“Medically Unexplained Symptoms”

One of the biggest challenges faced by people who have chronic illnesses is that of being believed. Of being listened to by professionals, and finding people who understand that conditions like fibromyalgia, M.E. and so on are real, physical illnesses. After my encounter with the rheumatologist last week, I went back to a post that had been flagged up in the FibroME For Action Facebook community (link in the side bar) about the Barnet Clinical Commissioning Group’s pilot study in managing people with “Medically Unexplained Symptoms” (MUS). (more info here on the dx revision watch website)

This all sounds like a bunch of NHS jargon-speak, which it is, but essentially they were putting forward the idea that people with MUS (which they class as fibromyalgia, M.E, chronic pain, post-viral fatigue, CFS and “somatic anxiety/depression”) shouldn’t be referred on to secondary care (rheumatologists etc.) but should stay under the management of GPs . The purpose of this?

  • “Reduced GP secondary [rheumatology, physio, OT etc] and tertiary [inpatient programmes] referrals.”
  • “Reduced unnecessary hospital investigations and prescribing of medicines”
  • “Reduced GP appointments and out of hours appointments to A&E or GP”

So, a pilot that’s designed to reduce access to specialists and prescribed medicines for people with conditions like fibromyalgia, M.E. and other chronic pain disorders . Well this can’t possibly go wrong.

This is clearly a cost-reducing exercise. But the NHS can’t just say “sorry, you’re just too expensive to treat” and needs to give some kind of reasoning behind their actions. Let’s start by having a look at how they describe those of us with “MUS”:

“Other terms used to describe this patient group include:…Bodiliy Distress Syndrome (BDS)”

Remember where we’ve seen that term used before? Our friend Dr. Fink, who considers these conditions to be mental disorders. So that’s concerning, for a start.

fibrogoogle

Always fun searching on Google…

There’s another document here that goes into a bit more depth about exactly what people with MUS are like (other than “generally annoyed and in pain”, obviously). I want to highlight some choice quotes:

  • “MUS cannot be easily ascribed to recognised diseases. They might be caused by physiological disturbance, emotional problems or pathalogical conditions which have not yet been diagnosed.”
  • “More common in women”
  • “Past health and psycosocial experiences may encourage some patients to minimise certain symptoms and over emphasise others to shift the doctor’s attention in a particular direction.”
  • “Most people with MUS who see their GP will improve without any specific treatment”

This paints chronic illness patients as manipulative and hysterical.  GPs are being told that anyone with an “MUS” doesn’t need to be referred to a specialist, that our symptoms are “emotional problems” and that we’re likely to try and manipulate our doctors to get what we want. Anyone who has been to a cynical doctor knows that sometimes, focusing on one particular symptom is the only way to get them to listen to you so you can get the treatment you need.

Here’s another quote from the same document:

“For MUS, good practice consensus recognises that not investigating may be best for the patient.”

The document recommends that to investigate – to give “credibility” to our pain and fatigue – is not good practice. This attitude belittles us, patronizes us and says “doctor knows best”.

mus

From “Pilot of Enhanced GP Management of Patients with Medically Unexplained Symptoms”

Focus on managing symptoms rather than getting a diagnosis, don’t treat with drugs, saying that “a serious cause is unlikely”. This puts conditions like fibromyalgia, M.E., et al. under the “not so bad” group. And then we’re back to “just get some more exercise” as a cure.

This is dangerous. I believe this is an unsafe way to practice medicine. To tell medical professionals that when people come to their surgeries with medically unexplained symptoms, you don’t investigate to see what the problem is. This is why we are facing a massive lack of research into conditions like fibromyalgia and M.E. We are fighting a long battle to get the medical profession as a whole to treat these as conditions and diseases, rather than just a pile of “unexplained” symptoms. They’re being told it’s not worth their time, that it’s a waste of money and resources. That we are not worth the trouble. That, quite frankly, is appalling. Once again, it comes down to the tired, sick, exhausted and chronically ill to do their own research and fight the battle.

If you don’t look for a diagnosis but just manage the symptoms, people with chronic illnesses will go undiagnosed. They will not get the correct treatment. This is how we end up with people getting psychological treatment for a physical illness. Figures for the prevalence of illness will be inaccurate, and it will be very difficult to make the case for more research into these conditions.

I believe we need to be doing more research into these chronic conditions so we can find a cure for them.  The attitude at the moment that “managing” the symptoms is enough. Please do read the documents I’ve linked to, I’m really interested in hearing other people’s views on what they say. And then let’s work out how we can change this.


“Yeah, it’s probably fibromyalgia.”

Oh to hear the words that mean you finally have a diagnosis! Or rather, to be prodded for 15 minutes while you wear a hospital gown and have the rheumatologist say to you “yeah, it’s probably fibromyalgia”. Yey? I suppose? Well, I’m taking that as an official diagnosis as it’s probably the best I’m gonna get.

She seemed to think that fibro, CFS and M.E. were the same thing, which they’re clearly not. I’m not sleeping, I’m female, I’m overweight and I have pain. So, painkillers, sleep aid, get more exercise. Fibromyalgia as a stress/weight/being a female syndrome. Oh, also a nice leaflet from Arthritis UK that has this nice picture of some nice people meditating on the cover. Yoga and meditation for a cure. Yeah, no. I’m no expert, but I’ve read enough to know it’s not a “lose weight, take these pills and have a nice life” syndrome. It’s so much more than that. But there’s no funding for research, no-one wanting to look into fibromyalgia because it’s something that overweight women get so it’s not worth it. Eat better, exercise more, take pain pills. Repeat ad nauseam. Your illness is self-inflicted.

Bullshit.

The unspoken words of “yeah it’s probably fibromyalgia” are “hey, at least it’s not something serious! At least you don’t have cancer, or arthritis, or HIV! At least you don’t have something we can actually see! You’ve just got something we have to take your word for, so y’know, it’s not serious”. It speaks volumes about how women with chronic illnesses are treated. Women aren’t seen as having high priority jobs – we’re all mums, or wives, or dinner ladies or nursery nurses or cleaners. Just pop some pain pills and you’ll be fine. You’ll get through. We’re not seen as executives, as researchers and CEOs and people who undertake “important work”.

A quote from the Kickstarter-funded film about M.E. titled “Canary in a Coal Mine”:

“There’s $16 million in Male Pattern Baldness. And we get $3 million bucks going for Chronic Fatigue Syndrome.”

Don’t tell me this isn’t a gender issue, because it is. Remedies for hair loss and research into Viagra get plenty of funding. Diseases that effect mostly women and can ruin their lives? Get very little. It is very much a gender issue. And the people who have to do the research are the women who are in pain, are exhausted and are looking for answers.

So my next step? Is to research. Research everything I can. Read everything I can and learn to understand it all because this is my health. No-one wants to become an expert in my health, so I’m going to have to. Those of us with chronic illnesses have to become our own specialists, because no-one else wants to.


So I’ll start a revolution from my bed.

So everything seems to have taken off in quite a dramatic way over the last week or so. Ever since a few of us wrote about the possible reclassification of CFS, fibromyalgia and M.E. I’ve had the most hits on one day my blog has ever had. The World Health Organisation made sure the original article was taken down and went on a tweet spree to make sure everyone knew that this reclassification was NOT going to happen. But, the ball had started rolling and pyjama-clad warriors from all over the internet had started typing into action.

There’s now a Facebook page, there are bloggers and healthcare professionals and people who have chronic illnesses reading, and writing, and planning and talking. As I said in my previous entry, I’m a newcomer to this community. I don’t have a diagnosis yet. But I can read, and learn, and collate information. And help raise awareness of the issues that people with these chronic illnesses are having. Some of the things that have happened so far:

FibroMe For Action group on Facebook

Blog entry on Ramblings from a Fibro Fogged Mind

FibroGirl’s Call to Action

And why are we doing this? Although the WHO stated pretty clearly that they have no plans to reclassify fibro, M.E. and CFS, treatment of these conditions is far from ideal. There are still healthcare professionals out there who either don’t believe in these illnesses, or who believe they can be cured through therapy rather than medical intervention. I think that’s reason enough to shout about it.

There’s a lot to read, a lot to process and a lot to plan, and when it’s being done by people who have very limited amounts of energy it’s hard. But it shows that people are willing to fight. I’ve realised that my place in this campaign is probably going to be to blog, to educate myself and to post my own story. At the moment that’s the most powerful thing I’ve got.


CFS, M.E. and fibromyalgia could be re-classified as “mental disorders”

[Edit 13th Feb: The WHO has confirmed on Twitter that they have no plans to reclassify the conditions, and that their site is a BETA site for health professionals to contribute to. However the work of Dr. Fink still persists and these misdiagnoses of CFS/M.E./fibromyalgia still occur and are still just as dangerous so I feel the point this blog post makes is still just as relevant and important.]

This afternoon, a load of posts appeared on Twitter about an article that had appeared on the Liberty Voice website.The article was titled “Fibromyalgia and ME/CFS Labeled Mental and Behavioral Disorders by WHO” and has, understandably caused a whole load of panic among the fibro/M.E/CFS community. The fight to get these diseases correctly classified as physiological rather than psychological has been long and on-going, and this seems a big step back in the wrong direction.

As I type, the article has been taken down – we don’t know why. This is a link to an image of the article before it was removed so you can read it, but the basic gist of it was that Dr Per Fink, a psychiatrist from Denmark, has classified fibromyalgia, CFS and M.E. as a “bodily distress disorder”. According to the WHO website:

“Bodily distress disorder is characterized by high levels of preoccupation regarding bodily symptoms, unusually frequent or persistent medical help-seeking, and avoidance of normal activities for fear of damaging the body.”

Bodily distress disorder is classified on the WHO classifications as a “mental and behavioral disorder”. This means that fibromyalgia, CFS and M.E. will be classified as something that has to be treated as a psychological illness, rather than a physical one. This is very problematic. Although psychological illnesses are valid illnesses that need to be treated correctly, treating a physical condition as a psychological one does not work. You cannot treat cancer solely by sending someone to group therapy, you cannot treat M.E. solely by sending someone to CBT.

Dr. Fink runs a clinic called The Research Clinic for Functional Disorders and Psychosomatics. On his website, he classifies conditions such as fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome as “bodily distress syndromes”. He feels that these conditions are all the same thing, that if a condition can’t be diagnosed in testing (such as arthritis) then it is a psychological disorder. This clinic is currently responsible for Karina Hansen, a 24 year old with M.E. who was forcibly removed from her home to go to the clinic and get treatment.

Classifying genuine physical conditions as psychological is dangerous. It will mean people will get the wrong treatment and will not be given any opportunities to improve their condition. In a lot of cases, it will make their condition worse. There is a lot of discussion in the M.E. community about graded exercise therapy and how successful or otherwise that is, and I’m planning on compiling some info about that for another post. However, regardless of whether these treatments work for some or otherwise, treating a physical illness as a psychological one means people who have these conditions will be mis-diagnosed and mis-treated.

It also de-legitimises the people who have these conditions. Psychological illnesses are very valid illnesses of course, but to tell someone that the pain and debilitating fatigue they suffer from is a psychological problem is, quite frankly, offensive.

On her blog, fibrogirl has suggested some ideas for action:

1. Research – pull it all together fully referenced in one place, including bloggers links etc
2. Lobby 
3. share our stories – our truths 
4. Galvanise the online community, our friends and loved ones to make a bloody big noise – that is coordinated and focused
5. leave a reply here if you are willing to help. Im just one scared angry voice – I cant do anything alone. I’m not an academic, or even a very good writer. but surely if all the bloggers, academics, medics who believe in us and we make enough of a stink we might just finally break through and get what we deserve...a true diagnosis and treatment that helps us manage these disabling illnesses

I totally agree with what she says. I am a relative newcomer to this community, there are many people out there who have been fighting this battle for years. However I feel I have a duty to educate myself on this, and to share the information I find out in a way that might make it easier for people to understand the problems we’re facing. I agree with fibrogirl – we need to step up the fight and start making a bigger noise.

Fibrogirl’s post

Spoonydoc’s post