In medicine, Occam’s razor teaches that the simplest explanation is often the right one. But for chronic Lyme, this idea is sometimes used against patients. Ongoing symptoms are too quickly explained away with theories that don’t fit the real experience. The simplest answer—that the infection may not have been fully cleared—deserves more careful attention.

The “Alternative Explanations” Patients Hear

Instead of recognizing that chronic Lyme symptoms may come from a lingering infection, patients are often told their struggles are due to stress, depression, anxiety, or other unrelated conditions. Patients may be told symptoms are due to:

1. “Immune debris” — lingering bacterial fragments

2. “Post-infectious inflammation” — immune activation after infection

3. Central sensitization — nervous system becomes overly sensitive and keeps amplifying pain signals, even after the original injury or illness has healed

4. Autoimmune reactions without infection — the body attacking its own tissues

5. Functional diagnoses — fibromyalgia or chronic fatigue syndrome

6. Psychological factors — stress, anxiety, or trauma

Some patients receive the label post-treatment Lyme disease syndrome (PTLDS).

In the context of chronic Lyme, invoking Occam’s razor shouldn’t shut down the conversation. Instead, it should prompt a careful review for persistent infection and possible co-infections, ensuring patients get the answers and care they need.

Why Ignoring Persistent Infection Breaks Occam’s Razor

Multiple factors can exist, but dismissing infection for more abstract explanations can actually violate Occam’s razor. In chronic Lyme, overlooking a persistent Borrelia infection or co-infection can turn a clear explanation into unnecessary complexity.

Persistent Infection: The Signs

Patients often present with symptoms consistent with active disease, including:

1. Cognitive slowing and memory issues

2. Sensory hypersensitivity

3. Impaired balance or coordination

4. Crushing fatigue

5. Migratory joint or nerve pain

6. Autonomic symptoms, such as rapid heart rate or dizziness

These symptoms fit much more closely with an active infection than with unrelated explanations like “leftover debris.”

In chronic Lyme, the simplest explanation is often the most overlooked: the infection is still active.

The Risks of Getting Occam’s Razor Wrong

Misapplying Occam’s razor in chronic Lyme cases can lead to:

1. Missed diagnosis of persistent Borrelia or other tick-borne pathogens

2. Delayed treatment and irreversible damage

3. Loss of years of potential recovery

4. Declining quality of life and disability

A Smarter Diagnostic Approach

Occam’s razor is a powerful tool when applied correctly. In chronic Lyme, that means ruling out persistent infection before accepting more complex theories.

Hickam’s dictum, the counterpoint, reminds us patients can have more than one problem at once, meaning co-infections, immune dysfunction, and secondary complications can coexist with infection.

The Takeaway:
When applied to chronic Lyme disease, Occam’s razor should point toward the simplest unifying cause: persistent infection. Ignoring it risks missing the diagnosis that matters most.

Resources:

1. Choosing a Lyme Treatment
2. Lyme Disease Treatment Our Approach
3. ILADS Guidelines on Lyme Disease