Adequacy of the Comprehensive Clinical Evaluation Program A Focused Assessment (1997) / Chapter Skim
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4 IOM Review: Difficult-to-Diagnose and Ill-Defined Conditions
4 IOM Review: Difficult-to-Diagnose and Ill-Defined Conditions
Pages 25-36
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From page 25... ...
The committee reviewed information on the development of screening instruments in order to contribute to the understanding and assessment of the adequacy of the CCEP protocol. The role of screening in the area of ill-defined conditions is to be able to identify a subset of individuals from a larger group who clearly fit a description of interest.
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From page 26... ...
A major question surrounding diagnosis of CFS concerns whether CFS or any of its subset is a pathologically discrete entity as opposed to a debilitating but nonspecific condition shared by many different entities. In 1994, the CDC convened the International Chronic Fatigue Syndrome Study Group to develop a conceptual framework and a set of research guidelines for use in studies of CFS.
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From page 27... ...
Findings included decreased natural killer cell number and activity, altered lymphocyte subset numbers and percentage; and increased expression of activation markers on lymphocyte subsets. However, none of these findings was ultimately found to be adequately consistent to be used as a diagnostic measure.
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From page 28... ...
. · Any isolated and unexplained physical examination finding or laboratory or imaging test abnormality that is insufficient to strongly suggest the existence of an exclusionary conditions (e.g., an elevated antinuclear antibody titer that is inadequate to strongly support the diagnosis of a discrete connective tissue disorder without other laboratory or clinical evidence, Fukuda et al., 1994~.
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From page 29... ...
Additional clinical features may include irritable bowel syndrome, paresthesias, headache, irritable bladder, somatization, and social dysfunction. Problems with the classification and diagnosis of Fibromyalgia led to development of the following criteria by the American College of Rheumatology.
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From page 30... ...
Although dolorimetry would appear to be a more reliable approach than digital palpation to measuring the pain threshold because it eliminates examiner variability in both the amount of pressure used and the interpretation of patient response, data analyses indicate that both digital palpation and manual palpation are more accurate diagnostic approaches. This may be because the gauge is pressed on one site at a time, whereas during palpation, the examiner can feel around for the exact place to exert pressure.
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From page 31... ...
Available treatments for fibromyalgia range from conventional medication therapy with tricyclic antidepressants to nonconventional interventions such as biofeedback. It appears that there is short-term benefit in the treatment of fibromyalgia syndrome with tricyclic agents, but this has not proved longlasting in placebo-controlled trials.
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From page 32... ...
Findings suggest that MCS patients do not detect odors at lower thresholds than others, but they may respond more markedly once odors are detected. The relationship of this finding to reports of inflammatory nasal pathology and increased nasal resistance is unexplored, but the pathologic findings require confirmation with controlled studies.
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From page 33... ...
As part of this scenario, MCS patients view themselves as victims of external and uncontrollable factors, and they reject the concept that symptoms are not indicative of severe disease and may have psychological components. A factor that may contribute to this belief system is the increasing concern of the public regarding environmental pollution and the health effects of exposure to manmade chemicals (Sparks et al., 1994a)
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From page 34... ...
A recommendation for complete avoidance of chemical exposures is not indicated because there is no evidence for a cumulative toxic injury and it is impossible to accomplish. Treatment could also include medication to control symptoms, an increase in physical and social activity, and treatment of other coexisting medical illnesses.
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From page 35... ...
produced results that seemed to indicate there was a subset of CFS patients who have a Sjogren's-like syndrome, with dry eyes, dry mouth, and at least some of the laboratory abnormalities seen in Sjogren's syndrome. The cardinal features of these illnesses are chronic regional or chronic widespread pain in the absence of nociceptive input, fatigue, and dysfunction of visceral organs or sensory amplification.
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