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A Pilot Study of Airborne Hazards and Other Toxic Exposures in Iraq War Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093299. [PMID: 32397395 PMCID: PMC7246947 DOI: 10.3390/ijerph17093299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/07/2020] [Indexed: 01/10/2023]
Abstract
During their deployment to Iraq in support of Operation Iraqi Freedom (OIF), many Veterans were exposed to a wide array of toxic substances and psychologic stressors, most notably airborne/environmental pollutants from open burn pits. Service members do not deploy whilst unhealthy, but often they return with a multitude of acute and chronic symptoms, some of which only begin to manifest years after their deployment. Our findings, while preliminary in nature, suggest that Iraq War Veterans who participated in our survey reported a decrease in overall physical fitness and increased respiratory clinical symptoms compared with pre-deployment periods. The objective of this report is to provide information that will benefit how combat Veterans are cared for post-deployment. Strategies for a wider and more comprehensive assessment and medical screening process post-deployment are recommended.
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Trautmann A, Gascan H, Ghozzi R. Potential Patient-Reported Toxicities With Disulfiram Treatment in Late Disseminated Lyme Disease. Front Med (Lausanne) 2020; 7:133. [PMID: 32373619 PMCID: PMC7184924 DOI: 10.3389/fmed.2020.00133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/27/2020] [Indexed: 12/12/2022] Open
Abstract
Recently, disulfiram has been proposed as a promising treatment for people suffering from persistent symptoms of Lyme Disease. Disulfiram has several distinct molecular targets. The most well-known is alcohol dehydrogenase, a key enzyme for detoxifying the organism after alcohol ingestion. Other targets and modes of action of disulfiram, that may present problematic side effects, are less commonly mentioned. The French Federation against Tick Borne Diseases (French acronym, FFMVT), which associates three main Lyme patient organizations, MDs and PhDs, has recently been alerted to severe and persistent toxic events in a patient suffering from a late disseminated form of Lyme Disease following disulfiram intake. FFMVT reacted by launching a national call to examine whether other patients in France following a similar treatment could be identified, and what benefits, or side effects could be reported. The statements of 16 patients taking disulfiram have been collected and are presented here. Thirteen out of 16 patients reported toxic events, and seven out of 16 reported benefits for at least part of their symptoms. Based on the collected observations, it seems too early to promote disulfiram as a promising new treatment until the reasons underlying the reported toxicities have been explored, and the results of a well-conducted double blind clinical trial published. The importance of taking into account patient-reported outcomes in Lyme Disease is underlined by the present study.
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Affiliation(s)
- Alain Trautmann
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Hugues Gascan
- Institut de Génétique et Développement de Rennes (IGDR), Rennes, France
| | - Raouf Ghozzi
- Centre Hospitalier de Lannemezan, Lannemezan, France
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Schéle I, Ask I, Claeson AS. Prototype stories of life with Chemical Intolerance – when the environment becomes a threat to health and well-being. OPEN PSYCHOLOGY 2019. [DOI: 10.1515/psych-2018-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractWe aimed to explore how individuals living with Chemical Intolerance (CI) describe the onset and progression of CI, and how they live and cope with CI. The participants were recruited via Swedish websites hosted by CI support groups. A postal survey, including a Life history calender, was sent to potential participants. Eleven respondents fitted the consensus-based criteria for CI while not reporting comorbidity. A narrative analysis of their written replies resulted in five prototypical stories based on similarities in the onset and course of CI. All five stories contain descriptions of alienation from society and insufficient social support. Differences in participants’ perceptions of the symptom onset – with regard to suddenness, the point in life and the perceived cause of symptoms – partly corresponded to etiological theories of CI related to stress or inflammation. Further differences between the prototype stories mainly concern the possible effects on health and well-being related to social support and coping. Given these differences, we recommend that medical professionals and others apply a holistic, context-sensitive approach before discouraging or promoting a specific coping strategy in relation to CI.
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Affiliation(s)
| | - Ida Ask
- Department of Psychology, Umeå University and Byske Health Center
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Volinn E, Yang B, Chen N, Ying J, Lin J, Sheng X, Zuo Y. The Constellation of Chronic Low Back Pain and Other Subjective Symptoms: Does the View Differ From China? Spine (Phila Pa 1976) 2016; 41:705-12. [PMID: 26650875 PMCID: PMC4826330 DOI: 10.1097/brs.0000000000001319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN This was a pilot, cross-sectional study. Its site was West China Hospital in Chengdu, Sichuan Province. OBJECTIVE An objective was to explore whether, in China, chronic low back pain (cLBP) characteristically is one symptom among co-occurring subjective symptoms. More basic objectives were to test a supplemented list of symptoms and to reconfigure findings from the literature on co-occurrence of symptoms so that they pertain specifically to cLBP. The governing metaphor was a constellation of symptoms in which cLBP is located. SUMMARY OF BACKGROUND DATA With the exception of small, isolated societies, previous studies of co-occurrence of symptoms were conducted in the affluent West. Although China's population is larger than the combined populations of affluent countries of the West, research on co-occurring symptoms has been neglected in China. Unknown is whether results from studies conducted in the affluent West may be extended to China. METHODS A survey with the supplemented symptom list was cross-culturally adapted into Chinese and administered to cLBP patients (N = 72) and normal controls (N = 102). Multiple regression analysis was used to determine the effects of covariates (age, gender, education) on symptom reporting. RESULTS cLBP patients reported higher median numbers of symptoms than normal controls, including total symptoms (9 vs. 3), musculoskeletal symptoms (4 vs. 1), and nonmusculoskeletal symptoms (6 vs. 2.5); differences between cLBP and normal controls were highly significant (p < 0.001). Covariates had a little effect on symptom reporting. CONCLUSION cLBP characteristically was one symptom in a constellation of symptoms. This finding came from one research site in China. Nevertheless, consistency between studies is notable, with findings from the affluent West supporting the finding from the Chinese site. The tendency to concentrate on a discrete clinical entity, cLBP itself, may obscure the constellation of symptoms. The more expansive view of cLBP has implications for clinical practice and research. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Ernest Volinn
- *University of Utah, Departments of Anesthesiology and Sociology, Pain Research Center, Salt Lake City, UT †Pain Management Department, West China Hospital, Sichuan University, Chengdu, PRC ‡Department of Medical Statistics, West China School of Public Health, Sichuan University, Chengdu, PRC §Department of Internal Medicine, University of Utah, Salt Lake City, UT ¶Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, PRC ||Department of Pediatrics, University of Utah, Salt Lake City, UT
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5
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White RF, Steele L, O'Callaghan JP, Sullivan K, Binns JH, Golomb BA, Bloom FE, Bunker JA, Crawford F, Graves JC, Hardie A, Klimas N, Knox M, Meggs WJ, Melling J, Philbert MA, Grashow R. Recent research on Gulf War illness and other health problems in veterans of the 1991 Gulf War: Effects of toxicant exposures during deployment. Cortex 2015; 74:449-75. [PMID: 26493934 PMCID: PMC4724528 DOI: 10.1016/j.cortex.2015.08.022] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/19/2015] [Accepted: 08/28/2015] [Indexed: 11/01/2022]
Abstract
Veterans of Operation Desert Storm/Desert Shield - the 1991 Gulf War (GW) - are a unique population who returned from theater with multiple health complaints and disorders. Studies in the U.S. and elsewhere have consistently concluded that approximately 25-32% of this population suffers from a disorder characterized by symptoms that vary somewhat among individuals and include fatigue, headaches, cognitive dysfunction, musculoskeletal pain, and respiratory, gastrointestinal and dermatologic complaints. Gulf War illness (GWI) is the term used to describe this disorder. In addition, brain cancer occurs at increased rates in subgroups of GW veterans, as do neuropsychological and brain imaging abnormalities. Chemical exposures have become the focus of etiologic GWI research because nervous system symptoms are prominent and many neurotoxicants were present in theater, including organophosphates (OPs), carbamates, and other pesticides; sarin/cyclosarin nerve agents, and pyridostigmine bromide (PB) medications used as prophylaxis against chemical warfare attacks. Psychiatric etiologies have been ruled out. This paper reviews the recent literature on the health of 1991 GW veterans, focusing particularly on the central nervous system and on effects of toxicant exposures. In addition, it emphasizes research published since 2008, following on an exhaustive review that was published in that year that summarizes the prior literature (RACGWI, 2008). We conclude that exposure to pesticides and/or to PB are causally associated with GWI and the neurological dysfunction in GW veterans. Exposure to sarin and cyclosarin and to oil well fire emissions are also associated with neurologically based health effects, though their contribution to development of the disorder known as GWI is less clear. Gene-environment interactions are likely to have contributed to development of GWI in deployed veterans. The health consequences of chemical exposures in the GW and other conflicts have been called "toxic wounds" by veterans. This type of injury requires further study and concentrated treatment research efforts that may also benefit other occupational groups with similar exposure-related illnesses.
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Affiliation(s)
- Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States.
| | - Lea Steele
- Baylor University Institute of Biomedical Studies, Waco, TX, United States.
| | - James P O'Callaghan
- Molecular Neurotoxicology, Toxicology & Molecular Biology Branch (MS-3014), Health Effects Laboratory Division, Centers for Disease Control and Prevention - NIOSH, Morgantown, WV, United States.
| | - Kimberly Sullivan
- Boston University School of Public Health, Department of Environmental Health, Boston, MA, United States.
| | - James H Binns
- Research Advisory Committee on Gulf War Veterans' Illnesses, Phoenix, AZ, United States.
| | | | - Floyd E Bloom
- Molecular & Integrative Neuroscience Department, The Scripps Research Institute, La Jolla, CA, United States.
| | - James A Bunker
- National Gulf War Resource Center, Topeka, KS, United States.
| | - Fiona Crawford
- Director, TBI Research Program, Roskamp Institute, Sarasota, FL, United States.
| | - Joel C Graves
- Captain, U.S. Army, Retired, Crestview, FL, United States.
| | - Anthony Hardie
- Veterans for Common Sense, Bradenton, FL, United States.
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Miami, FL, United States.
| | - Marguerite Knox
- McEntire Joint National Guard Base, Eastover, SC, United States.
| | - William J Meggs
- Department of Emergency Medicine, 3ED311, The Brody School of Medicine, East Carolina University School of Medicine, Greenville, NC, United States.
| | - Jack Melling
- U.S. Government Accountability Office, Salisbury, Wiltshire, UK.
| | | | - Rachel Grashow
- Northeastern University, Department of Civil and Environmental Engineering, Boston, MA, United States.
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Arnold LM, Bateman L, Palmer RH, Lin Y. Preliminary experience using milnacipran in patients with juvenile fibromyalgia: lessons from a clinical trial program. Pediatr Rheumatol Online J 2015; 13:27. [PMID: 26112278 PMCID: PMC4480575 DOI: 10.1186/s12969-015-0025-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 06/11/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There are no approved medications for juvenile fibromyalgia (JFM), a disorder that is often under-diagnosed. The effects of milnacipran, a drug approved for the management of fibromyalgia (FM) in adults, was assessed in a clinical trial program for JFM. METHODS Patients, ages 13-17 years who met the Yunus and Masi criteria for JFM and/or 1990 American College of Rheumatology criteria for FM, were enrolled in a responder-enriched, randomized withdrawal trial. After receiving open-label milnacipran (8 weeks), patients with ≥50 % improvement in pain underwent double-blind randomization (1:2) to either placebo or continuing treatment with milnacipran (8 weeks). All patients, including those who did not meet the randomization criteria for double-blind withdrawal, were allowed to enter an extension study with open-label milnacipran (up to 52 weeks). The primary endpoint was loss of therapeutic response (LTR) during the double-blind period. Additional outcome measures included the Patient Global Impression of Severity (PGIS), Pediatric Quality of Life Inventory (PedsQL: Generic Core Scales, Multidimensional Fatigue Scale), and Multidimensional Anxiety Scale for Children (MASC). Safety assessments included adverse events (AEs), vital signs, electrocardiograms, and laboratory tests. RESULTS The milnacipran program was terminated early due to low enrollment. Because only 20 patients were randomized into the double-blind withdrawal period, statistical analyses were not conducted for the LTR endpoint. However, 116 patients entered the open-label period of the initial study and 57 participated in the open-label extension study. Their experience provides preliminary information about the use of milnacipran in JFM patients. During both open-label periods, there were mean improvements in pain severity, PGIC, PedsQL, and MASC scores. No unexpected safety issues were detected. The most commonly reported treatment-emergent AEs were nausea, headache, vomiting, and dizziness. Mean increases in heart rate and blood pressure were observed, and were consistent with the AE profile in adults with FM. CONCLUSIONS The open-label findings provide preliminary evidence that milnacipran may improve symptoms of JFM, with a safety and tolerability profile that is consistent with the experience in adult FM patients. Future trial designs for JFM should consider the relatively low recognition of this condition compared to adult FM and the difficulties with enrollment. TRIAL REGISTRATION NCT01328002 ; NCT01331109.
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Affiliation(s)
- Lesley M. Arnold
- Women’s Health Research Program, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH 45219 USA
| | - Lucinda Bateman
- Fatigue Consultation Clinic, 1002 E. South Temple Street, Suite 408, Salt Lake City, UT, 84102, USA.
| | - Robert H. Palmer
- Forest Research Institute, an affiliate of Actavis, Inc., Harborside Financial Center, Plaza V, Suite 1900, Jersey City, NJ 07311 USA
| | - Yuhua Lin
- Forest Research Institute, an affiliate of Actavis, Inc., Harborside Financial Center, Plaza V, Suite 1900, Jersey City, NJ, 07311, USA.
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Alobid I, Nogué S, Izquierdo-Dominguez A, Centellas S, Bernal-Sprekelsen M, Mullol J. Multiple chemical sensitivity worsens quality of life and cognitive and sensorial features of sense of smell. Eur Arch Otorhinolaryngol 2014; 271:3203-8. [PMID: 24687801 DOI: 10.1007/s00405-014-3015-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 03/17/2014] [Indexed: 11/25/2022]
Abstract
Multiple chemical sensitivity (MCS) is characterized by a loss of tolerance to a variety of environmental chemicals. Multiple chemical sensitivity is frequently triggered by exposure to chemical agents, especially insecticides. The aim of the study was to measure the sense of smell and quality of life in patients with MCS compared to the control group. We studied the sense of smell, both sensitive and sensorial characteristics, in female patients with MCS (n = 58, mean 50.5 ± 8.5 years) and healthy female volunteers without rhinosinusal pathologies (n = 60, mean age 46 ± 10.2 years). Olfactometry (Barcelona Smell Test 24/BAST-24), sinonasal symptoms (visual analogue scale/VAS 0-100 mm), and quality of life (Quick Environmental Exposure and Sensitivity Inventory/QEESI) were assessed. Multiple chemical sensitivity patients showed a significant impairment in smell identification (19 ± 12 %; p > 0.05) and forced choice (62 ± 18 %; p > 0.05), but not in smell detection (96 ± 4 %) compared to the control group. Multiple chemical sensitivity patients reported more odours as being intense and irritating and less fresh and pleasant when compared with the control group. Patients scored a high level (40-100) on QEESI questionnaire (symptom severity, chemical intolerances, other intolerances, life impact). In MCS patients, total symptom intensity (VAS/0-700 mm) score was 202 ± 135, while disease severity score was 80 ± 23. The most frequent symptoms were itching and posterior rhinorrhea. Multiple chemical sensitivity patients have an impairment in smell cognitive abilities (odour identification and forced choice, but not for detection) with increased smell hypersensitivity and poor quality of life.
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Affiliation(s)
- Isam Alobid
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, c/Villarroel, 170, Barcelona, 08036, Spain,
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Nordin M, Andersson L, Nordin S. Coping strategies, social support and responsibility in chemical intolerance. J Clin Nurs 2010; 19:2162-73. [PMID: 20659196 DOI: 10.1111/j.1365-2702.2010.03264.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To study coping strategies, social support and responsibility for improvement in chemical intolerance (CI). BACKGROUND Limited knowledge of CI among health professionals and lay persons places demands on the chemically intolerant individual's coping strategies and perception of social support and ability to take responsibility for improvement. However, there is sparse literature on these issues in CI. DESIGN A cross-sectional, questionnaire-based, quasi-experimental study. METHOD Fifty-nine persons with mild, 92 with moderate and 31 with severe CI participated by rating (i) usage and effectiveness of six problem- and six emotion-focused coping strategies, (ii) emotional, instrumental and informative support provided by various sources and (iii) society's and the inflicted individual's responsibility for improvement. RESULTS The participants reported that the most commonly used and effective coping strategies were avoiding odorous/pungent environments and asking persons to limit their use of odorous/pungent substances (problem-focused strategies) as well as accepting the situation and reprioritising (emotion-focused strategies). High intolerance severity was associated with problem-focused coping strategies and relatively low intolerance with emotion-focused strategies. More emotional than instrumental and informative support was perceived, predominantly from the partner and other family members. Responsibility attributed to society was also found to increase from mild to moderate/severe intolerance. CONCLUSIONS Certain coping strategies are more commonly used and perceived as more effective than others in CI. However, intolerance severity plays a role regarding both coping strategies and responsibility. Emotional support appears to be the most available type of support. RELEVANCE TO CLINICAL PRACTICE For improved care, certain coping strategies may be suggested by nurses, the healthcare system needs to provide better social support to these patients and the issue of responsibility for improvement may be discussed with the patient.
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Affiliation(s)
- Maria Nordin
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
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Toussaint L, Overvold-Ronningen M, Vincent A, Luedtke C, Whipple M, Schriever T, Luskin F. Implications of forgiveness enhancement in patients with fibromyalgia and chronic fatigue syndrome. J Health Care Chaplain 2010; 16:123-39. [PMID: 20658426 DOI: 10.1080/08854726.2010.492713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this review is to examine forgiveness as a means to enhance coping with the emotional sequelae of two disorders, fibromyalgia and chronic fatigue. As with many chronic illnesses, fibromyalgia and chronic fatigue often result in a host of negative emotions including, anger, stress, fear, and depression. We contend that learning to become more forgiving may be a complementary treatment to cope with the ongoing stress, frustration, and negative emotions that result from these two conditions. Our review includes descriptive information on fibromyalgia and chronic fatigue, a brief review of the literature on anger and its influence on health, a review of the connections between forgiveness and well-being, and methods to enhance forgiveness in patients' lives. We conclude with a conceptual model that we hope will be useful to design and/or evaluate work on forgiveness in these patients.
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Affiliation(s)
- Loren Toussaint
- Department of Psychology, Luther College, Decorah, Iowa 52101, USA.
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Landgrebe M, Hauser S, Langguth B, Frick U, Hajak G, Eichhammer P. Altered cortical excitability in subjectively electrosensitive patients: results of a pilot study. J Psychosom Res 2007; 62:283-8. [PMID: 17324677 DOI: 10.1016/j.jpsychores.2006.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 11/02/2006] [Accepted: 11/13/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Hypersensitivity to electromagnetic fields is frequently claimed to be linked to a variety of unspecific somatic and/or neuropsychological complaints. Whereas provocation studies often failed to demonstrate a causal relationship between electromagnetic field exposure and symptom formation, neurophysiological examinations highlight baseline deviations in people claiming to be electrosensitive. METHODS To elucidate a potential role of dysfunctional cortical regulations in mediating hypersensitivity to electromagnetic fields, cortical excitability parameters were measured by transcranial magnetic stimulation in subjectively electrosensitive patients (n=23) and two control groups (n=49) differing in their level of unspecific health complaints. RESULTS Electrosensitive patients showed reduced intracortical facilitation as compared to both control groups, while motor thresholds and intracortical inhibition were unaffected. CONCLUSIONS This pilot study gives additional evidence that altered central nervous system function may account for symptom manifestation in subjectively electrosensitive patients as has been postulated for several chronic multisymptom illnesses sharing a similar clustering of symptoms.
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Affiliation(s)
- Michael Landgrebe
- Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Regensburg, Regensburg, Germany
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Affiliation(s)
- David H Alpers
- Washington University School of Medicine, St Louis, Missouri, USA.
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12
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Abstract
Perceived poisoning may manifest in numerous ways; however, all cases share certain characteristics. All are fostered by the wide availability of unreliable information about chemical safety, poor understanding of scientific principles, and ineffective risk communication. Although this problem is still incompletely understood, some approaches have been demonstrated to be useful, such as education about risk, appropriate reassurance, and empathy on the part of the practitioner. Successful management may curtail the spread or exacerbation of symptoms, whereas unsuccessful treatment may cause the problems to escalate, with detrimental effects on both society and patient.
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Affiliation(s)
- Kristine A Nañagas
- Division of Medical Toxicology, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206-1367, USA.
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13
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Ortega Pérez A. «Sensibilidad a múltiples compuestos», una enfermedad comúnmente inadvertida. Med Clin (Barc) 2005; 125:257-62. [PMID: 16137487 DOI: 10.1157/13078105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Arturo Ortega Pérez
- Unidad de Medicina Legal y Toxicología, Facultad de Medicina y Ciencias de la Salud, Universidad Rovira i Virgili, Reus, Tarragona, Spain.
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Viljoen M, Panzer A. Non-termination of sickness behavior as precipitating factor for mental disorders. Med Hypotheses 2005; 65:316-29. [PMID: 15922107 DOI: 10.1016/j.mehy.2004.08.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Accepted: 08/13/2004] [Indexed: 11/20/2022]
Abstract
Sickness behavior can be defined as a combination of coordinated behavioral and physiological changes that develop in response to any condition that elicits pro-inflammatory activity. It is an adaptational homeostasis initiated by the influence of pro-inflammatory cytokines on central nervous system neurohormonal functioning. This paper introduces the concept of non-termination of sickness behavior as a potential threat to mental health. In view of the similarities between the behavioral symptoms, the neuroendocrine and the cytokine profiles of sickness behavior and that of a number of mental disorders it is hypothesized that the inappropriate continuation of sickness behavior, (i.e., non-termination), after recovery from the initial disease, could form the basis for mental disturbances. This would be particularly relevant in individuals with alterations in stress vulnerability (altered activation threshold and impaired negative feedback), which may occur due to the combination of genetic disposition and priming by early life experiences.
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Henningsen P. The body in the brain: towards a representational neurobiology of somatoform disorders. Acta Neuropsychiatr 2003; 15:157-60. [PMID: 26983562 DOI: 10.1034/j.1601-5215.2003.00032.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Peter Henningsen
- 1Department of Psychosomatic Medicine, University Hospital Heidelberg, Germany
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Naranch K, Park YJ, Repka-Ramirez MS, Velarde A, Clauw D, Baraniuk JN. A tender sinus does not always mean rhinosinusitis. Otolaryngol Head Neck Surg 2002; 127:387-97. [PMID: 12447232 DOI: 10.1067/mhn.2002.129038] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sinus tenderness has not been quantitatively assessed. OBJECTIVE We sought to compare sinus and systemic tenderness in rhinosinusitis, allergic rhinitis, and chronic fatigue syndrome (CFS), and healthy (non-CFS) groups. METHODS Cutaneous pressures (kg/cm(2)) causing pain at 5 sinus and 18 systemic sites were measured in acute and chronic rhinosinusitis, active allergic rhinitis, healthy non-CFS/no rhinosinusitis, and CFS subjects. RESULTS Sinus thresholds differed significantly (P </= 10(-11), ANOVA) between non-CFS/no rhinosinusitis (1.59 +/- 0.14 kg/cm(2), mean +/- 95% CI, n = 117), allergic rhinitis (1.19 +/- 0.31, n = 30), exacerbations of chronic rhinosinusitis (1.25 +/- 0.26, n = 25), non-CFS/chronic rhinosinusitis (1.23 +/- 0.27, n = 23), acute rhinosinusitis (1.10 +/- 0.20, n = 22), CFS/no rhinosinusitis (0.98 +/- 0.15, n = 70), and CFS/chronic rhinosinusitis (0.78 +/- 0.12, n = 56). Systemic pressure thresholds were lower for CFS (1.46 +/- 0.15) than for non-CFS (2.67 +/- 0.22, P </= 10(-11)). CONCLUSIONS The lower sinus thresholds of rhinosinusitis groups validated the sign of sinus tenderness. Sinus and systemic thresholds were both 44% lower in CFS than in non-CFS subjects, suggesting that systemic hyperalgesia contributed to CFS sinus tenderness and "rhinosinusitis" complaints.
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Affiliation(s)
- K Naranch
- Chronic Pain and Fatigue Research Center, Division of Rheumatology, Immunology and Allergy, Georgetown University, Washington, DC 20007-2097, USA
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