Editorial
"Spinal Irritation" and Fibromyalgia: A Surgeon General and the Three Graces
FASEB J. 2008 Feb;22(2):327-31.
Gerald Weissmann, Editor-in-Chief
Spinal Irritation is characterized by multiple tender spots
distributed over the female body, probably caused by sexual
excess.... A couple of leeches to the inside of the nostrils are
remarkably efficacious [and as for] counter-irritants, such as
blisters, croton oil, tartarized antimony, and the actual cautery,
cases every now and then appear in which they seem to be of
service... I suppose the most generally advantageous agent of the
kind is the actual cautery very lightly applied to the nuchae.
William A Hammond, Spinal Irritation, 1886 (2)
1990 ACR Criteria for the Classification of Fibromyalgia 1. History
of widespread pain... 2. Pain in 11 of 18 tender point sites on
digital palpation... Digital palpation should be performed with an
approximate force of 4 kg. For a tender point to be considered
"positive" the subject must state that the palpation was painful.
Tender is not to be considered "painful."
Wolfe et al. The American College of Rheumatology 1990 Criteria for
the Classification of Fibromyalgia. Report of the Multicenter
Criteria Committee (1)
TENDER POINTS
For almost two centuries, doctors (traditionally male) have been
responding to unexplained aches and pains of their patients
(traditionally female) by tweaking various tender or painful points
on their bodies. Once a particular constellation of points is
elicited, a diagnosis is made and treatment applied. The women have
been in real pain, current treatments have sometimes worked, but the
end-results have varied little over the years. Early in the 19th
century, based on their recent discovery of the reflex arc, doctors
named the syndrome of unexplained aches and pains "Spinal lrritation
(3) ." As described by Dr. Hammond, it was managed by applications of
leeches or by hot iron cauteries applied to the back of the neck (the nuchae).
Nowadays, of course, we are much wiser. Reflexology has been left to
the medically untutored and we attribute the slings and arrows of
daily painnow called fibromyalgia to a "central hypersensitivity to
nociception (4) ". Experts in the field suggest that
Persistent or intense nociception can lead to transcriptional
and translational changes in the spinal cord and brain resulting in
central sensitization and pain. This mechanism represents a hallmark of fibromyalgia and many other chronic pain syndromes, including
irritable bowel syndrome, temporomandibular disorder, migraine, etc. (4) .
Note the full text of this article is available for free at
http://www.fasebj.org/cgi/content/full/22/2/327
2 comments:
Good grief, this would be funny if it were not STILL happening. Leeches to the nose anyone? How about some burning hot irons tot he back of the neck? Nah, because if those don't work we can't blame the patient and say she isn't doing the program/taking her meds since we, as doctors, are the ones actually applying the treatments in the office. I know! Give the patient ineffective medicines, and when she complains that she isn't getting better, blame HER for not taking them as she was told to!
Then there is the medical jargon and physio-babble- if you don't know what something is but don't want to be considered ignorant, since as a doctor you are suposed to know EVERYTHING, dump a unch of twenty dollar words on top of it to decribe what you don't understand, since that way the patient won't understand it even more! You can sound impressive without actually knowing or doing ANYTHING.
At least if they'd been giving me leeches I'd have been convinced that they were doing something trying to help. Handing out medications KNOWN to be useless -- or worse yet, medications that I've been told to avoid due to adverse reactions -- proves their only goal was to collect $250 for a consult without actually earning it.
And, of course, they hate it that I spent most of my career analyzing medical records and I know what all their twenty-dollar words mean.
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