Benjamin Natelson

Source: Pain and Fatigue Study Center

Dr. Benjamin Natelson, is a Neurologist with post-doctoral training in Behavioral Medicine. He is head of the Pain and Fatigue Study Center in New York City which specializes in treating and researching myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), and severe pain and fatigue illnesses. He is, also, an Emeritus Professor of Neurology and Neurosciences at Rutgers and Professor of Neurology at the Icahn School of Medicine at Mt. Sinai.

Dr. Natelson was one of the experts on the "Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome" that was convened for the 2015 Institute of Medicine report.

He served as past President of the Board of Directors of the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis from 2001-2003.

Awards

• 2009, Rudy Perpich Senior Lectureship Award, presented to a distinguished CFS/FM scientist, physician or healthcare worker awarded by IACFS/ME

Education

• Medical degree: University of Pennsylvania in Philadelphia
• Neurology Residence: The Albert Einstein College of Medicine in the Bronx
• Post-doctoral training in Behavioral Medicine: Cornell University's New York Hospital and the Walter Reed Institute of Research (formerly) in Washington, DC

Medscape Continuing Medicine Education

• 2013, A Case-Based Approach to Chronic Fatigue Syndrome was a Medscape Continuing Medicine Education program co-authored by Dr Lisa Corbin, Dr Anthony Komaroff, Dr Benjamin Natelson, and Dr Peter Rowe.

Notable studies

A more complete list of Dr. Natelson's ME/CFS and FM research studies can be found at The Pain and Fatigue Study Center's Scientific Publications Link.

• 2017, Multi-Site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM): Design and Implementation of a Prospective/Retrospective Rolling Cohort Study

  "Abstract - In the Multi-Site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM), we relied on expert clinician diagnoses to enroll patients from 7 specialty clinics in the United States in order to perform a systematic collection of data on measures of myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS). Healthy persons and those with other illnesses that share some features with ME/CFS were enrolled in comparison groups. The major objectives were to: 1) use standardized questionnaires to measure illness domains of ME/CFS and to evaluate patient heterogeneity overall and between clinics; 2) describe the course of illness, identify the measures that best correlate with meaningful clinical differences, and assess the performances of questionnaires as patient/person-reported outcome measures; 3) describe prescribed medications, orders for laboratory and other tests, and management tools used by expert clinicians to care for persons with ME/CFS; 4) collect biospecimens for future hypothesis testing and for evaluation of morning cortisol profiles; and 5) identify measures that best distinguish persons with ME/CFS from those in the comparison groups and detect subgroups of persons with ME/CFS who may have different underlying causes. Enrollment began in 2012 and is planned to continue in multiple stages through 2017. We present the MCAM methods in detail, along with an initial description of the 471 patients with ME/CFS who were enrolled in stage 1."

• 2017, Elevations of ventricular lactate levels occur in both chronic fatigue syndrome and fibromyalgia

  Abstract - "Background: Chronic fatigue syndrome (CFS) and fibromyalgia (FM) frequently have overlapping symptoms, leading to the suggestion that the same disease processes may underpin the two disorders – the unitary hypothesis. However, studies investigating the two disorders have reported substantial clinical and/or biological differences between them, suggesting distinct pathophysiological underpinnings. Purpose: The purpose of this study was to further add to the body of evidence favoring different disease processes in CFS and FM by comparing ventricular cerebrospinal fluid lactate levels among patients with CFS alone, FM alone, overlapping CFS and FM symptoms, and healthy control subjects. Methods: Ventricular lactate was assessed in vivo with proton magnetic resonance spectroscopic imaging (1H MRSI) with the results normed across the two studies in which the data were collected. Results: Mean CSF lactate levels in CFS, FM and CFS + FM did not differ among the three groups, but were all significantly higher than the mean values for control subjects. Conclusion: While patients with CFS, FM and comorbid CFS and FM can be differentiated from healthy subjects based on measures of CFS lactate, this neuroimaging outcome measure is not a viable biomarker for differentiating CFS from FM or from patients in whom symptoms of the two disorders overlap."

• 2017, Multimodal and simultaneous assessments of brain and spinal fluid abnormalities in chronic fatigue syndrome and the effects of psychiatric comorbidity

  Abstract - "The purpose of this study was to investigate whether CFS patients without comorbid psychiatric diagnoses differ from CFS patients with comorbid psychiatric diagnoses and healthy control subjects in neuropsychological performance, the proportion with elevated spinal fluid protein or white cell counts, cerebral blood flow (CBF), brain ventricular lactate and cortical glutathione (GSH). The results of the study did not show any differences in any of the outcome measures between CFS patients with and without psychiatric comorbidity, thus indicating that psychiatric status may not be an exacerbating factor in CFS. Importantly, significant differences were found between the pooled samples of CFS compared to controls. These included lower GSH and CBF and higher ventricular lactate and rates of spinal fluid abnormalities in CFS patients compared to healthy controls. Thirteen of 26 patients had abnormal values on two or more of these 4 brain-related variables. These findings, which replicate the results of several of our prior studies, support the presence of a number of neurobiological and spinal fluid abnormalities in CFS. These results will lead to further investigation into objective biomarkers of the disorder to advance the understanding of CFS."

• 2011, Distinct Cerebrospinal Fluid Proteomes Differentiate Post-Treatment Lyme Disease from Chronic Fatigue Syndrome
• 2004, Cognitive Function Index for Patients with Chronic Fatigue Syndrome

  "Abstract - Background: A comprehensive approach to assessing neuropsychological deficits in CFS patients is developed by assessing cognitive function across a number of domains using a battery of tests, rather than relying on any single instrument. Objective: A factor analytic approach was employed to examine the underlying dimensionality of 15 standard cognitive function related test variables in CFS patients. A cognitive function index (CFI) was then developed using appropriately weighted and interpreted factors. Methods: Factor analysis was applied to an initial sample of 65 CFS patients, identifying eight factors accounting for over 70% of total variation. This factor structure was then independently verified on a separate sample of 124 CFS patients. An overall combined CFS sample of 212 was then used to derive the CFI using an appropriately interpreted and weighted average of the derived factors. Results: After including age and education as separate factors, the CFI consists of nine factors accounting for 70% of total variation in the overall CFS group. The CFI was not affected by the presence of current psychiatric comorbidity. A cut-off score for cognitive dysfunction was established using the lower quartile value of a group of sedentary controls on the same index. Conclusions: The CFI will provide a useful summary measure for researchers investigating cognitive function performance in CFS patients. It does not replace existing individual specialized tests."

• 2001, Health-Related Personality Variables in Chronic Fatigue Syndrome and Multiple Sclerosis

  "Summary - This study investigated personality variables in patients with Chronic Fatigue Syndrome (CFS) and Multiple Sclerosis (MS), with healthy, sedentary subjects as controls. CFS and MS groups were higher on alexithymia, characterized as difficulty in describing and differentiating emotions and marked externalization. CFS and MS groups reported a more depressive attributional style than healthy participants, reflecting beliefs that causes for good events are not diffused into other areas of life while causes for bad events will always be present. The CFS group was significantly lower on doctors/others locus of control indicating lack of trust in medical professionals. Results indicate that CFS and MS are similar to each other while different from the healthy group on certain personality variables that likely reflect the demoralizing effects of coping with a chronic, disabling illness marked by uncertainty."

• 2000, Psychiatric Comorbidity and Somatic Distress in Sudden and Gradual Onset Chronic Fatigue Syndrome

  "Abstract - The purpose of this study was to examine if type of Chronic Fatigue Syndrome (CFS) onset suggested two distinct illness patterns within CFS. One hundred and seventeen patients diagnosed with CFS by a multidisciplinary team were divided into two groups: sudden versus gradual onset of symptoms. These two subgroups were compared on the presence of lifetime comorbid Axis I diagnoses, the pattern of medically unexplained symptoms, and the number of patients who met criteria for Somatization Disorder (SD). The two subgroups did not differ in any of the experimental variables indicating that onset type is not distinguished by either comorbid psychopathology or medically unexplained symptoms. Implications of these findings are discussed."

• 1999, Impaired oxygen delivery to muscle in chronic fatigue syndrome (FULL TEXT)
• 1998, Measurement of CO2 in Chronic Fatigue Syndrome Patients

  Abstract - "This sludy has two goals: one, to compare the resting end-tidal pCCb (PctCCh) and heart rate (HR) of chronic fatigue syndrome patients (CFS) with controls; two, to examine the effects of a mouthpiece and noseclips upon measurements of PelC02 and HR. Patients from the CFS Center came to the University Hospital pulmonary function laboratory for one testing session. Arterial (PaCCh), PetCOi, end-nasal (PenCOi) and HR were measured twice; both with and again without the subject breathing through the mouthpiece. We found that PcnCCb was greater and HR lower for both CFS and non-CFS groups when subjects were not confined by the mouthpiece. We conclude that there is no abnormality in the regulation of respiration in CFS patients. Changes in HR accompany changes in PetCOi in this study. Most likely, both result from anxiety associated with mouthpiece breathing.

• 1998, Relation between neuropsychological impairment and functional disability in patients with chronic fatigue syndrome (FULL TEXT)

Interviews & talks

• TV and radio interviews

Clinical location

Pain and Fatigue Study Center

Phillips Ambulatory Care Center, Suite 4K

Beth Israel Medical Center

10 Union Square East

New York, NY 10003-3314

212-844-6665

Online presence

• The Pain & Fatigue Study Center

Books

• 2008, Fatigue Science for Human Health, edited by Yatanabe, Y., Evengard, B., Natelson, B.H., Jason, L.A., & Kuratsune, H.
• 2007, Your Symptoms Are Real: What to Do When Your Doctor Says Nothing Is Wrong
• 1998, Facing and Fighting Fatigue: A Practical Approach

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

cerebral blood flow (CBF) - the amount of blood that goes through the arterial tree in the brain in a given amount of time

cerebral blood flow (CBF) - the amount of blood that goes through the arterial tree in the brain in a given amount of time

cognition Thought processes, including attention, reasoning, and memory.

cognition Thought processes, including attention, reasoning, and memory.

somatic An adjective relating to the physical body or physical symptoms. It is often contrasted with the adjective "psychological", which refers to the human mind or mental symptoms. In biology, "somatic cells" refer to all the cells of the body, except those which form an egg or sperm.

medically unexplained physical symptoms (MUPS) - Technically, this term means that no cause or explanation for the patient's symptoms has yet been found. However, patients diagnosed with "MUPS" are generally lumped into a psychosomatic, or psychologically-caused category by those in the medical profession, without any scientific basis for doing so.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

heart rate (HR) - the number of times the heart beats within a certain time period, usually a minute

heart rate (HR) - the number of times the heart beats within a certain time period, usually a minute

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.