnosed fibromyalgia syndrome. The link between psychological stress and pain syndromes is emphasized. (PTSD masks a 21% incidence rate of FM. ) So, the literature clearly shows a commonality, an overlap, or comorbidity between the disorders. In fact, the medical community is beginning to consider them to be manifestations of the same underlying pathology. Consider: Psychoneuroendocrinology 2000 Jan;25(1):1-35 The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Heim C, Ehlert U, Hellhammer DH. Center for Psychobiological and Psychosomatic Research, University of Trier, Germany. Representing a challenge for current concepts of stress research, a number of studies have now provided convincing evidence that the adrenal gland is hypoactive in some stress-related states. The phenomenon of hypocortisolism has mainly been described for patients, who experienced a traumatic event and subsequently developed post-traumatic stress disorder (PTSD). However, as presented in this review, hypocortisolism does not merely represent a specific correlate of PTSD, since similar findings have been reported for healthy individuals living under conditions of chronic stress as well as for patients with several bodily disorders. These include chronic fatigue syndrome, fibromyalgia, other somatoform disorders, rheumatoid arthritis, and asthma, and many of these disorders have been related to stress. Although hypocortisolism appears to be a frequent and widespread phenomenon, the nature of the underlying mechanisms and the homology of these mechanisms within and across clinical groups remain speculative. Potential mechanisms include dysregulations on several levels of the hypothalamic-pituitary adrenal axis. In addition, factors such as genetic vulnerability, previous stress experience, coping and personality styles may determine the manifestation of this neuroendocrine abnormality. Several authors proposed theoretical concepts on the development or physiological meaning of hypocortisolism. Based on the reviewed findings, we propose that a persistent lack of cortisol availability in traumatized or chronically stressed individuals may promote an increased vulnerability for the development of stress-related bodily disorders. This pathophysiological model may have important implications for the prevention, diagnosis and treatment of the classical psychosomatic disorders. Med Hypotheses 2001 Aug;57(2):139-45 Common etiology of posttraumatic stress disorder, fibromyalgia, chronic fatigue syndrome and multiple chemical sensitivity via elevated nitric oxide/peroxynitrite. Pall ML. School of Molecular Biosciences and Program in Medical Sciences, Washington State University, Pullman, 99164-4660, USA. p…@mail.wsu.edu Three types of overlap occur among the disease states chronic fatigue syndrome (CFS), fibromyalgia (FM), multiple chemical sensitivity (MCS) and posttraumatic stress disorder (PTSD). They share common symptoms. Many patients meet the criteria for diagnosis for two or more of these disorders and each disorder appears to be often induced by a relatively short-term stress which is followed by a chronic pathology, suggesting that the stress may act by inducing a self-perpetuating vicious cycle. Such a vicious cycle mechanism has been proposed to explain the etiology of CFS and MCS, based on elevated levels of nitric oxide and its potent oxidant product, peroxynitrite. Six positive feedback loops were proposed to act such that when peroxynitrite levels are elevated, they may remain elevated. The biochemistry involved is not highly tissue-specific, so that variation in symptoms may be explained by a variation in nitric oxide/peroxynitrite tissue distribution. The evidence for the same biochemical mechanism in the etiology of PTSD and FM is discussed here, and while less extensive than in the case of CFS and MCS, it is nevertheless suggestive. Evidence supporting the role of elevated nitric oxide/peroxynitrite in these four disease states is summarized, including induction of nitric oxide by common apparent inducers of these disease states, markers of elevated nitric oxide/peroxynitrite in patients and evidence for an inductive role of elevated nitric oxide in animal models. This theory appears to be the first to provide a mechanistic explanation for the multiple overlaps of these disease states and it also explains the origin of many of their common symptoms and similarity to both Gulf War syndrome and chronic sequelae of carbon monoxide toxicity. This theory suggests multiple studies that should be performed to further test this proposed mechanism. If this mechanism proves central to the etiology of these four conditions, it may also be involved in other conditions of currently obscure etiology and criteria are suggested for identifying such conditions.

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