Liebe Forumteilnehmer, hier folgt der 2.Teil.
Die Literaturliste würde ich auf direkte Anfrage versenden.
Außerdem erhielt ich noch ein Interview mit Prof. Charles E.Argoff, Universität Massachusetts , und Prof. Jonathan Kay zum Thema: Is fibromyalgia real?
Beide sind für die Pharma-Industrie tätig.
Auch sie behaupten, dass es keine klare Krankheitseinheit gibt, dass häufig posttraumatische Belastungsstörungen, nach sexueller Traumatisierung, als Ursache angeschuldigt werden und dass Psychopharmaka sich bewährt haben.
Argoff hebt als Gemeinsamkeit der Störung die herabgesetzte Schmerzschwelle hervor, außerdem Fatigue und Schlafstörungen. Er meint, dass als Folge von sexuellem Missbrauch zahlreiche Störungen auftreten könnten, u.a. Autoimmunstörung.
Kay widerspricht der These von Argoff, dass Autoimmunstörungen eine Folge von sexuellem Missbrauch seien, und betont, dass bei den Störungen wie Asthma und Reizdarmsyndrom (die oft mit FM zusammen auftreten) sich keine Autoantikörper nachweisen ließen.
Nun, Autoantikörper bei Fibromyalgie hat man bisher nicht gefunden....
Vielleicht ist sexueller Missbrauch viel häufiger als gedacht und die Korrelation ist zufällig?
Nichts Genaues weiss man nicht!
miriam
Fortsetzung des Textes aus der vorigen Mail:
A neurologist pointed out the possible connection between digestive disease
and neuropathy,[7] which again has been linked to fibromyalgia: "Celiac
disease (CD) is increasingly recognized in North America and is associated
with a peripheral neuropathy. Patients with CD may have a neuropathy
involving small fibers, demonstrated by results of skin biopsy." An MD
responded, "Maybe celiac disease with peripheral neuropathy [is] the
diagnosis instead of fibromyalgia.".
How About Medications?
"Many times a medication is at fault. Check patients for previous uses of
fluoroquinolones such as Cipro® [ciprofloxacin], Levaquin® [levofloxacin],
Avelox® [moxifloxacin]," wrote one reader, prompting a family physician to
concur, "A good doctor needs to rule out drug induced pain. For some
patients diagnosed with fibromyalgia, a history of chronic use of
benzodiazepines, Z drugs, and narcotics is associated with the development
of tolerance and chronic pain....I have tapered many patients from these
drugs and have found them able to recover from chronic pain."
Things Heat Up: Why the Sexism?
Unfortunately, with chronic pain care can come extreme frustration and ill
will toward patients, and a number of skeptical treaters weren't afraid to
share their, at times, strong opinions. "The [fibromyalgia] patient will
describe her pain and suffering (with their eyes closed) with such a
dramatic performance that it suggests an Academy Award nomination," said one
particularly forthcoming physician, adding, "Seeing just one of these
unfortunate patients can surely ruin your day."
Not surprisingly, such opinions drew displeased reactions. One reader
responded, "As both a nurse and a 10-year sufferer of fibromyalgia, I find
your comments appalling," whereas many others pleaded for a civil
discussion. Unfortunately, numerous readers believe that sexism still looms
gray over fibromyalgia care.
A nurse commented, "I recently overheard a male rheumatologist telling a
male colleague in front of a group of med students how he had tricked a
female patient while examining her for trigger points on her back by
touching them lightly without telling her or asking if she felt anything. He
was proud of it. He was [also] saying that fibromyalgia was female hysteria
[and] fictitious. I was appalled." Still another justifiably irritated nurse
reported having a fibromyalgia-like syndrome which her male doctor referred
to as "tired housewife syndrome."
A number of patients chimed in with less-than-positive recounts as well. One
fibromyalgia sufferer wrote, "Some physicians have told me that it is all in
my head, albeit in a degrading fashion." Another patient pleaded, "The time
has come for physicians to recognize these illnesses apart from the
psychosomatic garbage that has been propagated," whereas another added, "For
those male physicians ridiculing patients, your disrespect may come back to
haunt you. What will you do if/when an infectious agent is found to cause
fibromyalgia? Remember when ulcers were caused by stress and not H pylori?"
Whether or not the mystery is solved anytime soon, hopefully whatever
unfortunate misogyny does exist in the medical community will subside as our
understanding of the condition improves.
Where Does This Leave Us?
Not surprisingly, in the end reader consensus was lacking. We were left with
an assortment of theories, conflicting etiologies and symptoms, and severe
brain drain from trying to piece it all together.
One reader wrote, "Sadly, as a result of reading this and comments, [I
realize] we are nowhere near a clinical case definition [of fibromyalgia]."
"This discussion has demonstrated the chasm between physicians and the
patients themselves," another reader added. Furthermore, "Physicians have
expressed frustration. Patients with medical training have expressed equal
frustration and disgust at some of the responses."
On a slightly more optimistic note, one MD concluded, "[This discussion]
shows that medicine is still an art rather than a science. Sometimes
emphasizing what we don't know helps us grow as clinicians."
We agree; there is a bright side here. There are effective fibromyalgia
therapies, albeit they are few in number. There's a discourse, and there are
researchers worldwide probing the complexities of this puzzling disorder.
Hopefully somewhere in this web of pain, sleep, diets, and deficiencies
there's an answer.