[Note: Dr. Cameron is current president of ILADS – the International Lyme and Associated Diseases Society (http://www.ilads.org) For detail on a study demonstrating “amoxicillin therapy provides significant relief without serious adverse events” in persistent Lyme disease, see Dr. Cameron’s report, “Severity of Lyme disease with persistent symptoms. Insights from a double-blind placebo-controlled clinical trial.”]
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 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.
Source: Medical Hypotheses, Nov 12, 2008. [E-pub ahead of print] PMID: 19013025, by Cameron DJ. Northern Westchester Hospital, Mount Kisco, New York, USA [E-mail: email@example.com]