Definition
A set of patient complaints that with careful history, physical examination, and lab testing has no apparent medical cause is thus unexplained. When this happens, some physicians jump to a psychiatric explanation in lieu of no other - often leaving the patient stigmatized. Instead, a group of experts has arrived at operational definitions of symptom-based syndromes to allow for diagnosis and research. When the symptom is predominantly fatigue, severe enough to reduce activity substantially, and lasting at least 6 months, the diagnosis is idiopathic chronic fatigue. When the symptom is predominantly body-wide pain, also lasting many months, and the patient is tender on palpation, the diagnosis is fibromyalgia. When the pain is limited to face and jaw, the diagnosis is temporomandibular joint syndrome, and when the pain is in the abdomen and associated with constipation and/or diarrhea, the diagnosis is irritable...
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References and Further Reading
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Cook, D. B., Lange, G., Ciccone, D. S., Liu, W. C., Steffener, J., & Natelson, B. H. (2004). Functional imaging of pain in patients with primary fibromyalgia. Journal of Rheumatology, 31(2), 364–378.
Evengård, B., Nilsson, C. G., Lindh, G., Lindquist, L., Eneroth, P., Fredrikson, S., et al. (1998). Chronic fatigue syndrome differs from fibromyalgia. No evidence for elevated substance P levels in cerebrospinal fluid of patients with chronic fatigue syndrome. Pain, 78(2), 153–155.
Hauser, W., Klose, P., Langhorst, J., Moradi, B., Steinbach, M., Schiltenwolf, M., et al. (2010). Efficacy of different types of aerobic exercise in fibromyalgia syndrome: A systematic review and meta-analysis of randomised controlled trials. Arthritis Research & Therapy, 12(3), R79.
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Weaver, S. A., Janal, M. N., Aktan, N., Ottenweller, J. E., & Natelson, B. H. (2010). Sex differences in plasma prolactin response to tryptophan in chronic fatigue syndrome patients with and without comorbid fibromyalgia. Journal of Women’s Health, 19(5), 951–958.
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Natelson, B.H. (2019). Medically Unexplained Symptoms. In: Gellman, M. (eds) Encyclopedia of Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6439-6_416-2
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DOI: https://doi.org/10.1007/978-1-4614-6439-6_416-2
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