Journal of Chronic Fatigue Syndrome: Volume 7, Issue 1, 2000

Volume 7, Issue 1, 2000

 * Editorial by Roberto Patarca-Montero
 * The Biochemistry of Chronic Pain and Fatigue"'Abstract - Background: Chronic pain and fatigue represent major reasons for seeking medical treatments, however, the mechanisms are poorly understood. Onset of these disorders has been associated with events (infections, trauma, stress) which initiate a host response requiring increased energy demands.Objectives: To investigate the biochemical mechanisms of chronic pain and fatigue. Methods: Data will be presented from 4 separate investigations of CFS and myofascial pain syndrome (MFPS) patients, and from age/ sex-matched controls, using metabolite profiling techniques. Results: Several types of chronic pain and fatigue disorders were discerned on the basis of their biochemistry. The metabolic events associated with chronic pain were distinct from those associated with chronic fatigue. The investigations have shown that chronic pain was associated with reductions in serum sodium, changes in urinary volume and output of amino and organic acids, increases in levels of markers of tissue damage (ALT, AST), and increases in the tyrosine: leucine ratio, which represents alterations in protein turnover. Fatigue was associated with alterations in urine excretion of amino and organic acids associated with tricarboxylic acid cycle (TCA) function. Levels of RNase-L were correlated with the expression of chronic fatigue related symptoms and were a good marker for CFS. Increased carriage of toxin-producing coagulase negative staphylococci was evident in MFPS and CFS patients, and this carriage was correlated with increased tyrosine: leucine ratios and pain severity. The toxin producing staphylococci appear to be a co-morbid pathogen that contributes to CFS patient morbidity. Conclusion: These studies indicated that changes in nitrogen homeostasis were associated with pain and fatigue symptoms and carriage of certain pathogens may sustain or exaggerate the chronic disorder.'"
 * The Development of Laboratory-Based Tests in Chronic Pain and Fatigue: 1. Muscle Catabolism and Coagulase Negative Staphylococci Which Produce Membrane Damaging Toxins"'Abstract - Background: The diagnosis of chronic fatigue syndrome (CFS) requires the exclusion of other known fatigue-related diseases because the core symptoms of CFS represent a general host response to many well-defined diseases. The patient set derived by this process is heterogeneous in their polysymptomatic presentation and has proved very difficult to study clinically and scientifically. Objectives: To investigate the alterations in urine excretion and microbiology in patients with CFS. Results: CFS patients had multiple anomalies in their amino and organic acid homeostasis. Sub-groups of CFS patients could be delineated on the basis of their urine excretion and their symptom presentation. The most common feature was an active muscle catabolism resulting in a depletion of amino acids and associated organic and keto-acids. The extent of muscle catabolism was directly correlated to pain severity. The carriage of toxin-producing coagulase negative staphylococci (MDT-CoNS) was strongly correlated with the catabolic response and pain severity. Conclusions: An hypothesis has been constructed where an occult pathogen, such as MDT-CoNS, may be an aetiological agent contributing to the sustenance of a chronic fatigue/pain disorder, a comorbid pathogen. Urine analysis offers an opportunity for assessment of muscle catabolism and sub-classification of chronic fatigue patients leading to a number of management options. The detection of MDT-CoNS identifies potentially treatable agents that contribute to the fatigue and pain condition.'"
 * Chronic Fatigue Syndrome and Cancer"'Abstract - Background: Several studies have indicated a link between chronic fatigue syndrome (CFS) and cancer, most of them based on anecdotal observations. We have attempted to use more population-based data to determine if the reported relationship is meaningful. Two outbreaks of a fatiguing illness which included well documented cases of CFS were evaluated ten years after the reported outbreak for long-term effects, particularly cancer. We found an unusual pattern of cancer which, in view of an increased incidence of brain tumors and non-Hodgkin's lymphoma (NHL) reported in other studies involving CFS, indicates the need for further study. At the present time this link, which is often presumed to be due to immune dysfunction, has not yet been documented. Not all CFS patients have apparent dysregulation of the immune system and a single causative agent is highly unlikely, making the study of two heterogeneous illnesses, CFS and cancer, highly problematic. With the continuing focus on subgroups, however, this area of research may prove to be more productive.'"
 * Immunologic Status Correlates with Severity of Physical Symptoms and Perceived Illness Burden in Chronic Fatigue Syndrome Patients"'Abstract - Background: The purpose of the present study was to investigate the relationship between immunologic status and physical symptoms in Chronic Fatigue Syndrome (CFS) patients. Twenty-seven patients diagnosed with CFS were included. Participants completed a questionnaire including selected subscales of the Sickness Impact Profile, the Cognitive Difficulties Scale, and frequency and severity of CFS-related physical symptoms. Cellular immune markers measured included number and percent of T-helper/inducer cells (CD3+CD4+), T-cytotoxic/ suppressor cells (CD3+CD8+), activated T-lymphocytes (CD26+CD2+ CD3+), activated T cytotoxic/suppressor cells (CD38+HLA-DR+CD8+), and CD4/CD8 ratio. Spearman's correlation coefficients revealed significant associations between a number of immunologic measures and severity of illness suggesting that the degree of cellular immune activation was associated with the severity of CFS-related physical symptoms, cognitive complaints, and perceived impairment secondary to CFS. Specifically, elevations in T-helper/inducer cells, activated T-cells, activated cytotoxic/suppressor T-cells, and CD4/CD8 ratio were associated with greater severity of several symptoms. Furthermore, reductions in T-suppressor/cytotoxic cells also appeared related to greater severity of some CFS-related physical symptoms and illness burden. Multiple regression analyses demonstrated that decreased percentage of CD3+CD8+ cells and increased number of CD38+HLA-DR+CD8+ cells were the strongest predictors of total illness burden and fatigue severity, accounting for almost 30% of the variance in these measures.'"
 * Silicone Breast Implants, Chronic Fatigue Syndrome and Fibromyalgia"'Abstract - Clinical studies have continued to suggest a relationship between silicone breast implants and chronic fatigue syndrome. Extensive epidemiologic studies, however, indicate that such a relationship is likely to be by chance and the successful lawsuits against producers of silicone breast implants are based on factors other than scientific proof. We present several perspectives on this issue which are probably relevant to other reports of putative etiologic agents for chronic fatigue syndrome.'"
 * Health Care Workers, Predominant Gender Females at High Risk: Turning the Spotlight on the Endocrine System"'Abstract - 'Cluster Outbreaks' of Chronic Fatigue (Immune Dysfunction) Syndrome (CFIDS)/Myalgic Encephalomyelitis (ME) have been well documented in the Healthcare professions. Large bodies of scientific evidence suggest that the endocrine system is very involved. In fact, it may be the most critical piece of the puzzle that needs to be examined in all future research. Although some subtle immunologic changes have been documented in persons with ME/CFIDS, recent studies on the endocrine system suggest that several hormonal abnormalities may account for the myriad of symptoms. Calkins and colleagues at Johns Hopkins have found that most patients have delayed orthostatic hypotension. Streeten and Bell extended these studies finding that most patients studied have severe hypovolemia. Hormones that prevent these conditions in healthy people are controlled by the pituitary and hypothalamus. It is interesting that the symptoms experienced by patients with Pan-Hypothyroidism are virtually identical to CFIDS/ME. Endocrine research shows that most patients have low cortisol levels. Overwhelming research shows a similar pattern to the many autoimmune diseases that occur predominantly in females. What looks like a multi-systemic disease, therefore, could be an endocrine disorder and could possibly explain the predisposition of the female gender. As health care professionals living with the disease, we would like to bridge the gap and help you help us return to our normal, pre-CFIDS/ME lives as best we can.'"
 * A Preliminary Study into the Effectiveness of Multi-Convergent Therapy in the Treatment of Heterogeneous Patients with Chronic Fatigue Syndrome"'Abstract - In this preliminary study twenty-eight heterogeneous Chronic Fatigue Syndrome (CFS) patients were treated with Multi-Convergent Therapy (MCT). This form of therapy has been used successfully for over ten years in the treatment of Irritable Bowel Syndrome, Tinnitus, Hyperventilation Syndrome, Chronic Pain and Anxiety Disorders. This small study was undertaken to assess whether MCT is effective in the treatment of CFS and to examine whether a more extensive investigation is warranted. Due to heterogeneity of symptoms, outcome measures were established on the basis of a shared decision-making process between patient and therapist. One patient dropped out of the study. All twenty-seven remaining patients achieved significant recoveries. Twelve patients recorded a mean improvement on baseline symptoms of 61%, eight patients who completed a Quality of Life questionnaire demonstrated a mean change from 2.4 to 6.3 (out of 10). Five patients reported a return to full normal function and two patients returned to school or work and regular exercise. At follow up nine-months to one-year later all eighteen patients who responded reported either continued improvements or maintenance of a well state. The findings of this study support the use of MCT in the management of patients with Chronic Fatigue Syndrome and justify the implementation of a major clinical trial.'"
 * Announcement: MPWME & American BRAME (A.K.A. MPWC/ME) "Medical Professionals/Persons with ME and American Blue Ribbon Awareness for ME" Supported by: The Boston Women's Health Book Collective.