Chronic Pain Syndromes and Their Laryngeal Manifestations, 2020, Piersiala et al

[Andy]

Importance Fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS) are traditionally considered as distinct entities grouped under chronic pain syndrome (CPS) of an unknown origin. However, these 3 disorders may exist on a spectrum with a shared pathophysiology.

Objective To investigate whether the clinical presentation of FMS, IBS, and CFS is similar in a population presenting with voice and laryngeal disorders.

Design, Setting, and Participants This case series was a retrospective review of the medical records and clinical notes of patients treated between January 1, 2016, and December 31, 2017, at the Johns Hopkins Voice Center in Baltimore, Maryland. Patients with at least 1 CPS of interest (FMS, IBS, or CFS) were included (n = 215), along with patients without such diagnoses (n = 4034). Diagnoses, demographic, and comorbidity data were reviewed. Diagnoses related to voice and laryngeal disorders were subdivided into 5 main categories (laryngeal pathology, functional voice disorders, airway problems, swallowing problems, and other diagnoses).

Main Outcomes and Measures Prevalence and odds ratios of 45 voice and laryngeal disorders were reviewed. Odds ratios (ORs) were calculated by comparing patients with CPS with control patients.

Results In total, 4249 individuals were identified; 215 (5.1%) had at least 1 CPS and 4034 (94.9%) were control participants. Patients with CPS were 3 times more likely to be women compared with the control group (173 of 215 [80.5%] vs 2318 of 4034 [57.5%]; OR, 3.156; 95% CI, 2.392-4.296), and the CPS group had a mean (SD) age of 57.80 (15.30) years compared with the mean (SD) age of 55.77 (16.97) years for the control group. Patients with CPS were more likely to present with functional voice disorders (OR, 1.812; 95% CI, 1.396-2.353) and less likely to present with laryngeal pathology (OR, 0.774; 95% CI, 0.610-0.982) or airway problems (OR, 0.474; 95% CI, 0.285-0.789).

Conclusions and Relevance The voice and airway presentation of patients with FMS, IBS, and/or CFS appears to be indistinguishable from each other. This finding suggests that these 3 diseases share upper airway symptoms.

Paywall, https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2764772
Sci hub, https://sci-hub.tw/10.0000/jamanetwork.com/jamaotolaryngology/article-abstract/2764772

Editorial: The Puzzle of Medically Unexplained Symptoms—A Holistic View of the Patient With Laryngeal Symptoms

Functional laryngeal and airway disorders are characterized by apparently normal anatomy and neurological function accompanied by clinically significant symptoms, which can include dysphonia, dysphagia, globus sensation, and dyspnea.

These disorders are often diagnoses of exclusion, since the presenting symptoms can also accompany important anatomic and neurologic abnormalities that must be ruled out. Primary muscle tension dysphonia (MTD), also often called functional dysphonia or hyperfunctional dysphonia, presents with various forms of laryngeal muscular dysregulation during voice and speech production and remains a voice disorder without established pathophysiology. Some signs and symptoms may be observable during the examination (eg, supraglottic hyperfunction, perceived vocal strain), while others may be elusive (eg, vocal fatigue, stress-induced hyperfunction). Functional airway disorders such as paradoxical vocal fold motion disorder (sometimes also called vocal cord dysfunction) are characterized by dysfunctional respiratory/laryngeal coordination. These can lead to dynamic airway narrowing at the glottis and shortness of breath despite a neurologically normal larynx.

Functional laryngeal and airway disorders are frequently associated with psychological distress, including depression, anxiety, and somatic concerns. Somatic concerns involving other parts of the body are also common in patients with MTD and are associated with heightened medical costs, which drive up the costs of health care and further burden patients, who may undergo numerous expensive evaluations, tests, and procedures owing to their symptoms.

Paywall, https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2764770
Not available via Sci hub at time of posting.

 

[Mithriel]

Fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS) are traditionally considered as distinct entities grouped under chronic pain syndrome (CPS) of an unknown origin.

35 years of reading the literature and I have never heard of this

 

[InitialConditions]

35 years of reading the literature and I have never heard of this

That's because it's bollocks.

 

[Peter T]

As a Speech & Language Therapist I am fairly confident that I do not have any specific voice or laryngeal issues that could not be explained by breath support issues. Nor am I aware of any higher incidence of such problems in other people with ME. Certainly it is not something I have come across in patient forums.

 

[shak8]

Wow, another example of publish or perish...rubbish.

 

[Daisybell]

As a Speech & Language Therapist I am fairly confident that I do not have any specific voice or laryngeal issues that could not be explained by breath support issues. Nor am I aware of any higher incidence of such problems in other people with ME. Certainly it is not something I have come across in patient forums.

Me too - to both statements!

 

[dreampop]

Ascertaining the number of patients with medi-cally unexplained symptoms is challenging because of physi-cians’ lack of awareness and the reluctance of most patientswith these conditions to seek help in the health care systemor receive medical treatment.7-9

Because all of these diseasesare defined by their physical symptoms, given that no testing is performed to confirm an underlying organic disease,10theyare a cost burden to the health care system; these conditionscan be diagnosed only by definitively excluding the organicdisease.11Furthermore, it is uncertain whether treatment it-self is effective.9,12

What a bizarre start this paper has, they authors can't get over their own words to try to paint diagnosing sick people as a burden to the system. Oh except, sorry, we just said physicians don't diagnose them and patients are reluctant to use the medical system. But isn't it a shame we have to waste testing on those that do?

As an aside this concept that seeking medical testing or treatments that don't produce results burdens the rest of the medical system, it makes no sense at all to me. Yes there are some supply limits but rarely does that apply to chronic illness testing. The chronically ill bear their own cost, but they can't go around saying I have dysphagia I can't test for it. Doctors and technicians have to do their job, and chronic illness creates more jobs and so on. It's seems a very bias way to phrase the whole thing.

 

[dreampop]

35 years of reading the literature and I have never heard of this

However,they may exist on a spectrum with ashared pathophysiology, and all of them may be grouped un-der CPS spectrum disorders.

This citation to this is a 32 year old paper by Lipowski. A strange citation give that, as far as I can see, provides no evidence for the sentence it is supposed to support.

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.469.4798&rep=rep1&type=pdf

 

[Peter T]

What a bizarre start this paper has, they authors can't get over their own words to try to paint diagnosing sick people as a burden to the system. Oh except, sorry, we just said physicians don't diagnose them and patients are reluctant to use the medical system. But isn't it a shame we have to waste testing on those that do?

So we are both reluctant to use the medical system whilst simultaneously desperately seeking expensive medical assessments to prove we have a biomedical condition. Does anyone ever get the impression that such researchers make up whatever premise happens to suit them at that point in time, without any concern about logically consistency within and between articles?

 

[dreampop]

So we are both reluctant to use the medical system whilst simultaneously desperately seeking expensive medical assessments to prove we have a biomedical condition. Does anyone ever get the impression that such researchers make up whatever premise happens to suit them at that point in time, without any concern about logically consistency within and between articles?

Yes, but what is shocking here is they are unable to see their own inconsistency within 3 sentences! Did they write each one of them a few days apart and then have a stranger put it back together?

 

[dreampop]

On page 5, figure 2, it looks breaks down by type of pain syndrome (ibs, fm, cfs). CFS looks to have pretty close to normal odds except in one category, higher than normal swallowing problems and higher than normal functional problems.

One important info missing is number of investigations to reach diagnosis. It would be interesting to see if someone with fibro, for example, recieved less studies than someone without and thereby maybe missing a non-functional diagnosis.

It also raises the spectre of GERD, gastropareisis, etc often seen in me/cfs, causing swallowing problems but also manifesting as "functional" problems. How many of these patients had an endoscopy, or tests for stomach emptying? I couldn't find out.