Olivier Lejus begins a new series on Chinese medicine's approach to a painful condition affecting women of middle years across the world
Some NOVA readers with long memories might remember the onset of chronic fatigue syndrome, which occurred in this country in the early 1980s. Around that time, doctors were startled by a sudden influx of patients who complained of debilitating tiredness. Most sufferers were women, who were unable to work for more than a couple of hours a day. Even performing mild household tasks, such as putting a load of washing on the line, would incapacitate a female patient in her thirties for the rest of the day.
Unfortunately for the Western medical practitioners, most laboratory tests were unable to detect any clear abnormalities in their patient's systems. Many doctors refused to believe it was a real disease, and the patients became an embarrassment to their local practitioners who were unable to treat them. They were sent from one specialist to the other. Some sufferers were told they were suffering from a new form of depression, while others were advised to increase their intake of minerals and vitamins, and take up some exercise programs. Later, it was found that the majority of patients had never fully recovered from past illnesses, such as glandular fever, which had severely depleted their system.
To many of us, it showed the limitations of the Western medical framework which, despite its outstanding expertise in surgery and life saving medications, considers anyone who is unwell but unable to return clear positive pathological tests to be perfectly healthy, while someone who is feeling absolutely fine will be put on medications for the rest of their life, with considerable potential side effects, if their blood pressure or cholesterol readings are too high.
Barely a decade later, the medical practitioners found themselves facing a similar challenge with the onset of a new syndrome called 'fibromylgia', or 'pain in the tissues'. The sufferers, who were in the majority women aged from 35 to 60 years old, were complaining of mild to severe pain in the joints, tendons, or muscles of the body without any causative factors such as trauma or accidents. Additional symptoms included joint stiffness, sleeplessness, and fatigue.
Once again, the medical community was divided. Examination of the affected joints failed to reveal any pathological changes, and many practitioners refused to recognise fibromylgia as a disease in the absence of diagnostic tests.
In response, in 1990, the American College of Rheumatology (ACR) adopted a classification criterion to help diagnosis. Still used today, it defines 18 areas of pain distributed throughout the trunk and the limbs, which are a specific feature of this condition. To be classified as a fibromylgia sufferer, the patient needs to have a history of chronic pain, and least 11 of these 18 sites registering pain on gentle palpation.
Although it appears to be a simple and effective method, some diagnostic errors can easily occur. During testing, a moderate amount of pressure should be applied by the practitioner, keeping in mind that if one presses hard enough, anyone will experience pain to some degree anywhere in the body. In reverse, the test will be negative if too little pressure is applied, or if the specific diagnostic site is wrongly located.
Twenty years after its original onset, while fibromylgia is still common in this country, we have now learnt a lot more about this debilitating condition. We know that it affects predominantly women in a ratio of 8:1 compared to men, in most countries and ethnic groups, regardless of local climatic differences. While younger women are sometimes afflicted, it is more prevalent in women aged 50 years and above. Symptoms include generalised aching, stiffness in the trunk, hip and neck shoulder girdles, or in the buttocks radiating down the legs. The pain will often begin in one region of the body, such as the shoulders, neck or lower back, to gradually become more widespread as the condition deteriorates. Patients may complain of numbness in the hands and feet, with abnormal sensitivity to temperature changes. In many cases, emotional stress and medical illnesses such as HIV, Lyme disease, rheumatoid arthritis or hypothyroidism can be causative or aggravating factors.
Since it is well known that depression and anxiety tend to increase the level of pain, various forms of antidepressive medications, which stimulate the production of neurotransmitters like serotonin and epinephrine, are commonly prescribed. Other forms of treatments include anti seizure drugs, while various forms of muscle relaxant medications used to control spasms and cramping in Multiple Sclerosis patients have proved to be quite effective in alleviating some of the side effects. Unfortunately, all these forms of pharmaceutical drugs have some serious side effects if taken for a long period of time. According to some insurance companies, many desperate patients are also turning to opioid drugs for pain relief despite the grave risk of addiction.
Alternatively, some lifestyle changes, including aquatic-based forms of cardiovascular exercises, can make huge improvements in the patient's quality of life, as long as the water temperature is warm enough.
In the next issue of NOVA, we will look at Chinese medicine's approach to treatment for this condition.
Olivier Lejus MHSc (TCM), BHSc (Acup.) is an accredited acupuncturist practising in Sydney.