Topic: Washington Post Article - Why Does It Still Hurt?...Promising new "Treatment"
lymednva
Frequent Contributor (1K+ posts)
Member # 9098
posted
When I saw the headline I wanted to scream. The following article is on the front of the Washington Post Health Section today.
Why Does It Still Hurt, Doc? For Some Patients Stumped by Unexplained Physical Symptoms, Answers Are Elusive. Now There's a Promising Treatment: Cognitive Therapy.
By Sandra G. Boodman Washington Post Staff Writer Tuesday, August 29, 2006; HE01
They regularly visit doctors' offices complaining of baffling combinations of symptoms for which no medical cause can be found: chest pain one month, gynecologic problems the next, followed by headaches or crushing fatigue.
Hospital staff privately refer to them as "crocks" -- people who repeatedly show up in emergency rooms demanding expensive, exhaustive tests to unearth the elusive cause of their numerous symptoms. Reassurance that their tests don't show anything amiss has the opposite effect, convincing these patients that physicians haven't looked hard enough -- or don't believe them.
While everyone at some point experiences symptoms for which no cause is found, patients who have what is known as somatization disorder suffer from a host of disabling problems. Most are women who develop the lifelong disorder during adolescence.
It's impossible to accurately determine how many patients have somatization disorder, although the problem "probably occurs on a continuum and accounts for many, many doctor visits," said Lesley Allen, an associate professor of psychiatry at the University of Medicine and Dentistry of New Jersey.
Between 0.2 and 2 percent of Americans have sufficient symptoms to fit psychiatry's strict definition of somatization disorder, but Allen and other experts say the problem, which frustrates patients and their doctors, frequently goes undiagnosed. To further complicate matters, about 40 percent of these patients also suffer from a related disorder, hypochondria -- a persistent, irrational fear of serious illness.
Fearful of being dismissed as crazy or fakers, patients typically shun mental health practitioners and spend years bouncing from doctor to doctor, undergoing expensive diagnostic workups and even surgery to alleviate their pain. One study found that patients with the disorder incur medical expenses that are six to 14 times higher than the national average.
Now Allen and her colleagues, and researchers at Michigan State University, appear to have demonstrated an effective treatment for somatization: cognitive behavioral therapy (CBT), which teaches patients practical skills to help manage their symptoms. Both teams last month published randomized, controlled studies showing that CBT coupled with supportive counseling, relaxation techniques, moderate exercise and in some cases antidepressants diminished the severity of their symptoms.
The patients' ability to function, as measured by the number of stairs they could climb and the distance they could walk, was improved, and they reported being less troubled by 40 symptoms, including headaches, nausea, joint pain and difficulty swallowing.
"It's not a cure," said Allen, whose study, funded by the National Institute of Mental Health, appears in the July 24 issue of the Archives of Internal Medicine.
Allen and her colleagues recruited 84 patients between 18 and 70 years of age who had been diagnosed with somatization disorder. Half received 10 weekly sessions of cognitive treatment while the rest did not. Fifteen months after they started treatment, all patients were evaluated by researchers who did not know which ones had received CBT.
Forty percent of the 17-member CBT group were deemed "very much improved" or "much improved" using a widely accepted rating scale, compared with 5 percent, or two members, of the control group.
In the Michigan State study -- published in the Journal of General Internal Medicine -- 100 patients treated for a year with cognitive therapy and antidepressants were nearly twice as likely to show improvement in their level of functioning and decreased use of medical services as a similar number who did not receive therapy.
Norman Jensen, an emeritus professor of internal medicine at the University of Wisconsin and an expert in treating such patients, called Allen's study "very important and very encouraging" because it is one of the first to demonstrate that cognitive therapy works for patients whose disorder has been considered largely untreatable.
Dealing with such patients "is a pain in the butt for doctors," said Jensen, who treats them. "Many people suffer enormously from it, and their doctors waste millions of health care dollars" in futile attempts to diagnose their problems.
"These people alienate themselves from friends and family with their discussion of their constant symptoms," Jensen added. "They tend to be very lonely and isolated."
Wired for Pain?
These patients, Jensen and other experts say, are much more focused on their bodies than other people and much less able to ignore or accept what others regard as normal aches and pains. One theory, so far unproven, is that their nervous systems are hypersensitive.
Fairfax psychiatrist Thomas N. Wise, editor of the journal Psychosomatics, said primary care doctors typically see these patients. "Psychiatrists rarely see these folks because they're so focused on a medical explanation," said Wise, a professor of psychiatry at the Georgetown and Johns Hopkins medical schools. But, he added, it's important for doctors who can't pinpoint a physical cause not to assume one doesn't exist or that the pain isn't real.
Composer George Gershwin, Wise recalled, was told by a phalanx of New York's most eminent doctors that his splitting headaches were the product of his neuroses. In fact, they were caused by a malignant brain tumor that killed the 38-year-old composer in 1937.
Arthur Barsky, a professor of psychiatry at Harvard Medical School and expert on medically unexplained symptoms, said he considers cognitive therapy essential.
"I focus on the way people think about their symptoms and try to decrease their hyper-vigilance," said Barsky, who has published studies of both somatization and hypochondria. He teaches patients to stop scrutinizing how fast their heart is beating, for example, to quit touching their neck to see if a lymph node is swollen, and to avoid searching the Internet for clues to their symptoms.
Barsky advises patients to substitute those preoccupations with a pleasurable or distracting activity. Patients who succeed tell him that they are still aware of the physical problem -- that lump in their throat, for example -- but tend not to think about it and consider it less bothersome.
Cognitive behavioral therapy is aimed at reducing specific symptoms by challenging the dysfunctional, irrational thoughts that helped create and perpetuate them. Among the thoughts commonly expressed by somatizing patients: "This is never going to go away" and "I'm never going to be able the live the life I want," said New Jersey's Allen. Treatment involves exploring and then changing those thoughts, which in turn ameliorate symptoms.
Most experts say that many patients with unexplained symptoms have histories of childhood physical or sexual abuse or other trauma, but it is not clear whether these are related.
"Childhood experiences are presumably important," Barsky said, "but there are no good data" about their effect.
Another goal, Allen said, is to explore the "secondary gain" patients derive from illness -- the unconscious benefit that accrues from being a patient.
"A lot of people adopt the sick role," she said, and receive more attention from their husbands or other family members when they are in pain.
Allen and others say that a major obstacle in treatment is patients' singular lack of insight into their own problems.
"It's a big struggle in treatment," Allen said. "When you ask, 'What are you thinking? What are you feeling?' the answer tends to be, 'I don't know.' "
Looking for Trouble
One danger such patients face, said Fairfax's Wise, is the natural inclination of doctors to order tests, prescribe medicines and perform procedures out of a fear of missing a serious medical problem. Such interventions, he warned, carry their own risks.
Jensen said he vividly remembers one such patient, whom he treated for 28 years. She was referred to him by a surgeon who had refused to operate on her for abdominal pain because he couldn't find an organic cause.
Jensen said he began seeing the woman every month or two for 20 minutes but ordered tests sparingly and only if he suspected something new was wrong -- an approach first outlined by a psychiatrist in a New England Journal of Medicine article in 1986. Mostly, he said, he listened carefully and provided brief reassurance.
"She felt like we had a partnership, and we developed a certain personal fondness for each other," Jensen recalled. "She trusted that I wouldn't overlook or over-treat her."
But once when Jensen was on vacation, the woman went to an emergency room complaining of chest pain, one of her frequent symptoms. A physician unfamiliar with her history discovered a partially blocked artery and, assuming this was causing her pain, performed a cardiac catheterization.
During the procedure, the woman suffered a heart attack. She developed heart failure as a result and was dead within the year. She complained of chest pain until the day she died. �
posted
Be nice if somatization wasn't just a frequent excuse for physician ignorance as to the real underlying cause. This is how you get rid of tiresome patients you can't figure out either because the science isn't there or doctor incompetence. I wonder if there is a correlation between the decreasing time in appts with doctors and the diagnosis of somatization? I predict a positive correlation.
Posts: 8430 | From Not available | Registered: Oct 2000
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treepatrol
Honored Contributor (10K+ posts)
Member # 4117
posted
This big study just tells me that these people are being led to the slaughter.
Because these Drs think that there not quite right in the head its all in there mind!
The following wasnt in her mind it was a blocked artery
This dr I say lightly
Look here: Jensen said he began seeing the woman every month or two for 20 minutes but ordered tests sparingly and only if he suspected something new was wrong -- an approach first outlined by a psychiatrist in a New England Journal of Medicine article in 1986. Mostly, he said, he listened carefully and provided brief reassurance.
"She felt like we had a partnership, and we developed a certain personal fondness for each other," Jensen recalled. "She trusted that I wouldn't overlook or over-treat her."
But once when Jensen was on vacation, the woman went to an emergency room complaining of chest pain, one of {{{her frequent symptoms}}}. A physician unfamiliar with her history discovered a {{{partially blocked artery and, assuming this was causing her pain, performed a cardiac catheterization}}}.
During the procedure, the {{{woman suffered a heart attack. She developed heart failure as a result and was dead within the year. She complained of chest pain until the day she died.}}}
Well maybe if this had been performed years earlier she wouldnt have suffered a heart attack
How F n Blind are these people!!!!!!!!!!!
Iam just about ready too take matters into my own hands.
ps perminant adjustment
-------------------- Do unto others as you would have them do unto you. Remember Iam not a Doctor Just someone struggling like you with Tick Borne Diseases.
treepatrol
Honored Contributor (10K+ posts)
Member # 4117
posted
Iam so sick of these self rightous pieces of chit Harvard,Yale, etc trained my butt Iam SO Infuriated by these self rightous Iam God know it all's they swim in there own excrement and cant even smell it!
At the same time destroying good people mostly. I cant wait for judgement day when God has these people there Iam No angel! but I sure would like to see it.
There wont be any bullchit there's No bluffing the Creator.
Maybe he will give them what they caused to continue! too them the self rightous for the same amount of years quite even punishment huh?
Just think all the crap they have put out and they will have to spend in turn each life destroyed taken.
Stand in for each one of us one at a time for as many years as it takes.
Iam pretty MAD
-------------------- Do unto others as you would have them do unto you. Remember Iam not a Doctor Just someone struggling like you with Tick Borne Diseases.
posted
It is hard not to project myself onto this as if it is me.
Because, it is not.
If I indeed did have somatozation disorder, I would be happy for the help to heal it, even if it were cognitive thereapy that were offered.
This is very sensitive to those of us who have struggled with real illness, and on top of it, one that can indeed progress to a psychiatric manifestation...
who cares if it is neurobio spirochette in its cause.
The main thing is (and I did not read this entire article), if there is a tone
of isolation in the article itself...
condemning such patients that indeed are likely to exist,
wouldn't this further lend itself to
a personal isolation?
I am very open to considering the mental aspect of lyme disease.
All I want is real help.
Ignorance and non compassion run rampant in humanity and vengeance does nothing to help solve it.
treepatrol
Honored Contributor (10K+ posts)
Member # 4117
posted
Its a good thing I believe in God and know he would rather I wait on him.
-------------------- Do unto others as you would have them do unto you. Remember Iam not a Doctor Just someone struggling like you with Tick Borne Diseases.
valymemom
Frequent Contributor (1K+ posts)
Member # 7076
posted
I am glad I did not read the Post today. I wish any one of our local llmds would respond to this. So many undiagnosed folks.
Just recently I heard of a local gal who was seeing our primary for a length of time. (Within the past year this physician has starting testing for lyme thru Igenex.) Turns out this patient has lyme!!!!! (It was another lymenet poster who a year ago urged this doctor to test her loved one thru Igenex.)
Posts: 1240 | From Centreville,VA | Registered: Mar 2005
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Aniek
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Member # 5374
posted
Replace "somatization" with "hysteria." More women than men. Onset in adolescence.
Cognitive therapy would probably reduce symptoms in most people with chronic illness. It takes the mind off the illness.
We know relaxation reduces pain. I feel best when I'm busy. Duh!
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
This is a by product of the power that our society gives to doctors AND the lack of training that they get in medical school. Society in general puts them on a pedestal and they are rewarded with money and respect, whether they deserve it or not.
Doctors spend a lot of time learning to become a doctor and are not balanced in their social developement. Lack of maturity and power don't go well together.
Also, the way medical schools train doctors is lacking in some of the basic skills that they need in order to be good doctors. They do not have the training to think logically so unless that comes naturally, (which is rare), they do not have the ability to effectively problem solve. I have been utterly shocked at the sheer lack of logical thinking that many doctors openly display.
Many people mistakenly think that medical science is much more advanced than it is. That if the doctor can't figure it out, then it doesn't exist so it must all be in your mind. A doctor is expected to know all the answers. Doctor's themselves buy into this.
Essentially, we have egotistical people with incomplete training and a lack of maturity. It's no surprise that they come up with some bogus diagnosis to excuse the fact that they can't figure out what is wrong.
That said, we all know that there are many exceptions to this characterization because there are good doctors out there who are compassionate and caring and have the ability to put their ego aside. If there weren't, we would not have LLMD's and others who put themselves on the line to help us. Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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lymednva
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Valymemom that's a great idea. I'm emaling said LLMD to be sure he saw this and ask him to respond to it.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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posted
I know I am having a bad day but every time I read the word somatozation I read it as sodomization, some take from a more acurate word I am thinking of.
Posts: 106 | From Texas | Registered: Jun 2005
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lymednva
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Member # 9098
posted
Well, my LLMD has now received a link to the article as well as an email from me suggesting it would be helpful if physicians who treat patients who have illnesses that do not show up on lab tests would respond to the article.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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Carol in PA
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Member # 5338
posted
My sister had a friend with a connective tissue disorder, and after being ill for many years, she died from a heart attack.
My sister was unable to attend the funeral, but a friend who went told her that another woman commented that the deceased had been such a hypochondriac.
Yikes, how sick do you have to be before someone believes you?
Carol
Posts: 6956 | From Lancaster, PA | Registered: Feb 2004
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trails
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Yes lymednva!-- there ARE many illnesses (besides lyme) that can not be detected by tests or scans. And many have vague symptoms. And many have etiologies that are NOT psychological.
Tree--I am just as angry as you are about this!---dumb docs could have saved the woman if they had LISTENED to her and HAD tried new approaches and didnt pigeon hole as a complainer, but took her seriously and saw that she had HEART DISEASE. grrrrrr
I love what you wrote painted turtle. I feel very much like you do. I dont have the words as clearly as you do, that was really well written.
I wish a good shrink would make me feel better. It would be a lot cheaper and a LOT less painful.
And I also agree with Aniek-- the only point I agree with in this article is that taking your mind off your pain and your body CAN help reduce your percieved amount of pain. We learned that, what in the 1940's???
This article is an attack on women and could have been written 50 years ago. Posts: 1950 | From New Mexico | Registered: Sep 2001
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posted
An opportunity to shed light on lyme! Write Ms. Boodman and encourage her to investigate mysterious sources of pain, such as...LYME DISEASE! Who knows? She just might pursue. There are enough of us in the DC area that she could gather plenty of material.
Maybe it is best that the patients take on the media and let the doctors take on the medical community. Much safer for them too. They really have to be careful what they say publicly.
If you will write her, I will! If you want to email, you can do it through the Post's website. If you want to be sure it goes directly to her, register, go to feedback, look for link to staffwriters' email.
Posts: 422 | From Herndon, Virginia | Registered: Oct 2005
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valymemom
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Member # 7076
posted
A good point, lymeout! Let's write her.
Posts: 1240 | From Centreville,VA | Registered: Mar 2005
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posted
Yep, this is disgusting indeed....Is this the year 2006???? or 1956????
----------------
hey foggedup...
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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Aniek
Frequent Contributor (1K+ posts)
Member # 5374
posted
quote:Originally posted by Lymetoo: Yep, this is disgusting indeed....Is this the year 2006???? or 1956????
I believe it's 1856. I'm off to get a rib taken out so I can fit in my new corset. The doctor said it will help with my hysteria fits.
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
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Michelle M
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posted
Especially galling as who among us hasn't seen this exact same tsk-tsk look or heard this little condescending speech from some duck as he completely misdiagnosed us?
They could be describing the typical lyme patient run-around.
I love the part about discouraging patients from seeking help on the internet.
If their diagnoses were correct, they ought to withstand scrutiny.
Unlike Gershwin, I took my splitting headaches to the internet, since my own "phalanx of eminent doctors" could not figure out the problem. Had I not kept looking, I feel sure I would be dead by now.
These doctors' arrogance is stunning. They ignore a very old tenet of medicine: Listen to your patient.
Michelle
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The following article is on the front of the Washington Post Health Section today.
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n Blind are these people!!!!!!!!!!!![[loco]](graemlins/loco.gif)
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