Functional neuroimaging in patients presenting w/somatoform disorders: model for investigating persisting symptoms after tick bites..,2019,Guedj et al

Andy

Andy

Retired committee member
Full title: Functional neuroimaging in patients presenting with somatoform disorders: A model for investigating persisting symptoms after tick bites and post-treatment Lyme disease syndrome?
Highlights
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Patients may develop chronic pain and subjective symptoms after having been treated for and cured of Lyme disease, or after a tick bite. The pathophysiology of these symptoms is unknown, and biomarkers are lacking. This article reviews functional neuroimaging studies of somatoform disorders that could have possible clinical implications for post-treatment Lyme disease symptoms and chronic subjective symptoms after a tick bite.

Abstract
Approximately 10% of patients presenting with Lyme disease experience fatigue, musculoskeletal pain, concentration disorders, or short-term memory deficits in the six months following treatment. This entity has been defined as post-Lyme disease syndrome or post-treatment Lyme disease syndrome. The pathophysiology of this syndrome is unknown, but neither persistence of the bacterium nor effectiveness of antibiotics are currently reported in the literature.

The French High Council for Public Health (French acronym HCSP) has recently defined a new entity called “persistent polymorphic symptoms after a tick bite” allowing for designing studies to better understand these subjective presentations, for which objective biomarkers are currently lacking. This entity encompasses patients experiencing fatigue and generalized pain in the months following a tick bite and can be associated with several subjective symptoms with major impact on the quality of life. In the field of somatoform disorders, this article reviews functional neuroimaging studies in patients presenting with subjective complaints and discusses potential clinical implications for persisting symptoms after tick bites and post-treatment Lyme disease syndrome.
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Paywalled at https://www.sciencedirect.com/science/article/pii/S0399077X18306772
 
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Is defining symptoms as 'subjective' a subjective exercise? Who is being 'subjective' the reporting patient or the diagnosing doctor?

If pain without a currently identified origin can be so severe as to result in vomiting or fainting, is it a subjective symptom? Are sleep disturbances that produce measurable changes in sleep patterns subjective?

It feels to me, though I can be as guilty as the professionals, that there is so much loose language, fuzzy thinking and philosophical woolliness in the whole area of somatoform disorders (real or imaginary in the minds of the clinicians).
 
Peter Trewhitt said:
Is defining symptoms as 'subjective' a subjective exercise? Who is being 'subjective' the reporting patient or the diagnosing doctor?

If pain without a currently identified origin can be so severe as to result in vomiting or fainting, is it a subjective symptom? Are sleep disturbances that produce measurable changes in sleep patterns subjective?

It feels to me, though I can be as guilty as the professionals, that there is so much loose language, fuzzy thinking and philosophical woolliness in the whole area of somatoform disorders (real or imaginary in the minds of the clinicians).
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It seems to me that whether or not a symptom is subjective just has to do with the nature of the symptom.

The problem is when the conclusion or implication is that subjective --> psychogenic/psychoperpetuated. When an article such as this one uses the term 'Somatoform Disorders' apparently without caveat, this sort of subtext would be unsurprising.
 
"...but neither the persistence of the bacterium nor effectiveness of antibiotics are currently reported in the literature."

I don't think they looked very hard. There is an entire school of thought in the Lyme medical community that has published about the limitations of current abx protocols and persistence of bacterium, but that aside, there is a long line of case studies - eg, Vicky Logan and Neil Spector - that speak to both. Remove this statement in quotations and their argument falls apart.

What has happened to Science?
 
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duncan said:
What has happened to Science?
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Not much. It's just that most of the easy problems have been solved, those that can revolutionize science overnight by chance. Most of scientific research has been like that, it's just more obvious when you don't have the sheer luck of stumbling on breakthroughs anymore to get everyone past the whole "is this even real?".

The remaining problems require much more resources to get traction. Usually that step was skipped over because chance gave the first few insights, giving confidence that it was worth pursuing. And since exploratory research is usually not funded, the remaining problems are tackled with all the efficacy of a wet noodle trying to hammer something into hardwood.

We always get the same answer to our questions: we don't ring-fence specific diseases. Well, this is what it gets you when chance can't solve those problems. It looks bloody ridiculous and useless.
 
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