Programmed Symptoms: Disparate Effects United by Purpose

Abstract

Central sensitivity syndromes (CSS) share features of similar multiple symptoms, virtually unknown mechanisms and lack of effective treatments. The CSS nomenclature was chosen over alternatives because it focused on a putative physiological mechanism of central sensitization common to disorders such as fibromyalgia, irritable bowel syndrome, vulvodynia and temporomandibular disorder. Increasing evidence from multiple biological systems suggests a further development. In this new model central sensitization is part of a ensemble that includes also the symptoms of widespread pain, fatigue, unrefreshing sleep and dyscognition. The main feature is an intrinsic program that produces this ensemble to guide behavior to restore normal function in conditions that threaten survival. The well known “illness response” is a classic example that is triggered in response to the specific threat of viral infection. The major leap for this model in the context of CSS is that the symptom complex is not a reactive result of pathology, but a purposeful feeling state enlisted to combat pathology. Once triggered, this state is produced by potential mechanisms that likely include contributions of the peripheral and central immune systems, as well as stress response systems such as the autonomic system and the hypothalamic–pituitary–adrenal (HPA) axis. These act in concert to alter behavior in a beneficial direction. This concept explains similar symptoms for many triggering conditions, the poorly understood pathology, and the resistance to treatment.

Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial

“…These pathways can be modified and potentially reversed by creating new, corrective experiences, especially by encouraging patients to approach and experience rather than inhibit or avoid important emotions and interpersonal interactions. This perspective is consistent with the “stress intolerance and pain hypersensitivity syndrome model” of FM [59], as well as the “promoted or purposeful quiescence” theory, which suggests that FM reflects recuperative and avoidance behaviors that protect a person from psychological threat [26]. The current trial adds to other studies that attest to the value of therapies that directly target avoided emotional processes in people with pain and other somatic disorders [1,34], including written emotional disclosure [8,23], emotional processing of trauma [41], and enhanced emotional awareness [30] for FM.…”

Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification

“…This is consistent with the intriguing concept that overlapping pain conditions and underlying disruption of central pain regulatory systems are responses that are harnessed to combat pathology. 42 …”

Systemic Hyperalgesia in Females with Gulf War Illness, Chronic Fatigue Syndrome and Fibromyalgia

“…Prospective studies of veterans from other conflicts may identify subgroups with sudden onset of pain and systemic hyperalgesia, or more gradual progression after toxic or other military exposures. A comprehensive set of Common Data Elements 42 that assess this wide array of signs, symptoms and organ systems in an interdisciplinary fashion may provide much needed clinical understanding of the overlap between GWI, CFS, FM, sensitization syndromes, migraine, irritable bowel syndrome and affective disorders 1,3,17,34,[43][44][45][46][47] and insights into molecular pathophysiological mechanisms 6 .…”