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Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) are serious, debilitating conditions that affect millions of people in the United States and around the world. ME/CFS can cause significant impairment and disability. Despite substantial efforts by researchers to better understand ME/CFS, there is no known cause or effective treatment. Diagnosing the disease remains a challenge, and patients often struggle with their illness for years before an identification is made. Some health care providers have been skeptical about the serious physiological - rather than psychological - nature of the illness. Once diagnosed, patients often complain of receiving hostility from their health care provider as well as being subjected to treatment strategies that exacerbate their symptoms.
Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome proposes new diagnostic clinical criteria for ME/CFS and a new term for the illness - systemic exertion intolerance disease(SEID). According to this report, the term myalgic encephalomyelitis does not accurately describe this illness, and the term chronic fatigue syndrome can result in trivialization and stigmatization for patients afflicted with this illness. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome stresses that SEID is a medical - not a psychiatric or psychological - illness. This report lists the major symptoms of SEID and recommends a diagnostic process.One of the report's most important conclusions is that a thorough history, physical examination, and targeted work-up are necessary and often sufficient for diagnosis. The new criteria will allow a large percentage of undiagnosed patients to receive an accurate diagnosis and appropriate care.
Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome will be a valuable resource to promote the prompt diagnosis of patients with this complex, multisystem, and often devastating disorder; enhance public understanding; and provide a firm foundation for future improvements in diagnosis and treatment.
eBook
Mental and physical fatigue-related biochemical alterations
To confirm fatigue-related biochemical alterations, we measured various parameters just before and after relaxation and fatigue-inducing mental or physical sessions.
Fifty-four healthy volunteers were randomized to perform relaxation and fatigue-inducing mental and physical sessions for 4 h in a double-blind, three-crossover design. Before and after each session, subjects were asked to rate their subjective sensations of fatigue, and blood, saliva, and urine samples were taken.
After the fatigue-inducing mental and physical sessions, subjective scores of fatigue were increased. After the fatigue-inducing mental session, the vanillylmandelic acid level in urine was higher and plasma valine level was lower than after the relaxation session. In contrast, after the fatigue-inducing physical session, serum citric acid, triacylglycerol, free fatty acid, ketone bodies, total carnitine, acylcarnitine, uric acid, creatine kinase, aspartate aminotransferase, lactate dehydrogenase, cortisol, dehydroepiandrosterone, dehydroepiandrosterone sulfate, plasma branched-chain amino acids, transforming growth factor-β1 and -β2, white blood cell and neutrophil counts, saliva cortisol and amylase, and urine vanillylmandelic acid levels were higher and serum free carnitine and plasma total amino acids and alanine levels were lower than those after the relaxation session.
Some mental or physical fatigue-related biochemical changes were determined. Various biochemical alterations reflecting homeostatic perturbation and its responses might be shown. We believe that our results contribute to clarifying the mechanism of fatigue, developing evaluation methods, and establishing a basis for treatment.
Journal Article
095 Steering Wheel Angle Excursions as a Measure of Fatigue-Related Driver Performance Impairment
Introduction Fatigue from sleep loss and circadian misalignment causes automobile driving performance impairment. Metrics based on steering wheel angle, which is straightforward to measure, could be used to quantify this impairment. As the tail of the distribution of steering wheel angles (absolute magnitude of deviation from center) increases with fatigue, we investigated whether driving performance impairment could be quantified based on the prevalence of steering wheel excursions beyond a given angle threshold. We used data from two published laboratory studies of simulated shift work, in which fatigue remained low during day shifts but increased across time awake during night shifts. Methods N=37 healthy adults (ages 26.8±5.2y; 25 men) were assigned to a simulated night shift schedule (awake 20:00-10:00) or day shift schedule (awake 08:00-22:00; study 1 only). After an adaptation period, participants underwent two 5-day shift cycles with an intervening rest period. Driving performance was measured on a high-fidelity simulator during adaptation (data not used) and four times at 3h intervals during each shift day. Every drive involved 30min driving at 55mph, including ten 0.5mi uneventful straightaways being considered here. Steering wheel angle was measured at 72Hz (study 1) or 60Hz (study 2). A total of 1,471 drives (31,394,498 angle measurements) were available for analysis. Results We investigated angle thresholds across 0.01-0.25rad in 0.01rad intervals and counted the corresponding number of threshold excursions in each drive for each participant. For study 1, we applied mixed-effects ANOVA with fixed effects for condition and time awake, and their interaction, and determined the local effect size for interaction. A 0.03rad (1.7°) threshold yielded the greatest effect size, f²=0.031 (small). For this threshold, we repeated the analysis using the data from both studies, controlling for study. The interaction was significant (F[3,1428]=13.23, p<0.001), showing low driving impairment across time awake during day shifts but increasing impairment across time awake during night shifts. Conclusion The prevalence of steering wheel excursions beyond a 1.7° angle threshold yielded sensitivity to fatigue-related driving performance impairment during simulated night shifts. Further research will extend our results to driving through curves and with greater fatigue levels. Support (if any) FMCSA DTMC75-07-D-00006
Journal Article
MULTIDIMENSIONAL FATIGUE SYMPTOM INVENTORY-SHORT FORM: A SYSTEMATIC REVIEW OF ITS PSYCHOMETRIC PROPERTIES
Fatigue is among the most common problems experienced by cancer patients. The Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), a 30-item self-report measure, assesses five empirically-derived dimensions: general, physical, emotional and mental fatigue and vigor We reviewed and evaluated the MFSI-SF's psychometic properties based on its use in published research studies. We identified 70 studies published between 1998 and 2013. Alpha coefficients and test-retest correlations were summarized to characterize internal consistency reliability and test-retest reliability, respectively. Correlation coefficients between subscales and other published measures were summarized to characterize concurrent, convergent and divergent validity. The mean difference statistic (d) was calculated to characterize sensitivity to change and discriminative validity. Mean alpha coefficients for subscales ranged from 0.83 to 0.93 and mean test-retest correlations from 0.48 to 0.67. Correlations between subscales and other fatigue measures ranged from 0.36 to 0.91. The mean correlation between MRFI-SF vigor and other measures of vitality/vigor was .64. Correlations with depression and anxiety measures were small to large and in the expected direction (range=0.10-0.80). Effect sizes for sensitivity to change and discriminative validity ranged from very small to very large. The MFSI-SF has been widely used to assess fatigue. Its psychometric properties include high internal consistency and moderate test-retest reliability. Its concurrent validity is moderate to high; there is good evidence for its convergent and divergent validity. Evidence for its sensitivity to change and discriminative validity is positive. These findings encourage continued use of the MFSI-SF in fatigue research studies.
Journal Article
The Perrin technique : how to beat chronic fatigue syndrome/ME
After many years of careful study coupled with practical hands-on experience, Perrin has arrived at the firm conclusion that M.E. is a structural disorder with definite diagnosable physical signs. This technique gives you the chance to take charge of your own structural health and rid yourself of years of toxin build-up.
Book
Acupuncture for chronic fatigue syndrome and idiopathic chronic fatigue: a multicenter, nonblinded, randomized controlled trial
Background
The causes of chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF) are not clearly known, and there are no definitive treatments for them. Therefore, patients with CFS and ICF are interested in Oriental medicine or complementary and alternative medicine. For this reason, the effectiveness of complementary and alternative treatments should be verified. We investigated the effectiveness of two forms of acupuncture added to usual care for CFS and ICF compared to usual care alone.
Methods
A three-arm parallel, non-blinded, randomized controlled trial was performed in four hospitals. We divided 150 participants into treatment and control groups at the same ratio. The treatment groups (Group A, body acupuncture; Group B, Sa-am acupuncture) received 10 sessions for 4 weeks. The control group (Group C) continued usual care alone. The primary outcome was the Fatigue Severity Scale (FSS) at 5 weeks after randomization. Secondary outcomes were the FSS at 13 weeks and a short form of the Stress Response Inventory (SRI), the Beck Depression Inventory (BDI), the Numeric Rating Scale (NRS), and the EuroQol-5 Dimension (EQ-5D) at 5 and 13 weeks.
Results
Group A showed significantly lower FSS scores than Group C at 5 weeks (
P
= 0.023). SRI scores were significantly lower in the treatment groups than in the control group at 5 (Group A,
P
= 0.032; B,
P
<0.001) and 13 weeks (Group A,
P
= 0.037; B,
P
<0.001). Group B showed significantly lower BDI scores than Group C at 13 weeks (
P
= 0.007). NRS scores from the treatment groups were significantly reduced compared to control at 5 (Group A and B,
P
<0.001) and 13 weeks (Group A,
P
= 0.011; B,
P
= 0.002).
Conclusions
Body acupuncture for 4 weeks in addition to usual care may help improve fatigue in CFS and ICF patients.
Trial registration
Clinical Research Information Service (CRIS)
KCT0000508
; Registered on 12 August 2012.
Journal Article