Dysregulation Spectrum Syndrome:
A Unified Field Theory of Fibomyalgia and Related Illnesses

Reported by Miryam Williamson 
Copyright ©1997, Miryam Ehrlich Williamson - All Rights Reserved

Updated 7/5/98 

The following is a report on a presentation by MuhammadYunus, MD, rheumatologist and professor of medicine at the University of Illinois College of Medicine, Peoria, at the Ohio '97 fibromyalgia conference, August 8-10, 1997. The conference was sponsored by the Fibromyalgia Alliance of America and Anadem Publishing Co.  Any errors contained in this article are the author's, not those of Dr Yunus.

In a talk titled "Fibromyalgia and Other Members of the Dysregulation Spectrum Syndrome, " Yunus described the link between FM (fibromyalgia), CFS (chronic fatigue syndrome,) IBS (irritable bowel syndrome,) tension headache, migraine, and restless leg syndrome. He groups them under an umbrella he labels "Dysregulation Spectrum Syndrome," defined as "a common biophysical syndrome characterized by endocrine dysregulation and dysfunction." Yunus sees it as related to stress, but points out that not all stress is necessarily psychological. He said he used to use the term "dysfunctional," but has dropped that because the psychiatric community takes that to mean that these illnesses, FM included, are of psychiatric origin, which Yunus thinks is incorrect. 

Yunus identifies these characteristics of the DSS paradigm: 

  • 1. Clustering of DSS members (IBS, migraine, etc.) in a given patient group. These symptoms occur more often in this group than in the general population. 
  • 2. A sharing of clincial characteristics among patients. 
  • 3. A generalized hyperalgesic (heightened sensitivity to pain) state. 
  • 4. Absence of the "classical disease model" (in which injury or illness can be identified by clinical signs, lab tests produce confirmation, and conventional treatment can be expected to work to effect a cure or relief.) 
  • 5. Absence of the typical psychiatric model 
  • 6. A common neuroendocrine mechanism (biophysiology, not pathophysiology) 
  • 7. A common genetic linkage 
  • 8. Response to neuromodulating drugs or interventions 

  • Statistically, IBS, headache, and dysmenorrhea (menstrual problems) occur in FM more commonly than in the general population; this occurrence is far greater than it would be by mere chance. Restless leg syndrome occurs in 31% of PWF (people with fibromyalgia), 15% of people with rheumatoid arthritis (RA), and 2% of the general population. 

    IBS is more common in people with FM and FM is more common in people with IBS. This is not true of inflammatory bowel disease -- Chron's, ulcerative colitis, for example. 

    1/3 of patients with RA have FM. 

    He presented arguments against FM as a depressive illness: 

  • * the prevalence of depression in FM is similar to other chronic pain conditions 
  • * FMS and depression have different biochemical characteristics, as found in serotonin and hypothalamic-pituitary-adrenal axis studies 
  • * the types of sleep disturbance are different 
  • * the characteristics of cognitive dysfunction are different 
  • * FMS responds to much smaller doses of tricyclic agents (he doesn't call them antidepressants) 

  • As to the fact that tricyclics can help PWF, he points out that there is an antimalarial drug that has been found useful in treating RA, but that doesn't prove that RA is malaria. 

    He had a diagram of the synchronicity of FM causes and symptoms that I can't reproduce here but that you can draw: make a rectangle with poor sleep in the upper left corner, fatigue in the upper right, pain in the lower left, and physical deconditioning in the lower right. Draw two-headed arrows between poor sleep and fatigue, poor sleep and pain, pain and fatigue, pain and physical deconditioning, and fatigue and physical deconditioning. 

    A "couple of dozen" controlled studies of PWF have reported abnormalities in neurohormal functioning. 

    Yunus presented arguments in favor of IBS being a centrally mediated illness rather than a gut disease: 

    -- no gut pathology is found -- gut motility studies show inconsistency, but motor abnormalities are present only when the patient is conscious -- the central nervous sytem influences gut motility 

    Copyright ©1997, Miryam Ehrlich Williamson - ALL RIGHTS RESERVED



     

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