**Validation of Severity/Persistence of Symptoms... fwiw

Discussion in 'Lyme Disease Archives' started by victoria, Nov 19, 2008.

  1. victoria

    victoria New Member


    Clinical trials validate the severity of persistent Lyme disease symptoms
    From the Journal Medical Hypotheses,
    available online 13 November 2008.

    Daniel J. Cameron

    http://dx.doi.org/10.1016/j.mehy.2008.09.030

    Background

    Persistent Lyme Disease Symptoms (PLDS) have included fatigue,
    headaches, poor concentration and memory, lightheadedness, joint pain,
    and mood disturbances. Evidence-based guidelines committees disagree
    over the severity of PLDS. The 2004 International Lyme and Associated
    Diseases Society (ILADS) concluded that PLDS are severe. The 2006
    Infectious Disease Society of America (IDSA) guidelines committee
    concluded that PLDS are nothing more than the “aches and pains of daily living” and an ad hoc International Lyme group concluded that PLDS are “symptoms common in persons who have never had Lyme disease.”

    Hypothesis

    Clinical trials validate the severity of persistent Lyme disease symptoms.

    Evaluation of the Hypothesis

    There are 22 standardized instruments used to measure the severity of
    PLDS among the four published National Institutes of Health (NIH)
    sponsored double-blind randomized placebo-controlled trials (RCTs).

    Validating the hypothesis

    All four NIH sponsored RCTs validate the severity of PLDS. PLDS are as
    severe as symptoms seen in other serious chronic illnesses, and result
    in a quality of life lower than for the general population as determined by 22 standardized measures of QOL, including fatigue, pain, role function, psychopathology, and cognition. None of the four RCTs support the IDSA hypothesis that PLDS are nothing more than “the aches and pains of daily living” nor the ad hoc International Lyme group conclusion that PLDS are “symptoms common in persons who have never had Lyme disease.”

    Implications of the hypothesis

    If the QOL of life for these patients is as poor as for patients with
    other serious chronic diseases, their symptoms need to be addressed by
    their doctors. Studies differ as to the precise cause of PLDS, the most effective treatments, and whether a cure is possible. But the fact that there is disagreement is not a license for physicians to ignore or turn away patients complaining of PLDS, or to dismiss their symptoms as purely psychosomatic.

    For physicians, the goal or purpose of treating PLDS should be the same as their purpose in treating other chronic illnesses that result in a poor QOL: vigorous pursuit of a cure, and where a cure proves impossible, amelioration of patients’ symptoms and suffering.

    Even if this hypothesis fails to be apply to more than a fraction of the total Lyme disease population, this still represents a significant number of patients, and these findings could address a neglected aspect of caring for patients with Lyme disease.

    http://dx.doi.org/10.1016/j.mehy.2008.09.030