Neurohumoral Profiles and Childhood Adversity of Patients with Multisomatoform Disorder and Pain as the Leading Bodily Symptom, 2022, Achenbach et al

Andy

Andy

Retired committee member
Abstract

Objective. Patients suffering from chronic pain often present with multifactorial underlying conditions, sometimes without concrete pathological physical findings. Functional somatic syndromes (FSS) and somatoform disorders show a high prevalence of 8-20% and are often associated with adverse childhood experiences (ACE) and chronic stress. As many different FSS have overlapping symptoms, the concept of multisomatoform disorder (MSD) has been introduced as an encompassing concept.

We hypothesize that a common neurohumoral profile is present in patients with MSD that is distinct from gender- and age-matched controls and thus provides insight into possible common underlying mechanisms.

Design. In 151 patients with MSD (138 females) and 149 matched controls (131 females), we determined ACE by the Childhood Trauma Questionnaire (CTQ) and chronic stress by the Trier Inventory for Chronic Stress (TICS). Furthermore, the serum levels of leptin, FSH, LH, cortisol, DHEA-S, and IGF-1 have been assessed.

Results. There were significant differences in the levels of leptin, FSH, IGF-1, and cortisol between patients and controls, mainly driven by female participants. Levels of leptin were significantly correlated with BMI in patients, in controls, and in the female subgroup. This correlation was exaggerated in female patients when compared to female controls. Both CTQ and TICS predicted MSD directly and indirectly through the levels of leptin.

Conclusion. There is evidence of a distinct neurohumoral profile in female patients with MSD when compared to matched healthy controls, similar to what has been demonstrated in other chronic pain states. The observed profile can be taken as possible evidence for a dysregulated response to chronic stress and metabolic balance as well as a state of hypocortisolism and HPA-axis dysfunction. ACE and chronic stress play a major role in the development of MSD and altered neurohumoral profile.

Open access, https://www.hindawi.com/journals/dm/2022/7958375/
 
Patients suffering from chronic pain often present with multifactorial underlying conditions, sometimes without concrete pathological physical findings. Functional somatic syndromes (FSS) and somatoform disorders show a high prevalence of 8-20% and are often associated with adverse childhood experiences (ACE) and chronic stress. As many different FSS have overlapping symptoms, the concept of multisomatoform disorder (MSD) has been introduced as an encompassing concept.
Click to expand...

The lunatics have taken over the asylum, and they will not take no for an answer.

This stuff genuinely terrifies me. It is control lust and empire building gone beserk. Patients are going to have to fight the same battles all over again.

WTF has happened to medicine?
 
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"Levels of leptin were significantly correlated with BMI in patients, in controls, and in the female subgroup. "

Really? Is there no understanding of basic biology?

Was there a check on meds/ diet/ insulin status ?

ETA - in the supplementary materials section we have

Supplementary Materials
Table S1: overview of medication use of patients and controls according to gender. Figure S1: BMI frequency distribution of female patients and controls. (Supplementary Materials)

This is simply an A4 sheet with these headings when I downloaded it ? I take it this is data which must be requested?
 
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The Childhood Trauma scale used is a German version with 28 items - does anyone know how it compares to other versions ( Coyne has panned much of the ACE methodology and most of his comments seem founded)


There is also -
"In human and animal studies, it has been shown that adverse childhood experiences (ACE) play a major role in the development of FSS and somatoform disorders [10, 11] and are associated with susceptibility to painful conditions [12, 13]."

How are ACES measured in animal studies?
10 is a meta analysis and may well be GIGO ( but i havn't delved)

References are peppered with links between stress, pain, trauma and a variety of genes.I havn't checked through them but this one
  1. A. Korszun, E. A. Young, N. C. Engleberg et al., “Follicular phase hypothalamic-pituitary-gonadal axis function in women with fibromyalgia and chronic fatigue syndrome,” The Journal of Rheumatology, vol. 27, no. 6, pp. 1526–1530, 2000.View at: Google Scholar
results and conclusion noted -

Results
There were no significant differences in FSH, progesterone, or estradiol levels in patients versus controls. There were no significant differences in pulsatile secretion of LH.
Conclusion
There is no indication of abnormal gonadotropin secretion or gonadal steroid levels in this small, but systematic, study of HPG axis function in patients with FM and CFS.

So it may be that others do not relate to or support the hypothesis


ETA - Link to CTQ - PDFfiller - Childhood Trauma Questionnaire.pdf (uslegalforms.com)
 
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Cortisol levels - results are in ug/dL (or mcg/dL)
Normal ranges for samples at 8 am are 5 to 25 ug/dL

There were only 13 male patients, so not really enough for a good result. Cortisol levels were not statistically different
Controls 15.1; Patients 14.2 p=0.61

There were 130 female patients. Cortisol levels were statistically lower in patients, but still very normal. The relatively small difference is probably explained by lifestyle differences (people regularly exposed to stress including physical stress like sports have higher cortisol levels).
Controls 16.6; Patients 14.8. p=0.002

Suggesting that people with these so-called functional somatic syndromes have hypocortolism and a dysregulated response to chronic stress on the basis of these cortisol levels is just silly.
 
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