Overtraining Syndrome one more piece of the Central Sensitivity Syndrome puzzle

The initial focus of overtraining syndrome was physical overexertion with inadequate rest, causing severe chronic fatigue and decreased performance. The pathophysiological knowledge has subsequently evolved, and although the exact mechanisms of overtraining syndrome are unknown, several hypotheses arise. The most prominent of these are: the existence of an immunoneuroendocrine imbalance and dysfunction of the central nervous system and of the neuroendocrine axis. On the other hand, central sensitivity syndrome encompasses nosological entities that share the pathophysiological mechanisms that cause them, that is, an immunoneuroendocrine and mitochondrial dysfunction as well as an oxidative stress imbalance. The most common entities within central sensitivity syndrome are fibromyalgia, tension headache and/or migraine, chronic fatigue syndrome, irritable bowel syndrome, multiple chemical syndrome, electrosensitivity syndrome, irritable bladder syndrome, and restless leg syndrome, among others. The pathophysiological and clinical analogy between overtraining syndrome and central sensitivity syndrome raises the possibility of including overtraining syndrome within central sensitivity syndrome, since a stressful stimulus such as chronic overtraining coupled with unbalanced compensatory systems can generate, at a given time, immunoneuroendocrine sensitization and therefore central sensitivity syndrome. Resumen El enfoque inicial del síndrome de sobreentrenamiento ha sido el sobreesfuerzo físico con un descanso no adecuado, que provocaba fatiga crónica severa y disminución en el rendimiento. Posteriormente ha ido evolucionando el conocimiento fisiopatológico, y aunque se desconocen los mecanismos fisiopatológicos exactos del síndrome de sobreentrenamiento, se plantean diversas hipótesis. Las más destacadas son: la existencia de un desbalance inmunoneuroendocrino y disfunción del sistema nervioso central y el eje neuroendocrino. Por su parte el síndrome de sensibilidad central engloba entidades nosológicas que tienen en común las razones fisiopatológicas que las ocasionan, esto es, una disfunción inmunoneuroendocrina, mitocondrial y un desbalance del estrés oxidativo. Las entidades más comunes dentro del síndrome de sensibilidad central suelen ser la fibromialgia, la cefalea tensional y/o migraña, el síndrome de fatiga crónica, el síndrome de intestino irritable, el síndrome químico múltiple, el síndrome de electrosensibilidad, el síndrome de la vejiga irritable, el síndrome de piernas inquietas, entre otros. La analogía fisiopatológica y clínica entre el síndrome de sobreentrenamiento y el síndrome de sensibilidad central, plantea la posibilidad de englobar al síndrome de sobreentrenamiento dentro del síndrome de sensibilidad central, ya que ante la presencia de un estímulo estresante como lo es el sobreentrenamiento crónico, unido a sistemas compensadores desequilibrados, puede generar en un momento determinado una sensibilización. Resumo O foco inicial da síndrome do supertreinamento foi o excesso de esforço físico com descanso inadequado, causando fadiga crônica grave e diminuição do desempenho. Posteriormente o conhecimento fisiopatológico evoluiu e, embora os mecanismos exatos da síndrome do supertreinamento sejam desconhecidos, surgem várias hipóteses. Os mais proeminentes são: a existência de um desequilíbrio imunoneuroendócrino e disfunção do sistema nervoso central e do eixo neuroendócrino. Por outro lado, a síndrome da sensibilização central engloba entidades nosológicas que compartilham os mecanismos fisiopatológicos que as causam, ou seja, uma disfunção imunoneuroendócrina e mitocondrial, bem como um desequilíbrio de estresse oxidativo. As entidades mais comuns dentro da síndrome da sensibilização central são fibromialgia, cefaleia e/ou enxaqueca, síndrome de fadiga crônica, síndrome do intestino irritável, síndrome química múltipla, síndrome de eletrosensibilidade, síndrome da bexiga irritável e síndrome das pernas inquietas, entre outros. A analogia fisiopatológica e clínica entre síndrome do supertreinamento e síndrome da sensibilização central levanta a possibilidade de incluir a síndrome do supertreinamento dentro da síndrome da sensibilização central, uma vez que um estímulo estressante, como o supertreinamento crônico, juntamente com sistemas compensatórios desequilibrados, pode gerar, em determinado momento, sensibilização imunoneuroendócrina e, portanto, síndrome da sensibilização central.

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The Future Holds a Lot of Hope

All About Fibromyalgia ◽

10.1093/oso/9780195147537.003.0038 ◽

2002 ◽

Author(s):

Daniel J. Wallace ◽

Janice Brock Wallace

Keyword(s):

Chronic Fatigue ◽

Research Strategies ◽

Irritable Bladder ◽

American College Of Rheumatology ◽

Fatigue Syndrome ◽

Salutary Effect ◽

Headache Pain ◽

Research And Education ◽

Organized Medicine ◽

Irritable Bowel

When we became interested in fibromyalgia over 20 years ago, we quickly learned how it felt to be lonely. The Fibrositis Study Club (now the Fibromyalgia Study Club) of the American Rheumatism Association (now the American College of Rheumatology) had an average attendance of ten at its annual meetings. In 2001, more than 500 rheumatologists attended the same meeting. During the early 1980s, an average of 14 articles a year appeared in the fibromyalgia medical literature, and less than $100,000 was being spent annually on fibromyalgia research. The recognition of fibromyalgia by organized medicine as a distinct syndrome has had a salutary effect on research. As of this writing, 500 articles are now published yearly and $2 million is spent annually on research. All this attention and interest bodes well for more scientific breakthroughs in the field. What can fibromyalgia patients hope for over the next 20 years? In all probability, the name fibromyalgia will be replaced by a more all-encompassing term, one that includes related syndromes that have similar causes and physiologic processes. A better (and catchier) term that combines symptoms and signs reported in tension headache, pain amplification, irritable bowel syndrome, irritable bladder, and chronic fatigue syndrome, among others, will be devised and agreed on. When organized medicine marshals the resources of experts in gastroenterology, infectious disease, rheumatology, and other subspecialties to work together, our knowledge of pain amplification, neurotransmitter-mediated, behaviorally influenced fatigue syndromes will be increased, and research strategies will be better coordinated and focused. Fibromyalgia advocacy groups will unite to increase funding for research and education that will make a difference. We predict that 2–5 percent of the U.S. population has chronic neuromuscular pain with the systemic overlay mentioned above. Over the next 20 years, the precise racial and ethnic backgrounds of these individuals will be identified, as well as the genes that influence the process. Additionally, environmental and occupational factors that cause or aggravate chronic neuromuscular pain will be clarified. Through coordinated strategies involving all forms of media, the public will become aware of what fibromyalgia is and what factors are associated with it.

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There is only one functional somatic syndrome

The British Journal of Psychiatry ◽

10.1192/bjp.185.2.95 ◽

2004 ◽

Vol 185 (2) ◽

pp. 95-96 ◽

Cited By ~ 117

Author(s):

Simon Wessely ◽

Peter D. White

Keyword(s):

Tension Headache ◽

Chronic Fatigue ◽

Functional Somatic Syndrome ◽

Hyperventilation Syndrome ◽

Major Health ◽

Fatigue Syndrome ◽

School Of Medicine ◽

King's College ◽

Irritable Bowel ◽

Medical Subspecialty

Functional somatic symptoms and syndromes are a major health issue. They are common, costly, persistent and may be disabling. Most of the current literature pertains to specific syndromes defined by medical subspecialties. Indeed, each medical subspecialty seems to have at least one somatic syndrome. These include: irritable bowel syndrome (gastroenterology); chronic pelvic pain (gynaecology); fibromyalgia (rheumatology); non-cardiac chest pain (cardiology); tension headache (neurology); hyperventilation syndrome (respiratory medicine) and chronic fatigue syndrome (infectious disease). In 1999, Wessely and colleagues concluded on the basis of a literature review that there was substantial overlap between these conditions and challenged the acceptance of distinct syndromes as defined in the medical literature (Wessely et al, 1999). They proposed the concept of a general functional somatic syndrome. But is there any empirical evidence for such a general syndrome? Is it even a useful concept? Five years on, Professor Simon Wessely, King's College London, revisits this debate. He is opposed by Dr Peter White from St Bartholomew's Hospital and Queen Mary School of Medicine and Dentistry, London.

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Making a Diagnosis When One is Not Apparent: Bridging the Gap Between Somatic Patient and Frustrated Physician

CNS Spectrums ◽

10.1017/s1092852900014243 ◽

2006 ◽

Vol 11 (3) ◽

pp. 165-165

Author(s):

Jack M. Gorman

Keyword(s):

Tension Headache ◽

Chronic Fatigue ◽

Medical Problem ◽

Advocacy Groups ◽

Fatigue Syndrome ◽

Push Forward ◽

Secret Code ◽

Irritable Bowel ◽

Test Result ◽

Poor Concentration

From medical school, we all know the secret code words: “functional”, “supertentorial”, “idiopathic”, and so forth. These, of course, are some of the ways that physicians may refer to patients for whom they cannot make a definitive diagnosis. Such patients, often labeled “somatisizers”, frequent primary care and specialty care physicians' offices as well as emergency rooms.They present with complaints of a variety of aches and pains, fatigue, insomnia, poor concentration, diarrhea, constipation, etc. Any one of these could be the initial signal of a serious medical problem but for this group of patients nothing can be found on physical examination or laboratory and blood tests.Depending on the specialty of the physician, somatisizers receive a variety of diagnoses. Neurologists cite tension headache, rheumatologists cite fibromyalgia, internists cite chronic fatigue syndrome, gastroenterologists cite irritable bowel syndrome, and psychiatrists cite depression or an anxiety disorder. With the exception of the latter, no treatment has proven particularly successful, and many of these patients, regardless of the diagnosis, wind up being prescribed antidepressants. Does that mean that all somatisizers are suffering from underlying depression or anxiety? Some insist that is the case, but advocacy groups and many patients themselves resist that classification. Physicians are often afraid to suggest to patients that what they are complaining about is really due to a psychiatric problem, fearful of insulting the person. Some doctors, fearing they might overlook something, send the patient for increasingly sophisticated tests, running up healthcare costs and exposing patients to some risk. Inevitably, a test result comes back on the border of abnormality, thus, creating a reason to push forward with even more tests.

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Review of The psychopathology of functional somatic syndromes: Neurobiology and illness behavior in chronic fatigue syndrome, fibromyalgia, Gulf War illness, irritable bowel, and premenstrual dysphoria.

Families Systems & Health ◽

10.1037/1091-7527.24.1.103b ◽

2006 ◽

Vol 24 (1) ◽

pp. 103-105

Author(s):

Thérèse M. Namenek

Keyword(s):

Chronic Fatigue Syndrome ◽

Chronic Fatigue ◽

Gulf War ◽

Illness Behavior ◽

Functional Somatic Syndromes ◽

Gulf War Illness ◽

Fatigue Syndrome ◽

Irritable Bowel

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Competences Required for the Delivery of High and Low-Intensity Cognitive Behavioural Interventions for Chronic Fatigue, Chronic Fatigue Syndrome/ME and Irritable Bowel Syndrome

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465814000290 ◽

2014 ◽

Vol 42 (6) ◽

pp. 760-764 ◽

Cited By ~ 5

Author(s):

Katharine A. Rimes ◽

Janet Wingrove ◽

Rona Moss-Morris ◽

Trudie Chalder

Keyword(s):

Irritable Bowel Syndrome ◽

Chronic Fatigue Syndrome ◽

High Intensity ◽

Chronic Fatigue ◽

Behavioural Interventions ◽

Low Intensity ◽

Fatigue Syndrome ◽

Cognitive Behavioural ◽

Irritable Bowel ◽

Cognitive Behavioural Interventions

Background: Cognitive behavioural interventions are effective in the treatment of chronic fatigue, chronic fatigue syndrome (sometimes known as ME or CFS/ME) and irritable bowel syndrome (IBS). Such interventions are increasingly being provided not only in specialist settings but in primary care settings such as Improving Access to Psychological Therapies (IAPT) services. There are no existing competences for the delivery of “low-intensity” or “high-intensity” cognitive behavioural interventions for these conditions. Aims: To develop “high-intensity” and “low-intensity” competences for cognitive behavioural interventions for chronic fatigue, CFS/ME and IBS. Method: The initial draft drew on a variety of sources including treatment manuals and other information from randomized controlled trials. Therapists with experience in providing cognitive behavioural interventions for CF, CFS/ME and IBS in research and clinical settings were consulted on the initial draft competences and their suggestions for minor amendments were incorporated into the final versions. Results: Feedback from experienced therapists was positive. Therapists providing low intensity interventions reported that the competences were also helpful in highlighting training needs. Conclusions: These sets of competences should facilitate the training and supervision of therapists providing cognitive behavioural interventions for chronic fatigue, CFS/ME and IBS. The competences are available online (see table of contents for this issue: http://journals.cambridge.org/jid_BCP) or on request from the first author.

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Treatment of fibromyalgia (chronic widespread pain) and chronic fatigue syndrome

New Oxford Textbook of Psychiatry ◽

10.1093/med/9780198713005.003.0131 ◽

2020 ◽

pp. 1330-1341

Author(s):

Jonathan Price

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Chronic Fatigue Syndrome ◽

Chronic Fatigue ◽

Chronic Widespread Pain ◽

Widespread Pain ◽

Fatigue Syndrome ◽

System P ◽

The Central Nervous System ◽

Key Aspects

Fibromyalgia (FM), one of the chronic widespread pain syndromes, and chronic fatigue syndrome (CFS) are important and common conditions. They are considered together here because they are commonly comorbid and because of their similarities—they are long-term conditions with a relatively poor prognosis; central nervous system mechanisms and deconditioning play an important role in aetiology; graded exercise and psychological treatments have an important role in management; and comorbid mental disorders are common and have an adverse impact on important outcomes, including disability and chronicity. The prevalence of FM is rising, while that of CFS is declining. There is increased acceptance of the pivotal role of central nervous system factors in FM, while in CFS, the positions of different aetiological ‘movements’ appear bitterly entrenched. The main focus of this chapter is on FM and, in particular, key aspects of aetiology and treatment, especially those relating to the central nervous system.

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