Fibromyalgia, Yunus explained, is a prototype of the NED model. People with FM have heightened pain not only in the musculoskeletal system, but also in other areas such as the bowels. Daniel Clauw, MD, for example, has demonstrated greater sensitivity in FM patients to pain in the esophagus and other researchers have shown similar hypersensitivity in the rectum. The lesson in this, according to Yunus, is that efforts should focus on stopping the chronicity of pain to prevent further alterations in neuroendocrine function. The second model combines NED and psychological factors.
Pain always has a psychological component.
The fact that mood-altering drugs can help people with fibromyalgia does not indicate that FM is a psychiatric illness, he insisted. Plaquenil, an antimalarial drug, has been found useful in treating rheumatoid arthritis, but that doesn't mean that rheumatoid arthritis is caused by the malaria parasite. He noted that the prevalence of depression among people with fibromyalgia is similar to that in other chronic diseases of organic nature having classical pathology such as rheumatoid arthritis. The third model combines NED and pathology. Psychological factors may be operative here, too, by virtue of chronic illness.