It's a little more coherent than that, though it's important to add that it's just a hypothesis. I would argue that among PRT advocates the "Fight or Flight" explanation is primarily meant as a way to convey to patients how mind states affect body states in ways that are biochemically measurable. The Fight or Flight response reminds us that *belief* in danger can have dramatic somatic effects. With a sufficient adrenaline surge, you can run on a sprained ankle, and it might save your life. Or your threat assessment may be way off (we're all error prone), and you were never in danger in the first place, but you still ran your ass off on a bad ankle.
You're right that energy surges and the suppression of pain are the opposite of energy disorders and pain syndromes. But the Fight or Flight explanaton doesn't stop at the moment when you have safely fled the real or imagined sabre tooth tiger. The hypothesis is a systemic one, as broadly outlined in the passage you quoted. When threat assessment becomes dysregulated, it can start acting within the space of our own bodies. The medical term for a dysregulated nervous system is central sensitization, which may not be connected to our flight or flight response at all (though it's not entirely implausible that it would be connected.) And there's no proof at present that central sensitization, while predictable and observable in several clinical contexts, is actually the explanation for any given pain syndrome (or fatigue disorder). That part gets overstated by PRT advocates, for what I would hope are largely good-faith reasons.
But the point is, neither is the underlying hypothesis pseudoscience. Dysregulated neurochemical systems are known to give rise to a whole host of somatic symptoms without any underlying local pathology, which puts the hypothesis that some chronic conditions may be dysregulatory phenomena on equal scientific footing with any number of proposed-but-as-yet-unvalidated hypotheses for the same conditions.
Not trying to prosyletize here; I just think some of what gets painted as "woo" in pain science boils down to poor communication by therapy communities who are mostly focused on techniques for which the evidence of effectiveness is stronger that the explanation of the etiology. As a medical hypothesis, it's completely coherent, though of course like all hypotheses it may well completely fail under duress.
Welcome to the forum,
@crispscone.
I have a few thoughts on points you raise in your post.
You say:
The medical term for a dysregulated nervous system is central sensitization,
First, we have repeatedly come across 'central sensitisation' used to explain pain and other symptoms, but, as you say, it is a hypothesis. Worse than that, it seems to be a hypothesis without any clear foundation or purpose other than to categories people suffering chronic pain and other symptoms doctors can't explain.
Take a look at how it is diagnosed, using the Central Sensitisation Inventory which is copied and discussed on this forum thread:
Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory, 2017, Neblett et al.
I suggest you go to that thread if you want to join the discussion.
You say:
there's no proof at present that central sensitization, while predictable and observable in several clinical contexts, is actually the explanation for any given pain syndrome (or fatigue disorder). That part gets overstated by PRT advocates, for what I would hope are largely good-faith reasons.
How can a hypothetical explanation based on a questionnaire based on symptoms ever explain anything? That seems a completely circular argument. Someone has pain and some other symptoms, so we given them a questionnaire we have chosen to use to diagnose CS in which they tick their symptoms, and we use that to say CS explains your symptoms.
Is this any better than me designing 'central hunger sensitisation inventory' quesionnaire that asks you lots of questions about whether you're hungry. Then saying 'central hunger sensitisation' expains your hunger, when the actual explanation might be that you haven't had any access to food for a day, ie nothing to do with central processing in your brain.
Questionnaire results are not biological explanations.
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You say:
I would argue that among PRT advocates the "Fight or Flight" explanation is primarily meant as a way to convey to patients how mind states affect body states in ways that are biochemically measurable.
I find this type of argument worryingly disingenuous.
In the UK there is an organisation of therapists who treat people with ME/CFS and Long Covid using psychobehavioural therapies, that is, they give advice on changing behaviours such as sleep and activity management and relaxation. The aim is suppsed to be to help people who experience post-exertional malaise and a wide range of symptoms to make their lives more managable but they also go further than that by 'explaining' to patients their 'dysregulation model' which includes stress response, mitochondrial dysfunction and central sensitisation. None of that hypothesising has any confirmed evidence base, so they are basically asking pwME to change their lives in ways that have no evidential support, often to their detriment [Edit: on the basis of misinformation].
The mind-body, brain retraining people take this a step further, insisting that the illness itself is caused by wrong thinking, stress, etc and can be reversed by retraining the brain. Again, there is no evidence for this, but they use the sorts of illustrations you suggest to convince people there is a scientific foundation to their training courses. That can cause immense harm for those who don't improve, they are basically lied to about the cause of their illness and it being in their power to reverse this cause. In LP people are not even allowed to join a course unless they agree to accept everything they are told without question. Then they are fed a lot of misinformation. That is hightly unethical.
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