Fibromyalgi-stigma

Abstract

Introduksjon Fibromyalgi er en lidelse som kjennetegnes av både somatiske og psykiatriske symptom. Adskillelsen mellom psyke og soma har vært en vedtatt sannhet i tradisjonell tilnærmingen til medisinske problemstillinger i den vestlige verden. Det har vært tatt for gitt at forskning på medisinske problemstillinger har respektert denne dualismen. Det dualistiske synet har spesielt siden Descartes’ tid, både bevisst og ubevisst, vært formende på måten vi tilnærmer oss medisin på. Nyere forskning viser at overgangen mellom disse to paradigmene, «soma» og «psyke», er mer flytende enn tidligere antatt. Fagfeltet immunopsykiatri er et relativt nytt fagfelt som forsøker å se sammenhenger i det man anser som en stadig mer flytende overgang mellom psyke og soma, med immunforsvaret og dets prosesser som innfallsvinkel. Ved inflammasjonsprosesser vil mengden av ulike stoff kunne endres fra det normale. Dette skjer blant annet med ulike B-vitaminer og deres metabolitter. B-vitaminene har vist seg å være sentrale i flere prosesser, blant annet i sentralnervesystemet, og avvik kan gi et symptombilde lignende det vi ser hos fibromyalgi-pasienter. I denne studien har vi derfor valgt å sammenligne ulike B-vitaminer mellom en pasientgruppe med fibromyalgi og en kontrollgruppe, som en del av grunnforskningen på fibromyalgi. Studien har som hovedmål å være retningsangivende for videre forskning. Metode En gruppe på 58 fibromyalgipasienter ble rekruttert fra senter for sammensatte lidelser på St. Olavs hospital. De ble sammenlignet med en kontrollgruppe på 53 friske deltakere. I studien sammenlignet man blant annet ulike stoff i perifert venøst blod. Ulike immunologiske markører er allerede undersøkt, og vi ser i denne delstudien på B-vitaminer og tilhørende metabolitter. På grunn av manglende normalfordeling ble det utført en Mann-Whitney U test for å sammenligne gruppene, fremfor en uavhengig T-test. Vi sammenlignet 16 variabler.

Resultat Vi fant statistisk signifikante forskjeller på 6 av de 16 variablene vi testet for. Da en av verdiene var svært nære en statistisk signifikant verdi valgte vi å inkludere dette som et potensielt funn. Variablene med definitiv statistisk signifikans var Folat (P=0,001), Nicotinamide (P=0,005), Pyridoxal 5 fosfat (P=0,0042) og Tiamin monofosfat (P=0,047). Pyridoxal (P=0,053) var stoffet som vi valgte å definere som potensielt statistisk signifikant. Stoffene som ikke viste seg å være statistisk signifikante er også viktige funn, og består av stoffene Cystathionine (P=0,138), Flavin mononukleotid (P=0,125), Kobalamin (P=0,855), N1-metylnicotinamide (P=0,207), Neopterin (P=0,846), Nicotinic acid (P=1,00), 4-pyridoxic acid (P=0,134), Pyridoxine (P=1,00), Riboflavin (P=0,486), Tiamin (P=0,852), Trigonelline (P=0,095).

Konklusjon Våre data viser en forskjell i enkelte B-vitaminer, og B-vitaminmetabolitter mellom en fibromyalgi-gruppe og en kontrollgruppe. Verdiene for stoffene var lavere for fibromyalgigruppen sammenlignet med kontrollene for folat, nicotinamide, pyridoxal, pyridoxal 5 fosfat og tiamin monofosfat. De eneste stoffene som var forhøyede i fibromyalgi-gruppen var Cotinine og Trans-3-hydroxycotinine. Resterende variabler (Cystathionine, Flavin mononukleotid, Kobalamin, N1-metylnicotinamide, Neopterin, Nicotinic acid, 4-pyridoxic acid, Pyridoxine, Riboflavin, Tiamin, Trigonelline) viste ingen forskjell mellom gruppene. For å finne forklaringsmodeller på resultatenes relevans for fibromyalgi trengs det mer forskning. Disse funnene vil potensielt kunne være retningsangivende for dette.

Introduction Fibromyalgia is a condition which is characterized by both psychiatric and somatic symptoms. The division between these two perspectives, psychiatry and somatic, has been dominating the approach to medical issues in the western world for the last centuries. Furthermore, has studies on these two perspectives respected the division. The philosopher Michael Foucault defined a term, episteme, which described established beliefs that are unconscious and fundamental in a paradigm. These episteme changes in various paradigms, they are not reviled before the scientific tradition has been changed(1). The dualistic view of the body and soul has dominated our approach to medical issues since Descartes, both conscious and unconscious. New studies indicate that this separation is not as binary as previously assumed. Are we witnessing the start of a paradigm shift, and has the dualist approach been one of our scientific tradition’s epistemes? Studies suggest that a more holistic view on the topic is on the rise. We now have good data on topics that link both the somatic and psychiatric disorders. The frequency of several severe diseases, such as cancer and different cardiac pathologies, has a proportional correlation to the amount of stress in childhood (adverse childhood experiences). And in extreme cases the stress response may cause a decrease in a child’s length growth . The opposite case, that somatic pathology may interfere with what was defined as psychiatric disorders, is also well documented. Malnutrition or malabsorption can in itself activate a psychosis or damage peripheral nerves to cause painful sensations. The field of immunopsychiatry is a relatively new field that tries to investigate connections in what is considered a more holistic view, with the immune system and its processes as its approach. An activated immune system causes changes in the quantity of different substances. Some of these substances are various B vitamins and their metabolites. It is well documented that several B vitamins and metabolites have an utterly crucial role to play in the maintaining of a normal metabolism, and more specifically a functioning nervous system (both central and peripheral). A deviation from a normal quantity of these substances can cause different symptoms, including symptoms that isarein fibromyalgia. This study is going to compare different B vitamins and some of their key metabolites between a fibromyalgia group, and a control group. The main goal of the study is to provide a direction for further research on the vaguely defined condition fibromyalgia, as part of the fundamental research.

Method A group of 58 female fibromyalgia (FM) patients were recruited from the pain center at St. Olav`s hospital in Trondheim. They were compared with a control group of 53 age and gender matched healthy participants. The study compared several parameters, among them were vitamin B and some of their key metabolites in peripheral venous blood, 16 substances in total. Rather than an independent T-test, a non independent Mann-Whitney U test was performed to analyze the data due to lack of normal distributions of the parameters.

Results Five of the substances where statistically significant, and one was so close to significans that it was defined as a potentially significant. The variables definitively statistically significant were Folat (P=0,001), Nicotinamide (P=0,005), Pyridoxal 5 phosphate (P=0,0042) and Thiamin monophosphate (P=0,047). Pyridoxal (P=0,053) was the parameter close to signifinace, and included as potentially significant.

Conclusion Our data show a difference in some of the B-vitamins and metabolites between a group with fibromyalgia patients and an age and gender matched control group. The quantity of the substances was lower in the fibromyalgia group for all of the substances with significant difference. The remaining substances that were not significantly deviant were Cystathionine, Flavin mononucleotid, Kobalamin, N1-metylnicotinamide, Neopterin, Nicotinic acid, 4-pyridoxic acid, Pyridoxine, Riboflavin, Tiamin and Trigonelline. More studies are needed to get a better understanding of the disorder fibromyalgia. The magnitude of the results of this study is yet unclear, but it may be directional.