The proportion of women with central sensitivity syndrome in gynecology outpatient clinics (GOPDs), 2018, Vij et al

Andy

Andy

Retired committee member
Abstract
Introduction and hypothesis

Patients in gynecology outpatient clinics (GOPDs) may present with symptoms that do not correlate well with the observed pathology and are usually labelled as having a functional disorder or medically unexplained symptoms (MUS). Underlying central sensitivity syndrome (CSS) with central sensitization (CS) as a potential mechanism may be responsible for some of their symptoms. The aim of this study is to identify the proportion of women with central sensitivity syndrome attending GOPDs.

Methods
This was a prospective study. All women attending a GOPD included in the study were asked to complete a validated Central Sensitization Inventory (CSI). The responses were graded on a Likert scale from 0 (never) to 4 (always). The total score ranges from 0 to 100. For screening purposes, a single CSI cutoff score of 40 was used to identify the group of women who may have central sensitization syndrome.

Results
Three hundred twenty-six women participated in the study. Overall, 123 (37%) women achieved a score above 40. This could be interpreted as these patients having increased risk of underlying central sensitization. Of these, 43 had a previously confirmed diagnosis of migraine, 55 (44%) depression, 39 (31.7%) anxiety, 11 fibromyalgia (FM), 34 irritable bowel syndrome (IBS) and 16 chronic fatigue syndrome (CFS/ME).

Conclusions
Managing patients and their expectations in gynecological outpatient departments when symptoms are inconsistent with observable pathological findings is challenging. This is further complicated when patients have a concomitant central sensitivity syndrome, which can also influence the surgical outcome. Identifying these patients is a key factor for appropriate management.
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Paywalled at https://link.springer.com/article/10.1007/s00192-018-3709-0
 
Managing patients and their expectations in gynecological outpatient departments when symptoms are inconsistent with observable pathological findings is challenging. This is further complicated when patients have a concomitant central sensitivity syndrome, which can also influence the surgical outcome. Identifying these patients is a key factor for appropriate management.
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It's such a shame that Gynaecology Outpatient Clinics have to treat women, there would be far fewer problems if they were dealing with men.

But here's a solution. Label your patients with the equivalent of hypochondria, then when they complain that your treatment hasn't helped, you can rest easy knowing that it's not your fault. The more they complain, the less at fault you are.
 
Patients in gynecology outpatient clinics (GOPDs) may present with symptoms that do not correlate well with the observed pathology and are usually labelled as having a functional disorder or medically unexplained symptoms (MUS).
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Since the average gynaecological examination (in my experience) was to look at the patient's belly, prod it a few times, and possibly feel around in the vagina, gynaecology itself is not a highly specialised or scientific medical discipline. If the GP who referred the patient has mentioned depression and other phrases of dismissal in their referral letter then patients are never going to get a fair hearing, and doctors won't bother actually eliciting any "pathology".

One examination of this type was done on me by a GP when I was roughly 30. He then screamed at me that there was nothing wrong with me and "GET OUT OF MY OFFICE!". About 6 months later I was being seen by an IVF clinic for the first time. When they scanned me they found 5 or 6 ovarian cysts, most of which were huge, and further examination and testing showed that they had existed for a very long time. This was what passed for gynaecological care throughout much of my life.

Oh - and gynaecological surgeons can't accurately elicit how many ovaries a woman has, which is a little bit of a problem.
 
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I had a go at filling in the Central Sensitization Inventory this morning. Score 40 or above indicates Central Sensitization Syndrome.

I did it once, as carefully and honestly as I could.

I scored 47.

Oh dear, I suffer from CSS.

I thought about it a bit for about 5 minutes. I decided I'd made too much of some things where my symptoms are slight or no different from healthy people my age. I filled it in again.

I scored 33.

I no longer have CSS.

I've magically cured myself with 5 minutes positive thinking.

I can work miracles!
I'm cured!

I think I'll set up a pyramid selling scheme to spread the good word, and charge people £1000 a time to come to my miracle workshops.
 
Trish said:
I can work miracles!
I'm cured!
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The more I look at that questionnaire the more I realise it is is utter BS. I've tried to think of common physical conditions that might lead to a positive diagnosis of CSS and so far I've come up with :

Having a severe cold, flu, or a respiratory infection; iron deficiency; vitamin B12 deficiency or pernicious anaemia; hypothyroidism; hyperthyroidism; ME/CFS; Alzheimer's Disease or other form of dementia; normal ageing; urinary and kidney infections; MS; endometriosis; GERD; gastritis; IBS; IBD; Crohn's Disease; Ulcerative Colitis; Coeliac Disease; lung diseases of various kinds e.g. COPD;

It makes healthcare so much easier and cheaper when you can deny the patient is sick at all.
 
Arnie Pye said:
It makes healthcare so much easier and cheaper when you can deny the patient is sick at all.
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I suspect that under it all, besides the usual egos and careers and incomes, etc, this is the big driver in the establishment resistance to dealing with PACE and similar nonsense. So much of government and private insurance industry policy rests on these claims being true.

They are too critical to be allowed to fail.
 
Sean said:
I suspect that under it all, besides the usual egos and careers and incomes, etc, this is the big driver in the establishment resistance to dealing with PACE and similar nonsense. So much of government and private insurance industry policy rests on these claims being true.

They are too critical to be allowed to fail.
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I agree.

And then there is this issue as well :

“Is curing patients a sustainable business model?” Goldman Sachs analysts ask

https://arstechnica.com/tech-policy...le-business-model-goldman-sachs-analysts-say/
 
Trish said:
I had a go at filling in the Central Sensitization Inventory this morning. Score 40 or above indicates Central Sensitization Syndrome.

I did it once, as carefully and honestly as I could.

I scored 47.

Oh dear, I suffer from CSS.

I thought about it a bit for about 5 minutes. I decided I'd made too much of some things where my symptoms are slight or no different from healthy people my age. I filled it in again.

I scored 33.

I no longer have CSS.

I've magically cured myself with 5 minutes positive thinking.

I can work miracles!
I'm cured!

I think I'll set up a pyramid selling scheme to spread the good word, and charge people £1000 a time to come to my miracle workshops.
Click to expand...
@Graham s training videos clearly worked very well @Trish
 
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