Ulrich Tiber Egle

Fibromyalgia: a stress disorder? Piecing the biopsychosocial puzzle together

Fibromyalgia (FM) is a controversial syndrome, characterised by persistent widespread pain, abnormal pain sensitivity and additional symptoms such as fatigue and sleep disturbance. The syndrome largely overlaps with other functional somatic disorders, particularly chronic fatigue syndrome (CFS). Although the exact aetiology and pathogenesis of FM are still unknown, it has been suggested that stress may play a key role in the syndrome. This article first reviews the function of the stress response system, placing special emphasis on the relationships between adverse life experiences, stress regulation and pain-processing mechanisms, and summarising the evidence for a possible aetiopathogenetic role of stress in FM. Finally, an integrative biopsychosocial model that conceptualises FM as a stress disorder is proposed, and the clinical and research implications of the model are discussed.

Childhood adversities in patients with fibromyalgia and somatoform pain disorder.

Primary fibromyalgia is regarded as disorder with a complex symptomatology, and no morphological alterations. Findings increasingly point to a dysfunction of the central nervous pain processing. The study aims to discuss vulnerability for fibromyalgia from a developmental psychopathological perspective. We investigated the presence of psychosocial adversities affecting the childhood of adult fibromyalgia patients (FM) and compared them to those of patients with somatoform pain disorders (SOM) and a control group (CG) with medically explained chronic pain. Using the structured biographical interview for pain patients (SBI‐P), 38 FM patients, 71 SOM patients, and 44 CG patients were compared on the basis of 14 childhood adversities verified as relevant regarding longterm effects for adult health by prospective studies. The FM patients show the highest score of childhood adversities. In addition to sexual and physical maltreatment, the FM patients more frequently reported a poor emotional relationship with both parents, a lack of physical affection, experiences of the parents’ physical quarrels, as well as alcohol or other problems of addiction in the mother, separation, and a poor financial situation before the age of 7. These experiences were found to a similar extent in the SOM patients, but distinctly less frequently in the CG. The results point to early psychosocial adversities as holding a similar etiological meaning in fibromyalgia as well as in somatoform pain disorders. The potential role of these factors as increasing the vulnerability for fibromyalgia is discussed.

Quality of life in patients with bladder carcinoma after cystectomy: First results of a prospective study

This study reports the changes in the quality of life (QoL) of 44 patients observed prospectively from pre-surgery to one year post-surgery. Two kinds of surgeries were compared: continent and incontinent urinary diversion. In most areas the QoL returned to the prior level within one year after surgery. However, patients were restricted in their physical activity, sexual activity, and emotional well-being. Using individual weights for different aspects of life (Fragen zur Lebenszufriedenheit – Module FLZM), QoL was higher than when using an unweighted measurement (Short Form 36, MOS). Two trends for the different developments in the QoL were established: general life satisfaction and social functioning tended to improve after a continent diversion but decreased after an incontinent diversion. The perceived global satisfaction with both kinds of diversion was high – 75% of the patients would choose the same kind of diversion again.

Reliability of retrospective assessments of childhood experiences in Germany

The retrospective assessment of adverse childhood experiences is a widely used technique. Few studies report heterogeneous results about the reliability and objectivity. A sample of 100 patients was independently interviewed by means of the Mainz Structured Biographical Interview by two different interviewers with mean time lag of 2.2 years. Reliability of reports of family situation, physical abuse, sexual abuse, and protective factors was assessed. The results show moderate to good reliability for most childhood experiences. Divorce/separation of parents had a &kgr; of .95, severe sexual abuse a &kgr; of .64, and regular harsh physical abuse a &kgr; of .56; protective factors were in the .50 range. The key features for obtaining good reliability seem to be the concreteness of the question and accuracy of the coding categories. There is some, but little, evidence that sensitive issues such as sexual abuse are more prone to errors in assessment than simple ones.

Observer independent analysis of cerebral glucose metabolism in patients with chronic fatigue syndrome

Objectives: To evaluate cerebral glucose metabolism, assessed by 18-fluorodeoxyglucose positron emission tomography (FDG-PET), in patients with chronic fatigue syndrome (CFS), using an observer independent analytical approach; and to characterise any observed alterations by correlating them with neuropsychological deficits. Methods: 26 patients (13 female, 13 male) were examined. They all fulfilled the CDC diagnostic criteria for CFS. Their ages ranged from 26 to 61 years (mean (SD) age, 43 (9.3) years). They underwent extensive psychometric testing including the hospital anxiety and depression scale (HADS) and the short form 36 item health questionnaire (SF-36). Brain FDG-PET was done in all the subjects. After stereotactic normalisation, single subject comparisons with an age and sex matched normal database (n = 18) and a group comparison between the patients and normal controls were undertaken, along with additional correlation analyses between brain metabolism and psychometric test scores. Results: 12 of the 26 patients showed no significant decrease in FDG uptake compared with the controls. Of the remaining 14, 12 showed hypometabolism bilaterally in the cingulate gyrus and the adjacent mesial cortical areas. Five of these 12 patients also had decreased metabolism in the orbitofrontal cortex. The two remaining patients had hypometabolism in the cuneus/praecuneus. Correlation analyses showed significant correlations between some test scores (anxiety, depression, health related quality of life) but not fatigue and regional reductions in glucose metabolism. Conclusions: Although abnormalities in FDG-PET were only detectable in approximately half the CFS patients examined, and no specific pattern for CFS could be identified, PET may provide valuable information in helping to separate CFS patients into subpopulations with and without apparent alterations in the central nervous system.

Determinants of health-related quality of life in patients with persistent somatoform pain disorder

Background. Health‐related quality of life (HRQOL) has been investigated widely in patients with chronic pain, but no study has focused particularly on the situation of patients with persistent somatoform pain disorder.

Prevalence of psychiatric disorders in an onset cohort of adults with type 1 diabetes

Previous studies indicate a high prevalence of psychiatric disorders in adults with type 1 diabetes mellitus. The aim of our study was to determine if newly diagnosed adults with type 1 diabetes already have an elevated rate of psychiatric disorders at the beginning of their physical illness.

Are childhood adversities relevant in patients with chronic low back pain

Previous studies have found a high number of childhood adversities in patients with chronic low back pain, particularly in patients reporting persisting problems after back surgery. Our aim was to reproduce these results.

Stress as a Key Concept in Chronic Widespread Pain and Fatigue Disorders

ABSTRACT. Objectives: To review recent studies on the etiopathogenetic role and clinical relevance of life stress in medically unexplained syndromes characterized by chronic widespread musculoskeletal pain and fatigue. Findings: Both fibromyalgia syndrome [FMS] and chronic fatigue syndrome [CFS] have been found to be frequently linked to different stressors, such as negative life events, occupational problems, posttraumatic stress [PTSD], adverse childhood experiences, and “overactive” lifestyle. In addition, the stress-modulating role of affect-regulation, perceptual-cognitive factors, and social support, as well as the relationship with depression have been investigated in FMS/CFS patients. However, methodological pitfalls and uncertainties about the neurobiological underpinnings of stress-related pain and fatigue prohibit definite conclusions from this research. Despite these limitations, the working hypothesis of “stress-system dysregulation” could be used in clinical practice with FMS/CFS patients as a valuable illness theory implying multiple handles for pragmatic help. Conclusions: Further investigations, based on new theoretical stress-paradigms and sophisticated research strategies connecting psychological and neurobiological stress parameters, are needed to enhance our knowledge of the role of life stress in chronic widespread pain and fatigue disorders.

Was misst der FKV

Zusammenfassung. Theoretischer Hintergrund: Der Fragebogen zur Krankheitsverarbeitung (FKV-LIS; Muthny, 1989) ist ein im deutschsprachigem Raum haufig eingesetzter Fragebogen zur Messung von Krankheitsbewaltigung. Fragestellung: Das Ziel der vorliegenden Studie ist die Uberprufung der Subskalen-Reliabilitat und -Spezifitat bei unterschiedlichen Erkrankungsgruppen. Methode: Die Gutekriterien der FKV-LIS Skalen werden bei Patienten mit chronisch-entzundlichen Darmerkrankungen (n = 1265), Typ-I-Diabetes (n = 552) oder Harnblasenkarzinom (n = 81) berechnet. Konvergente und divergente Trennscharfen der einzelnen Items werden analysiert. Ergebnisse: “Aktive Bewaltigung“ und “Depressive Verarbeitung“ zeigen hinreichende psychometrische Kennwerte, wahrend die weiteren Skalen nicht beibehalten werden konnten. Eine modifizierte FKV-Version mit 15 Items und verbesserter psychometrischer Qualitat wird vorgeschlagen. Schlussfolgerung: Der FKV-LIS bildet zwei wesentliche Bewaltigungsdimensionen bei Patienten mit unters...