Trial Report Chronic nonspecific multiple-sites pain [CNMSP] of unknown etiology: Biopsychosocial method of evaluation for the primary care level, 2024, Goel

https://journals.lww.com/jfmpc/full...ecific_multiple_sites_pain__cnmsp__of.37.aspx

Chronic nonspecific multiple-sites pain [CNMSP] of unknown etiology: Biopsychosocial method of evaluation for the primary care level

Goel, Deepak1; Avinash, Priya R.2; Shangari, Sushant1; Srivastav, Malini3; Pundeer, Ashwani3

Author Information
Journal of Family Medicine and Primary Care 13(4) 1393-1400, April 2024. | DOI: 10.4103/jfmpc.jfmpc_722_23

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Abstract
Background:
Understanding and dealing with chronic nonspecific pain (CNP) is the important entity at primary care hospital. Chronic nonspecific multiple-site pain [CNMSP] of unknown etiology creates diagnostic and therapeutic challenges for primary care physicians due to lack of guidance regarding evaluation and treatment.

Aims and Objectives:
To classify and formulate the evaluation, treatment strategies, and prediction of prognosis of patients with CNMSP of unknown etiology.

Methods:
Patients present with CNMSP of more than 3-month duration without any obvious medical cause. The biopsychosocial [BPS] model with 3P model was applied to see the biological, psychological, and social factors behind persistence. Finally, patients were classified into four groups for evaluation response to treatment and relapse rates in 12-month follow-up.

Results:
Of the total 243 patients of CNMSP, 243 [96.3%] were females. Sixty [24.7%] patients had short duration, and 183 [75.3%] had long duration. Headache was in 115 [47%], low back pain ± leg pain in 96 [39.4%], cervical pain ± shoulder/arm pain in 83 [34.1%], and diffuse body pain in 50 [20.5%] in various combinations. A total of 155 [63.8%] patients had high somatization–sensitization index (SSI), and 144 [59.3%] had low ferritin level. Group 1 [high SSI and low ferritin] had 37.9% of patients, group 2 [high SSI and normal ferritin] had 25.9% of patients, group 3 [low to medium SSI with low ferritin] had 21.4% of patients, and group 4 [low to medium SSI with normal ferritin] had 14.8% of patients. Response to pain symptoms was better in group 1, and relapse rate was higher in group 2.

Conclusion:
CNMSP of unknown etiology itself is a heterogeneous entity, and assessment based on the BPS model can be very useful to understand the treatment plan and outcome of these patients.

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"Person with CNMSP of unknown etiology can be termed as fibromyalgia syndrome [FMS], somatic symptom disorder [SSD], chronic fatigue syndrome [CFS], MPS, or systemic exercise intolerance disorder [SEID], which are associated with many overlapping diagnostic criteria, thus creating high confusion for the primary care doctors.[15-20]"

 

Quite indicative of the writers' confusion. Not only bypassing the years of prior research into FM and ME which point to a molecular etiology (as yet unknown).

But they seem to throw all the acronyms they are confused by into the air like so much spaghetti.

 

This stuff is really the core of the problem. This needs no such thing. The biopsychosocial model is mostly useless, there is never a need for something that is useless. It's what the authors want, what is oddly fashionable despite being useless, which has nothing to do with what the patients need.

This is a counterpart to the whole "exercise is good for everyone all the time" dogma. No, it's not. There is no need for it in most situations. But it's assumed to be, it's said to be, by people who want to do this thing, not out of any actual need, just what they want to do. I guess because it's a lot easier, carries no risk to them.

All models are wrong, some are useful. The biopsychosocial model is not one of those.

As to the idea that some people don't respond to treatment that doesn't apply to their problem, it only highlights how silly the whole construct is. All it means is that the treatment is inappropriate, but the "patient-centeredness" is all about blaming the patient for failing the treatment, rather than acknowledging the truth that it just doesn't apply to this problem.