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ISSN: 2167-0277
Journal of Sleep Disorders & Therapy
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Reclaim the Diagnosis of Somatoform Disorder and Neurasthenia

Raúl Regal Ramos*

Physician Evaluator of Provincial Directorate of the National Institute of Social Security, Spain

*Corresponding Author:
Raúl Regal Ramos
Physician evaluator of Provincial Directorate of the National Institute of Social Security
Street López de Hoyos, 16928002 Madrid, Spain
Tel: 34 915907432
E-mail: [email protected]

Received date: March 3, 2016; Accepted date: March 31, 2017; Published date: April 10, 2017

Citation: Ramos RR (2017) Reclaim the Diagnosis of Somatoform Disorder and Neurasthenia. J Sleep Disord Ther 6:262. doi: 10.4172/2167-0277.1000262

Copyright: © 2017 Ramos RR. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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The frequency of these fibromyalgia and chronic fatigue, the associated comorbidity, the diagnostic difficulties, the complex and prolonged treatment and the social impact require a special reflection about them because, despite the evolution of medicine and the multiple studies, we no find answers or solutions yet.


Fibromyalgia; Chronic fatigue syndrome; Multiple chemical sensitivity; Somatoform disorders


The clinical concept of sensitive-trigger points was introduced in 1977, when the existence of certain anatomical locations with excessive sensitivity to pain was described, but it was not until 1981 when Yunun et al. first introduced the term fibromyalgia. In 1990 the American College of Rheumatology, ACR [1] published diagnostic criteria based on the presence of chronic widespread pain (more than 3 months) and (in at least 3 of the 4 body quadrants), along with 11 or more 18 specific tender points. In 1992 the World Health Organization (WHO) officially recognizes and defines fibromyalgia as a painful joint condition not widespread, affecting predominantly muscle areas and rachis, and having an exaggerated sensitivity to multiple predetermined points. Over time the content of the disease has stopped focusing on the symptoms of the musculoskeletal system, and in 2010 the ACR [2] proposes new criteria that no longer require palpation of tender points and evaluating the patient based on number of painful regions (Widespread Pain Index [WPI]) and a severity scale (symptom severity Score [SS-Score]) of fatigue, restless sleep and cognitive symptoms. The term neurasthenia (“nervous exhaustion") was used by Beard in 1869 to refer to a condition with symptoms of fatigue, anxiety, headache, neuralgia and depressed mood. Over the years the term neurasthenia has been abandoned as a regular medical diagnosis and has been replaced by chronic fatigue syndrome. In 1988 Holmes et al. proposes sponsored by the US CDC (Center for Disease Control) the first diagnostic criteria. In 1994 he carried out a review and the CDC itself and the International CFS Study Group proposed and generalize an updated version, called "international standards" [3]. The common characteristics of fibromyalgia with somatoform disorders and neurasthenia with chronic fatigue syndrome have already been widely described in the literature [4-7].

What We Have Achieved With This New Terminology?

Have we benefited these patients? No. We have worsened

We have created an "organic" severe and disabling illness where there was previously only an adaptive disorder or a psychosomatic disorder. Carette [8] said "We have created a monster and now up to us to make peace." Other authors [9,10] have also suggested that the act of giving patients a name for their state legitimizes unproven theories pathophysiological contrary to scientific method and effective management of health resources. From this point of view doctors have been part of the problem and not part of the solution.

We have not cured these patients, are chronified patients, often with poor quality of life and high rate of attendance services and high health costs [11-14]. We have improved some patients who are given a closely monitored by various specialists but, are not it also would obtain better performance of other common diseases if they received this type of multidisciplinary treatment?

Have we benefited family-caregivers of these patients? No

With the diagnosis of chronic organic patient, we've closed the doors to healing. And we have made that much of your life revolves around a disease without hope. This makes them neglect other aspects of your life. A study at the University of Missouri-Columbia in 2010 [15] looked like fibromyalgia can affect marriages. The results reveal greater marital instability and anger of their spouses.

Have we improved the efficiency of the health system? No

In recent years, fibromyalgia (and could be predicted something similar for chronic fatigue syndrome by the increasing incidence) has gained increasing importance to become present in a public health problem of the first order by the high prevalence in the adult population, insufficient knowledge of its causes and the mechanisms that produce and by the absence of curative treatment. We have multiplied the number of patients and have not improved the use of health resources. As demonstrated by several authors, these patients often made a pilgrimage by different specialists with a consumption of important diagnostic and therapeutic resources, up to 10,000 euros per patient per year [16], which also does not usually involve a significant improvement in their state.

Then, after more than 20 years without objectifying the disease and even improve it. Who are we benefiting? Some of these patients get the benefit of keeping the sick role and sometimes obtain financial compensation. On the other hand, there are many private clinics that guide treatment without sufficient scientific basis and maintain expectations of patients in exchange for significant bills. Cannot we ask the diagnosis and therapeutic management of these patients? Should we wait another 20 years when the incidence reaches 10%? Should we allow the increase in new diagnoses of similar characteristics as idiopathic environmental intolerance or electromagnetic hypersensitivity?

We do not have to abandon research into these diseases, but if we reduce it and we must rethink the therapeutic approach for these patients. The approach to these patients should be made from primary care relying on mental health resources (more like liaison psychiatry than as mere psychiatry interclinical), avoiding possible current referrals to multiple specialists who have not demonstrated significant improvements in these patients [17].

This text contains the personal reflections of the author based on his training and experience in various fields of medicine. They are made from the conviction that these patients actually suffer all the symptoms reported (not imaginary illness), not simulated or consciously seek any secondary gains and sometimes their pathologies can be really limiting. These reflections are made with respect for the opinions of all professionals in the field of medicine and all the associations affected. Just pretend that we stop us to reconsider.


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