Fatigue: Biomedicine, Health & Behavior - Volume 7, Issue 4, 2019: Difference between revisions

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* Letter to the editor - ''Post-exercise autonomic function in chronic fatigue syndrome''<ref>{{Cite journal|last=Friedberg|first=Fred|author-link=Fred Friedberg|last2=Huang|first2=Chuan|author-link2=|last3=Ramjan|first3=Sameera|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2019-10-07|title=Post-exercise autonomic function in chronic fatigue syndrome|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1675856|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=229-231|doi=10.1080/21641846.2019.1675856|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref>
* Letter to the editor - ''Post-exercise autonomic function in chronic fatigue syndrome''<ref>{{Cite journal|last=Friedberg|first=Fred|author-link=Fred Friedberg|last2=Huang|first2=Chuan|author-link2=|last3=Ramjan|first3=Sameera|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2019-10-07|title=Post-exercise autonomic function in chronic fatigue syndrome|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1675856|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=229-231|doi=10.1080/21641846.2019.1675856|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref>
* ''Fatigue severity and emotion dysregulation: roles in mental health among trauma exposed college students''<blockquote> '''Abstract''' - '''Background''': There is increased recognition that traumatic events are a common experience among college students, and such events have shown to be associated with negative mental health outcomes and poorer well-being among this population. Although some work has focused on the relation between trauma exposure and mental health among college students, little work has explored the role of individual difference in fatigue severity within this group. '''Purpose''': Therefore, the current study sought to address this gap in the existing literature by examining the explanatory role of fatigue severity in terms of anxiety/depression and post-traumatic stress among trauma exposed college students. Further, the mechanistic role of emotion dysregulation was evaluated as a possible factor that may underlie the relation between fatigue severity and mental health. '''Method''': Seven hundred and thirty trauma-exposed college students were included in the present study (78.6% female, Mage = 22.59 years, SD = 5.48; 55.3% racial minority). '''Results''': Results revealed that individual differences in fatigue severity had a significant indirect effect on the studied internalizing symptoms through emotion dysregulation. '''Conclusion''': These novel findings suggest future work should continue to explore emotion dysregulation in the association between fatigue severity and internalizing symptoms among trauma-exposed college students.<ref>{{Cite journal|last=Manning|first=Kara|last2=Bakhshaie|first2=Jafar|last3=Shepherd|first3=Justin M.|last4=Jones|first4=Jenna|last5=Timpano|first5=Kiara R.|last6=Viana|first6=Andres G.|last7=Zvolensky|first7=Michael J.|date=2019-10-02|title=Fatigue severity and emotion dysregulation: roles in mental health among trauma exposed college students|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1661942|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=181–195|doi=10.1080/21641846.2019.1661942|issn=2164-1846}}</ref></blockquote>  
* ''Fatigue severity and emotion dysregulation: roles in mental health among trauma exposed college students''<blockquote> '''Abstract''' - '''Background''': There is increased recognition that traumatic events are a common experience among college students, and such events have shown to be associated with negative mental health outcomes and poorer well-being among this population. Although some work has focused on the relation between trauma exposure and mental health among college students, little work has explored the role of individual difference in fatigue severity within this group. '''Purpose''': Therefore, the current study sought to address this gap in the existing literature by examining the explanatory role of fatigue severity in terms of anxiety/depression and post-traumatic stress among trauma exposed college students. Further, the mechanistic role of emotion dysregulation was evaluated as a possible factor that may underlie the relation between fatigue severity and mental health. '''Method''': Seven hundred and thirty trauma-exposed college students were included in the present study (78.6% female, Mage = 22.59 years, SD = 5.48; 55.3% racial minority). '''Results''': Results revealed that individual differences in fatigue severity had a significant indirect effect on the studied internalizing symptoms through emotion dysregulation. '''Conclusion''': These novel findings suggest future work should continue to explore emotion dysregulation in the association between fatigue severity and internalizing symptoms among trauma-exposed college students.<ref>{{Cite journal|last=Manning|first=Kara|last2=Bakhshaie|first2=Jafar|last3=Shepherd|first3=Justin M.|last4=Jones|first4=Jenna|last5=Timpano|first5=Kiara R.|last6=Viana|first6=Andres G.|last7=Zvolensky|first7=Michael J.|date=2019-10-02|title=Fatigue severity and emotion dysregulation: roles in mental health among trauma exposed college students|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1661942|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=181–195|doi=10.1080/21641846.2019.1661942|issn=2164-1846}}</ref></blockquote>  
* ''Differentiating post-polio syndrome from myalgic encephalomyelitis and chronic fatigue syndrome''<blockquote> '''Abstract''' - '''Background''': Overlapping and concomitant symptoms among similar chronic illnesses have created difficulties for diagnosis and further treatment. Three such chronically fatiguing illnesses, Post-polio syndrome (PPS), Myalgic Encephalomyelitis (ME) and chronic fatigue syndrome (CFS) fall under this category. '''Purpose''': The aim of this study is to examine and distinguish between core symptoms found in these illnesses (i.e. muscle pain/weakness, fatigue or exhaustion, and autonomic symptoms) via three methods of analysis (DePaul Symptom Questionnaire 2 (DSQ-2), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and machine learning techniques). '''Results''': Items assessing onset and severity for individuals who reported having PPS were found to have experienced an onset of PPS related symptoms roughly 30 years after the onset of Polio. Items found in the DSQ-2, SF-36 compared all illness groups and found that participants with ME/CFS were more functionally impaired across symptoms than those with PPS. Across all analyses, three domains most commonly differentiated the illnesses (neurocognitive, Post-exertional malaise, and neuroendocrine). '''Conclusion''': Examining functional impairment amongst chronically fatiguing illnesses using multiple methods of analysis can be an important factor in distinguishing similar illnesses. These findings support further analysis of analogous symptomatology among other chronic illnesses to assist in diagnosis.<ref>{{Cite journal|last=Klebek|first=Lauren|author-link=|last2=Sunnquist|first2=Madison|author-link2=Madison Sunnquist|last3=Jason|first3=Leonard A.|author-link3=Leonard Jason|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2019-10-02|title=Differentiating post-polio syndrome from myalgic encephalomyelitis and chronic fatigue syndrome|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1687117|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=196–206|doi=10.1080/21641846.2019.1687117|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref></blockquote>  
* ''Differentiating [[post-polio syndrome]] from myalgic encephalomyelitis and chronic fatigue syndrome''<blockquote> '''Abstract''' - '''Background''': Overlapping and concomitant symptoms among similar chronic illnesses have created difficulties for diagnosis and further treatment. Three such chronically fatiguing illnesses, Post-polio syndrome (PPS), Myalgic Encephalomyelitis (ME) and chronic fatigue syndrome (CFS) fall under this category. '''Purpose''': The aim of this study is to examine and distinguish between core symptoms found in these illnesses (i.e. muscle pain/weakness, fatigue or exhaustion, and autonomic symptoms) via three methods of analysis (DePaul Symptom Questionnaire 2 (DSQ-2), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and machine learning techniques). '''Results''': Items assessing onset and severity for individuals who reported having PPS were found to have experienced an onset of PPS related symptoms roughly 30 years after the onset of Polio. Items found in the DSQ-2, SF-36 compared all illness groups and found that participants with ME/CFS were more functionally impaired across symptoms than those with PPS. Across all analyses, three domains most commonly differentiated the illnesses (neurocognitive, Post-exertional malaise, and neuroendocrine). '''Conclusion''': Examining functional impairment amongst chronically fatiguing illnesses using multiple methods of analysis can be an important factor in distinguishing similar illnesses. These findings support further analysis of analogous symptomatology among other chronic illnesses to assist in diagnosis.<ref>{{Cite journal|last=Klebek|first=Lauren|author-link=|last2=Sunnquist|first2=Madison|author-link2=Madison Sunnquist|last3=Jason|first3=Leonard A.|author-link3=Leonard Jason|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2019-10-02|title=Differentiating post-polio syndrome from myalgic encephalomyelitis and chronic fatigue syndrome|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1687117|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=196–206|doi=10.1080/21641846.2019.1687117|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref></blockquote>  
* ''A new fatigue protocol to assess postural sway in collegiate female athletes''<blockquote> '''Abstract''' - '''Background''': Core stability, i.e. the ability to control the position and motion of the body’s core has been proposed to be an important factor involved in postural sway. Muscle fatigue may adversely affect the function of core muscles. Although many studies have investigated effects of core muscle fatigue on balance, mostly non-standard fatigue protocols have been used which can potentially call into question the validity of their results. '''Purpose''': This paper contributes to the existing literature by developing a standard functional core fatigue protocol (FCFP) to functionally induce fatigue in all core muscles, and to examine its effects on postural sway in collegiate female athletes. '''Method''': The endurance of core muscles and postural sway was assessed in sixty female collegiate athletes using the Pressure Biofeedback Unit (PBU) and the Force Distribution Measurement-Small multifunction force-measuring plate, respectively. The confidence interval was set at 95% (p < 0.05). '''Results''': A significant decrease in endurance of core muscles was found in the experimental group after their participation in the FCFP (p < 0.001). Also, the displacement of the centre of pressure in both ‘path length’ and ‘area’ as indices of postural sway significantly increased compared to the related pre-fatigue values (p < 0.001). '''Conclusion''': The designed FCFP can induce fatigue in core muscles efficiently and has significant negative effects on postural sway in collegiate female athletes.<ref>{{Cite journal|last=Seidi|first=Foad|last2=Hamedani|first2=Pegah D.|last3=Rajabi|first3=Reza|last4=Sheikhhoseini|first4=Rahman|last5=Khoshroo|first5=Fatemeh|date=2019-10-02|title=A new fatigue protocol to assess postural sway in collegiate female athletes|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1699640|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=218–228|doi=10.1080/21641846.2019.1699640|issn=2164-1846}}</ref></blockquote>  
* ''A new fatigue protocol to assess postural sway in collegiate female athletes''<blockquote> '''Abstract''' - '''Background''': Core stability, i.e. the ability to control the position and motion of the body’s core has been proposed to be an important factor involved in postural sway. Muscle fatigue may adversely affect the function of core muscles. Although many studies have investigated effects of core muscle fatigue on balance, mostly non-standard fatigue protocols have been used which can potentially call into question the validity of their results. '''Purpose''': This paper contributes to the existing literature by developing a standard functional core fatigue protocol (FCFP) to functionally induce fatigue in all core muscles, and to examine its effects on postural sway in collegiate female athletes. '''Method''': The endurance of core muscles and postural sway was assessed in sixty female collegiate athletes using the Pressure Biofeedback Unit (PBU) and the Force Distribution Measurement-Small multifunction force-measuring plate, respectively. The confidence interval was set at 95% (p < 0.05). '''Results''': A significant decrease in endurance of core muscles was found in the experimental group after their participation in the FCFP (p < 0.001). Also, the displacement of the centre of pressure in both ‘path length’ and ‘area’ as indices of postural sway significantly increased compared to the related pre-fatigue values (p < 0.001). '''Conclusion''': The designed FCFP can induce fatigue in core muscles efficiently and has significant negative effects on postural sway in collegiate female athletes.<ref>{{Cite journal|last=Seidi|first=Foad|last2=Hamedani|first2=Pegah D.|last3=Rajabi|first3=Reza|last4=Sheikhhoseini|first4=Rahman|last5=Khoshroo|first5=Fatemeh|date=2019-10-02|title=A new fatigue protocol to assess postural sway in collegiate female athletes|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1699640|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=218–228|doi=10.1080/21641846.2019.1699640|issn=2164-1846}}</ref></blockquote>  
* ''Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)''<blockquote> '''Abstract''' - '''Background''': Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is a common medical condition that limits physical and cognitive functions, with no known effective medical treatment. '''Methods''': We report on the safety and effectiveness data accumulated in clinical practice when treating ME/CFS with low-dose naltrexone (LDN, 3.0 – 4.5 mg/day). The medical records from 218 patients who received ar diagnosis of ME/CFS and LDN treatment during 2010–2014 were retrospectively analyzed. '''Results''': Outcome data were available in 92.2% of patients with an average follow-up time of 1.7 years. A positive treatment response to LDN was reported by 73.9% of the patients. Most patients experienced improved vigilance/alertness and improved physical and cognitive performance. Some patients reported less pain and fever, while 18.3% of patients did not report any treatment response to LDN. Mild adverse effects (insomnia, nausea) were common at the beginning of the treatment. Neither severe adverse effects nor long-term adverse symptoms were reported. '''Conclusions''': The high frequency of treatment response and good safety profile observed in this retrospective open label study could prompt prospective controlled studies to confirm the feasibility of LDN in alleviating ME/CFS symptoms.<ref>{{Cite journal|last=Polo|first=Olli|author-link=Olli Polo|last2=Pesonen|first2=Pia|author-link2=|last3=Tuominen|first3=Essi|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2019-10-02|title=Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1692770|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=207–217|doi=10.1080/21641846.2019.1692770|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref></blockquote>  
* ''[[Low dose naltrexone|Low-dose naltrexone]] in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)''<blockquote> '''Abstract''' - '''Background''': Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is a common medical condition that limits physical and cognitive functions, with no known effective medical treatment. '''Methods''': We report on the safety and effectiveness data accumulated in clinical practice when treating ME/CFS with low-dose naltrexone (LDN, 3.0 – 4.5 mg/day). The medical records from 218 patients who received ar diagnosis of ME/CFS and LDN treatment during 2010–2014 were retrospectively analyzed. '''Results''': Outcome data were available in 92.2% of patients with an average follow-up time of 1.7 years. A positive treatment response to LDN was reported by 73.9% of the patients. Most patients experienced improved vigilance/alertness and improved physical and cognitive performance. Some patients reported less pain and fever, while 18.3% of patients did not report any treatment response to LDN. Mild adverse effects (insomnia, nausea) were common at the beginning of the treatment. Neither severe adverse effects nor long-term adverse symptoms were reported. '''Conclusions''': The high frequency of treatment response and good safety profile observed in this retrospective open label study could prompt prospective controlled studies to confirm the feasibility of LDN in alleviating ME/CFS symptoms.<ref>{{Cite journal|last=Polo|first=Olli|author-link=Olli Polo|last2=Pesonen|first2=Pia|author-link2=|last3=Tuominen|first3=Essi|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2019-10-02|title=Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1692770|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=207–217|doi=10.1080/21641846.2019.1692770|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref></blockquote>  


==References==
==References==

Revision as of 21:35, January 16, 2020

Titles and abstracts for the journal, Fatigue: Biomedicine, Health & Behavior, Volume 7, Issue 4, 2019.

Volume 7, Issue 4, 2019[edit | edit source]

  • Letter to the editor - Post-exercise autonomic function in chronic fatigue syndrome[1]
  • Fatigue severity and emotion dysregulation: roles in mental health among trauma exposed college students

    Abstract - Background: There is increased recognition that traumatic events are a common experience among college students, and such events have shown to be associated with negative mental health outcomes and poorer well-being among this population. Although some work has focused on the relation between trauma exposure and mental health among college students, little work has explored the role of individual difference in fatigue severity within this group. Purpose: Therefore, the current study sought to address this gap in the existing literature by examining the explanatory role of fatigue severity in terms of anxiety/depression and post-traumatic stress among trauma exposed college students. Further, the mechanistic role of emotion dysregulation was evaluated as a possible factor that may underlie the relation between fatigue severity and mental health. Method: Seven hundred and thirty trauma-exposed college students were included in the present study (78.6% female, Mage = 22.59 years, SD = 5.48; 55.3% racial minority). Results: Results revealed that individual differences in fatigue severity had a significant indirect effect on the studied internalizing symptoms through emotion dysregulation. Conclusion: These novel findings suggest future work should continue to explore emotion dysregulation in the association between fatigue severity and internalizing symptoms among trauma-exposed college students.[2]

  • Differentiating post-polio syndrome from myalgic encephalomyelitis and chronic fatigue syndrome

    Abstract - Background: Overlapping and concomitant symptoms among similar chronic illnesses have created difficulties for diagnosis and further treatment. Three such chronically fatiguing illnesses, Post-polio syndrome (PPS), Myalgic Encephalomyelitis (ME) and chronic fatigue syndrome (CFS) fall under this category. Purpose: The aim of this study is to examine and distinguish between core symptoms found in these illnesses (i.e. muscle pain/weakness, fatigue or exhaustion, and autonomic symptoms) via three methods of analysis (DePaul Symptom Questionnaire 2 (DSQ-2), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and machine learning techniques). Results: Items assessing onset and severity for individuals who reported having PPS were found to have experienced an onset of PPS related symptoms roughly 30 years after the onset of Polio. Items found in the DSQ-2, SF-36 compared all illness groups and found that participants with ME/CFS were more functionally impaired across symptoms than those with PPS. Across all analyses, three domains most commonly differentiated the illnesses (neurocognitive, Post-exertional malaise, and neuroendocrine). Conclusion: Examining functional impairment amongst chronically fatiguing illnesses using multiple methods of analysis can be an important factor in distinguishing similar illnesses. These findings support further analysis of analogous symptomatology among other chronic illnesses to assist in diagnosis.[3]

  • A new fatigue protocol to assess postural sway in collegiate female athletes

    Abstract - Background: Core stability, i.e. the ability to control the position and motion of the body’s core has been proposed to be an important factor involved in postural sway. Muscle fatigue may adversely affect the function of core muscles. Although many studies have investigated effects of core muscle fatigue on balance, mostly non-standard fatigue protocols have been used which can potentially call into question the validity of their results. Purpose: This paper contributes to the existing literature by developing a standard functional core fatigue protocol (FCFP) to functionally induce fatigue in all core muscles, and to examine its effects on postural sway in collegiate female athletes. Method: The endurance of core muscles and postural sway was assessed in sixty female collegiate athletes using the Pressure Biofeedback Unit (PBU) and the Force Distribution Measurement-Small multifunction force-measuring plate, respectively. The confidence interval was set at 95% (p < 0.05). Results: A significant decrease in endurance of core muscles was found in the experimental group after their participation in the FCFP (p < 0.001). Also, the displacement of the centre of pressure in both ‘path length’ and ‘area’ as indices of postural sway significantly increased compared to the related pre-fatigue values (p < 0.001). Conclusion: The designed FCFP can induce fatigue in core muscles efficiently and has significant negative effects on postural sway in collegiate female athletes.[4]

  • Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

    Abstract - Background: Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is a common medical condition that limits physical and cognitive functions, with no known effective medical treatment. Methods: We report on the safety and effectiveness data accumulated in clinical practice when treating ME/CFS with low-dose naltrexone (LDN, 3.0 – 4.5 mg/day). The medical records from 218 patients who received ar diagnosis of ME/CFS and LDN treatment during 2010–2014 were retrospectively analyzed. Results: Outcome data were available in 92.2% of patients with an average follow-up time of 1.7 years. A positive treatment response to LDN was reported by 73.9% of the patients. Most patients experienced improved vigilance/alertness and improved physical and cognitive performance. Some patients reported less pain and fever, while 18.3% of patients did not report any treatment response to LDN. Mild adverse effects (insomnia, nausea) were common at the beginning of the treatment. Neither severe adverse effects nor long-term adverse symptoms were reported. Conclusions: The high frequency of treatment response and good safety profile observed in this retrospective open label study could prompt prospective controlled studies to confirm the feasibility of LDN in alleviating ME/CFS symptoms.[5]

References[edit | edit source]

  1. Friedberg, Fred; Huang, Chuan; Ramjan, Sameera (October 7, 2019). "Post-exercise autonomic function in chronic fatigue syndrome". Fatigue: Biomedicine, Health & Behavior. 7 (4): 229–231. doi:10.1080/21641846.2019.1675856. ISSN 2164-1846.
  2. Manning, Kara; Bakhshaie, Jafar; Shepherd, Justin M.; Jones, Jenna; Timpano, Kiara R.; Viana, Andres G.; Zvolensky, Michael J. (October 2, 2019). "Fatigue severity and emotion dysregulation: roles in mental health among trauma exposed college students". Fatigue: Biomedicine, Health & Behavior. 7 (4): 181–195. doi:10.1080/21641846.2019.1661942. ISSN 2164-1846.
  3. Klebek, Lauren; Sunnquist, Madison; Jason, Leonard A. (October 2, 2019). "Differentiating post-polio syndrome from myalgic encephalomyelitis and chronic fatigue syndrome". Fatigue: Biomedicine, Health & Behavior. 7 (4): 196–206. doi:10.1080/21641846.2019.1687117. ISSN 2164-1846.
  4. Seidi, Foad; Hamedani, Pegah D.; Rajabi, Reza; Sheikhhoseini, Rahman; Khoshroo, Fatemeh (October 2, 2019). "A new fatigue protocol to assess postural sway in collegiate female athletes". Fatigue: Biomedicine, Health & Behavior. 7 (4): 218–228. doi:10.1080/21641846.2019.1699640. ISSN 2164-1846.
  5. Polo, Olli; Pesonen, Pia; Tuominen, Essi (October 2, 2019). "Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)". Fatigue: Biomedicine, Health & Behavior. 7 (4): 207–217. doi:10.1080/21641846.2019.1692770. ISSN 2164-1846.