Fatigue: Biomedicine, Health & Behavior - Volume 4, Issue 3, 2016

Volume 4, Issue 3, 2016

 * Cognitive-behavior therapy: why is it so vilified in the chronic fatigue syndrome community?, Editorial by Fred Friedberg. (FULL TEXT) "Conclusions - Without the disease-denying rhetoric and exaggerated claims regarding recovery that have been linked to this illness, perhaps CBT would not have the bad reputation it has among many in the CFS community. That said, many patients do not care about the type of intervention as long as it helps them. Yet patient reaction particularly among activists has thoroughly rejected the utility of CBT. Perhaps a new approach to educating providers (and influential medical practice organizations) is needed in this divisive environment. According to a recent qualitative study carried out with 19 CFS patients, factors that influence whether or not a patient engages with a behavioral intervention for CFS are: ensuring that the patient feels ‘accepted and believed’; that the patient accepts the diagnosis; and that the model of treatment offered matches the model of illness held by the patient. This is the kind of thoughtful, data-based approach that should be considered when educating practitioners about how to help the CFS patient. The International Association for CFS/ME (IACFS/ME*) Primer for Clinical Practitioners [Friedberg F, Bateman L, Bested A, et al. Chronic fatigue syndrome. Myalgic encephalomyelitis. A primer for clinical practitioners. 2012, 2014. Scottsdale, AZ: Wilshire Press.] approximates this more individualized approach to behavioral management with the patient and avoids the use of the CBT term given its negative connotations. With this more enlightened approach, we can do a better job of educating physicians and other practitioners on how to most effectively help CFS patients, rather than alienate them. For the practitioner interested in acquiring clinical skills for care of the CFS patient, professional workshops will be presented at the October 2016 IACFS/ME research and clinical conference (www.iacfsme.org). Finally, an ongoing effort at the Centers for Disease Control to develop CFS education materials, including behavioral management suggestions, is now underway with the goal of providing guidance for both practitioners and patients."
 * Widespread pain and altered renal function in ME/CFS patients "Abstract - Background: Widespread pain is noted in many patients with chronic fatigue syndrome (ME/CFS), fibromyalgia and temporomandibular disorders. These conditions usually start as a localized condition and spread to a widespread pain condition with increasing illness duration. Purpose: To aim was to assess the changes in biochemistry associated with pain expression and alterations in renal function. Methods: Forty-seven ME/CFS patients and age/sex-matched controls had a clinical examination, completed questionnaires, standard serum biochemistry, glucose tolerance tests and serum and urine metabolomes in an observational study. Results: Increases in pain distribution were associated with reductions in serum essential amino acids, urea, serum sodium and increases in serum glucose and the 24-hour urine volume; however the biochemistry was different for each pain area. Regression modelling revealed potential acetylation and methylation defects in the pain subjects. Conclusions: These findings confirm and extend our earlier findings. These changes appear consistent with repeated minor inflammatory-mediated alterations in kidney function resulting in essential amino acid deprivation and inhibition of protein synthesis and genetic translation within tissues."
 * Roles of the right dorsolateral prefrontal cortex during physical fatigue: a magnetoencephalographic study "Abstract - Background: A regulation system in the central nervous system plays an important role in controlling physical performance during physical fatigue. Purpose: To clarify the neural mechanisms of this regulation system during physical fatigue using magnetoencephalography (MEG) and a classical conditioning technique. Methods: Eleven right-handed, healthy volunteers participated in this study. On the first experimental day, subjects performed fatigue-inducing maximum handgrips with their left hand for 10 min. Metronome sounds were started 5 min after beginning handgrip trials. The metronome sounds were used as conditioned stimuli and the maximum handgrip trials as unconditioned stimuli. The next day, subjects were randomly assigned to six groups in a single-blinded, three-crossover fashion to undergo three types of MEG recordings; that is, for control, inhibition, and facilitation sessions, while imagining maximum grip exercise by the left hand guided by the metronome sounds for 10 min. Results: Decreased oscillatory power for the alpha-frequency band (8–13 Hz) in the right dorsolateral prefrontal cortex (DLPFC) was observed during the facilitation session relative to the control session within 300–400 ms after the onset of handgrip cue sounds. In addition, increased oscillatory power for the alpha-frequency band was identified in the right DLPFC during the inhibition session relative to the control session within the time window of 400–500 ms. Conclusions: These results show that the right DLPFC is involved in the neural substrates of the regulation system during physical fatigue."
 * Efficacy of two delivery modes of behavioral self-management in severe chronic fatigue syndrome "Abstract - Purpose: To assess the efficacy of fatigue self-management for severe chronic fatigue syndrome (CFS). Methods: This randomized trial enrolled 137 patients with severe CFS. Participants were randomized to one of three conditions: fatigue self-management with web diaries and actigraphs (FSM:ACT); fatigue self-management with less expensive paper diaries and pedometers (FSM:CTR); or an usual care control condition (UC). The primary outcome assessed fatigue severity at 3-month follow-up. Analysis was by intention-to-treat. Results: At 3-month follow-up, the FSM:CTR condition showed significantly greater reduction in fatigue severity compared to UC (p = .03; d = .58). No significant improvement was found at 12-month follow-up for the FSM:ACT or the FSM:CTR condition as compared to UC (p > .10). The combined active treatment conditions revealed significantly reduced fatigue at 3-month follow-up (p = .03), but not at 12-month follow-up (p = .24) compared to UC. Clinically significant improvements were found for 24–28% of the intervention groups as compared to 9% of the UC group. Attrition at 12-month follow-up was low (< 8%). Conclusion: Home-based self-management for severe CFS appeared to be less effective in comparison to findings reported for higher functioning groups. Home-based management may be enhanced by remotely delivered interventional feedback."
 * Assessing current functioning as a measure of significant reduction in activity level. "Abstract - Background: Myalgic encephalomyelitis and chronic fatigue syndrome have case definitions with varying criteria, but almost all criteria require an individual to have a substantial reduction in activity level. Unfortunately, a consensus has not been reached regarding what constitutes substantial reductions. One measure that has been used to measure substantial reduction is the Medical Outcomes Study Short-Form-36 Health Survey (SF-36). Purpose: The current study examined the relationship between the SF-36, a measure of current functioning, and a self-report measure of the percent reduction in hours spent on activities. Results: Findings indicated that select subscales of the SF-36 accurately measure significant reductions in functioning. Further, this measure significantly differentiates patients from controls. Conclusion: Determining what constitutes a significant reduction in activity is difficult because it is subjective to the individual. However, certain subscales of the SF-36 could provide a uniform way to accurately measure and define substantial reductions in functioning."