Daniel J. Wallace, MD
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Wallace D.; Rethinking Somatization. Ann Intern Med. 1997;127:1132. doi: 10.7326/0003-4819-127-12-199712150-00028
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Published: Ann Intern Med. 1997;127(12):1132.
TO THE EDITOR:
I enjoyed McWhinney and colleagues' article on rethinking somatization . The authors allude to the inadequacy of classifying such syndromes as fibromyalgia, the chronic fatigue syndrome, and functional bowel disorders as undifferentiated somatoform disorders in the Diagnosis and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
Recent advances in our understanding of pain mechanisms should lead to reclassifying these conditions as disorders characterized by chronic pain amplification. Yunus  has proposed labeling the overlapping symptoms and signs of fibromyalgia, the chronic fatigue syndrome, functional bowel disorders, irritable bladder, and tension headache as components of a dysfunctional spectrum syndrome (DSS) . Controlled studies have shown that patients with DSS have elevated cerebrospinal fluid levels of substance P, excitatory amino acids, and a relative serotonin deficiency [3, 4]. These abnormalities augment nociceptive responses and produce allodynia. Allodynia is a clinical situation in which pain results from a stimulus that should not normally be painful. Fibromyalgia, for example, is a form of chronic, widespread allodynia. Functional bowel disorders (nonulcer dyspepsia, noncardiac chest pain, spastic colitis, and chronic abdominal pain) are not consequences of dysmotility but examples of autonomically mediated visceral hyperalgesia .
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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