The BBC have EXTENDED their deadline for applications for BBC Generation 2016 until the end of this week. They would like to receive applications by midnight Friday 13th November.
They are still looking to reach the broadest possible range of young adults across communities in Wales, Scotland and Northern Ireland to take part in BBC programmes next year.
Bereavement may bring negative impacts on the mind, body, and spiritual well-being of grieving persons. Some bereaved persons with chronic fatigue syndrome- (CFS-) illness experience a dual burden of distress.
This study investigated the effects of bereavement on CFS-like illness by comparing bereaved and non-bereaved participants. It also adopted a random group design to investigate the effectiveness of Qigong on improving the well-being of bereaved participants.
The Qigong intervention comprised 10 group sessions delivered twice a week for 5 weeks and home-practice for at least three times a week lasting 15–30 minutes each. The participants’ fatigue, anxiety, and depression, quality of life (QoL), and spiritual well-being were measured at baseline and 3 months after treatment.
The bereaved participants experienced significantly greater mental fatigue (16.09 versus 14.44, p = 0.017) and lower physical QoL (34.02 versus 37.17, p = 0.011) than their nonbereaved counterparts. After 3 months, the mental fatigue (−8 versus −4, p = 0.010) and physical fatigue (−10 versus −5, p = 0.007) experienced by intervention group had declined significantly, and improvements on their spirituality (14 versus −2, p = 0.013) and psychological QoL (8.91 versus 0.69, p = 0.002) scores exceeded those of the control group.
From Body to Mind and Spirit: Qigong Exercise for Bereaved Persons with Chronic Fatigue Syndrome-Like Illness, by Jie Li, Jessie S. M. Chan, Amy Y. M. Chow, Lai Ping Yuen, and Cecilia L. W. Chan in Evid Based Complement Alternat Med. 2015; 2015: 631410 [Published online 2015 Oct 4]
Neuropathic pain is notoriously variable in its severity and impact on patients, as well as in its response to treatment. Certain therapies for neuropathic pain have better evidence for their use; however, it is apparent that although some therapies provide relief for only a minority of patients, the relief may be significant.
Without a trial of therapy, there is no way to know if that relief is achievable. Our treatment experiences have shown that occasionally unexpected benefit is obtained through a thorough investigation of all options, even in the setting of failure of those with the most compelling evidence or indication.
Chronic neuropathic pain is generally best treated with regularly dosed medications, balancing efficacy and tolerability. Evidence supports first-line trials of anticonvulsants, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors, alone or in certain combinations. While opioid medications, particularly methadone, can be effective in treating neuropathic pain, they are best used only in refractory cases and by experienced clinicians, due to concerns for both short- and long-term safety.
Some therapies have a long history of successful use for certain syndromes (e.g., carbamazepine for trigeminal neuralgia pain), but these should not be considered to the exclusion of other more recent, less-supported therapies (e.g., botulinum toxin A for the same), particularly in refractory cases.
We find the principles of palliative care highly applicable in the treatment of chronic neuropathic pain, including managing expectations, mutually agreed-upon meaningful outcomes, and a carefully cultivated therapeutic relationship.
Treatment of Neuropathic Pain, by MT Mendlik, TJ Uritsky in Curr Treat Options Neurol. 2015 Dec;17(12):5
Highlights
•The risk of CFS was 1.5-fold higher in the migraine cohort.
•The risk was most prominent in the ≥65 years group with a 2.11-fold increased CFS.
•CFS incidence appeared to increase with the frequency of migraine.
Objective:
The common concurrence of migraine and chronic fatigue syndrome (CFS) has been reported but whether migraine poses a higher risk of CFS remains unknown. In this retrospective case–control study, we examined the association between the 2 disorders by using a nationwide, population-based database in Taiwan.
Methods
The data were retrieved and analyzed from the National Health Insurance Research Database (NHIRD) of Taiwan; 6902 newly diagnosed migraine cases from 2006–2010 were identified in a subset of the NHIRD, and 27,608 migraine-free individuals were randomly selected as the comparison cohort. The multivariate Cox proportional hazards regression model was used to investigate the risk of CFS in migraineurs after adjustment for demographic characteristics and comorbidities.
Results
After adjustment for the covariates, the risk of CFS was 1.5-fold higher in the migraine cohort than in the comparison cohort (52.72 vs. 28.85 per 10,000 person-years). Intriguingly, the risk was most prominent in the oldest group (≥65 years), with a 2.11-fold increased risk (95% confidence interval 1.31–3.41) of CFS. In addition, the adjusted cumulative incidence of CFS in the follow-up years was higher in the migraine group (log-rank test, P < .0001), and CFS incidence appeared to increase with the frequency of migraine diagnoses.
Conclusion
The current study demonstrated an increased risk of CFS in migraineurs. Proposed mechanisms in previous studies such as mitochondrial dysfunction and central sensitization may underlie the shared pathophysiology of these seemingly distinct but potentially overlapping disorders.
Increased risk of chronic fatigue syndrome in patients with migraine: A retrospective cohort study, by Chi-Ieong Lau, Che-Chen Lin, Wei-Hung Chen, Han-Cheng Wang, Chia-Hung Kao in Journal of Psychosomatic Research [Published Online: October 21, 2015]
Chronic Fatigue Syndrome (CFS) is a multisystem illness, which may be associated with imbalances in gut microbiota. This study builds on recent evidence that sleep may be influenced by gut microbiota, by assessing whether changes to microbiota in a clinical population known to have both poor sleep and high rates of colonization with gram-positive faecal Streptococcus, can improve sleep.
Twenty-one CFS participants completed a 22- day open label trial. Faecal microbiota analysis was performed at baseline and at the end of the trial. Participants were administered erythromycin 400 mg b.d. for 6 days. Actigraphy and questionnaires were used to monitor sleep, symptoms and mood. Changes in patients who showed a clinically significant change in faecal Streptococcus after treatment (responders; defined as post-therapy distribution<6%) were compared to participants who did not respond to treatment.
In the seven responders, there was a significant increase in actigraphic total sleep time (p=0.028) from baseline to follow up, compared with non-responders. Improved vigour scores were associated with a lower Streptococcus count (ρ=−0.90, p=0.037). For both the responders and the whole group, poorer mood was associated with higher Lactobacillus.
Short term antibiotic treatment appears to be insufficient to effect sustainable changes in the gut ecosystem in most CFS participants. Some improvement in objective sleep parameters and mood were found in participants with reduced levels of gram-positive gut microbiota after antibiotic treatment, which is encouraging. Further study of possible links between gut microorganisms and sleep and mood disturbances is warranted.
Sleep quality and the treatment of intestinal microbiota imbalance in Chronic Fatigue Syndrome: A pilot study, by Melinda L. Jackson, Henry Butt, Michelle Ball, Donald Lewis, Dorothy Bruck in Sleep Science 23 October 2015
Following the publication of David Tuller’s damning critique of the PACE trial (Oct 21-23)and then further conclusions from the PACE trial team (Oct 27) the media debate has raged on. There has been much criticism of how the media has overstated the results of the trial and continued accusations that the researchers haven’t acknowledged glaring flaws in trial methodology.
Virology blog: Trial By Error, Continued: Did the PACE Study Really Adopt a ‘Strict Criterion’ for Recovery? by David Tuller [4 Nov 2015] This includes a discussion of what constitutes ‘normal ranges of recovery’. He concludes:
Given that relapsing after too much exertion is a core symptom of the illness, it is impossible to calculate the possible harms that could have arisen from this widespread dissemination of misinformation to health care professionals—all based on the flawed claim from the comment that 30 percent of participants had recovered according to the PACE study’s “strict criterion for recovery.”
And that “strict criterion,” it should be remembered, allowed participants to get worse and still be counted as better.
Guardian: Chronic fatigue sufferers need help and more research – not misleading headlines [Suzanne O’Sullivan Oct 29] A study in Lancet Psychiatry this week was reported as if exercise and counselling are magic cures for CFS. A closer reading of this timely research is required.
ME Research UK: Media ballyhoo over PACE by Dr Neil Abbot Oct 28 2015]
The real findings are unremarkable; as the authors themselves say, “There was little evidence of differences between the four groups in fatigue or in physical functioning at long-term follow-up”.
PLOS blog: Uninterpretable: Fatal flaws in PACE Chronic Fatigue Syndrome follow-up study [James Coyne Oct 29 2015]
…we should reject some of the interpretations offered by the PACE investigators as unfairly spun to fit what has already a distorted positive interpretation of the results.
Mental elf: The PACE Trial for chronic fatigue syndrome: choppy seas but a prosperous voyage [Simon Wessely Nov 4] A defence of the trial results concluding:
I think this trial is the best evidence we have so far that there are two treatments that can provide some hope for improvement for people with chronic fatigue syndrome. Furthermore the treatments are safe, so long as they are provided by trained appropriate therapists who are properly supervised and in a way that is appropriate to each patient. These treatments are not “exercise and positive thinking” as one newspaper unfortunately termed it; these are sophisticated, collaborative therapies between a patient and a professional. Having said that, there were a significant number of patients who did not improve with these treatments. Some patients deteriorated, but this seems to be the nature of the illness, rather than related to a particular treatment.
Phoenix rising blog: PACE Trial follow-up: Here’s the table looking at the effects of having CBT or GET after 52 weeks
The authors suggest that it is the CBT and GET after APT and specialist medical care alone that is the reason the differences between the groups disappeared. However the table doesn’t bear this out.
Indeed those that had 10 or more sessions of CBT and GET tended to have the lowest improvements of the three groups.
BMJ: Tackling fear about exercise produces long term benefit in chronic fatigue syndrome [Ingrid Torjesen Oct 28]
…the follow-up findings were complicated by the fact that some of the patients who were randomly assigned to specific treatments in the PACE trial went on to undergo additional treatments…
At the end of the follow-up period, which was a median of 31 months after randomisation, there was little difference in outcomes among patients in any of the original four treatment groups. There was also no significant difference between the original four groups in the proportions of patients reporting a long term deterioration in their general health.
Spectator: The ME lobby is just a symptom of our stupidity about mental illness [Rod Liddle Nov 7] The poisonous emails, the threats, the rage – it’s all rooted in our crude attitude to psychiatric suffering Rod Liddle compares ME and FM to a turn of the century fad, Morgellons disease.
OBJECTIVE: To investigate differences between young children, adolescents and adults with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).
STUDY DESIGN: Comparison of clinical cohorts from 8 paediatric and 27 adult CFS/ME services in the UK and a paediatric randomised controlled trial from the Netherlands. Outcome measures include: fatigue (the UK-Chalder Fatigue Scale); Disability (the UK-SF-36 physical function subscale; the Netherlands-CHQ-CF87); school attendance, pain, anxiety and depression (the UK-Hospital Anxiety & Depression Scale, Spence Children’s Anxiety Scale; the Netherlands-Spielberger State-Trait Anxiety Inventory for Children, Children’s Depression Inventory); symptoms; time-to-assessment; and body mass index. We used multinomial regression to compare younger (aged <12 years) and older (aged 12-18 years) children with adults, and logistic regression to compare UK and Dutch adolescents.
RESULTS: Younger children had a more equal gender balance compared to adolescents and adults. Adults had more disability and fatigue, and had been ill for longer. Younger children were less likely to have cognitive symptoms (OR 0.18 (95% CI 0.13 to 0.25)) and more likely to present with a sore throat (OR 1.42 (1.07 to 1.90).
Adolescents were more likely to have headaches (81.1%, OR 1.56 (1.36% to 1.80%)) and less likely to have tender lymph nodes, palpitations, dizziness, general malaise and pain, compared to adults. Adolescents were more likely to have comorbid depression (OR 1.51 (1.33 to 1.72)) and less likely to have anxiety (OR 0.46 (0.41 to 0.53)) compared to adults.
CONCLUSIONS: Paediatricians need to recognise that children with CFS/ME present differently from adults. Whether these differences reflect an underlying aetiopathology requires further investigation.
Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is different in children compared to in adults: a study of UK and Dutch clinical cohorts, by SM Collin, R Nuevo, EM van de Putte, SL Nijhof, E Crawley in BMJ Open. 2015 Oct 28;5(10)
TRIAL REGISTRATION NUMBERS: FITNET trial registration numbers are ISRCTN59878666 and NCT00893438. This paper includes secondary (post-results) analysis of data from this trial, but are unrelated to trial outcomes.
Immunological dysregulation is present in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), with recent studies also highlighting the importance of examining symptom severity.
This research addressed this relationship between CFS/ME severity subgroups, assessing serum immunoglobulins and serum cytokines in severe and moderate CFS/ME patients.
Participants included healthy controls (n= 22), moderately (n = 22) and severely (n=19) affected CFS/ME patients. The 1994 Fukuda Criteria defined CFS/ME and severity scales confirmed mobile and housebound CFS/ME patients as moderate and severe respectively.
IL-1β was significantly reduced in severe compared with moderate CFS/ME patients. IL-6 was significantly decreased in moderate CFS/ME patients compared with healthy controls and severe CFS/ME patients. RANTES was significantly increased in moderate CFS/ME patients compared to severe CFS/ME patients. Serum IL-7 and IL-8 were significantly higher in the severe CFS/ME group compared with healthy controls and moderate CFS/ME patients.
IFN-γ was significantly increased in severe CFS/ME patients compared with moderately affected patients. This was the first study to show cytokine variation in moderate and severe CFS/ME patients, with significant differences shown between CFS/ME symptom severity groups.
This research suggests that distinguishing severity subgroups in CFS/ME research settings may allow for a more stringent analysis of the heterogeneous and otherwise inconsistent illness.
Serum Immune Proteins in Moderate and Severe Chronic Fatigue Syndrome/Myalgic Encephalomyelitis Patients, by Sharni Lee Hardcastle, Ekua Weba Brenu, Samantha Johnston, Thao Nguyen, Teilah Huth, Sandra Ramos, Donald Staines, and Sonya Marshall-Gradisnik in Int J Med Sci. 2015; 12(10): 764–772 [Published online 2015 Sep 5]
Sleep and ME/CFS – Suzanne Vernon, PhD
at the Bateman Horne Center [uploaded on Oct 29, 2015]
“What hath night to do with sleep when you have ME/CFS” Suzanne Vernon, PhD A Bateman Horne Education Meeting – October 7, 2015
Sleep and ME/CFS – Suzanne Vernon, PhD
at the Bateman Horne Center [uploaded on Oct 29, 2015]
“What hath night to do with sleep when you have ME/CFS” Suzanne Vernon, PhD A Bateman Horne Education Meeting – October 7, 2015
PROBLEM: Up to one in three young people with chronic fatigue syndrome (CFS/ME) also has depressive symptoms. It is not known how best to treat young people with this comorbidity.
METHOD: This case report seeks to describe and discuss the use of a cognitive behavioral approach for depression and low self-esteem in a 16-year-old girl with CFS/ME.
FINDINGS/CONCLUSION: Therapy was effective in remediating the young person’s mood difficulties, but appeared to exacerbate their CFS/ME symptoms. Therefore, it is crucial that CFS/ME and mood treatments are designed and trialed to ensure a complementary approach. Good communication and joint working between involved professionals is also important, and ideally, treatments for mood and for CFS/ME would be provided by the same team to facilitate this.
The Cognitive Behavioral Treatment of Depression and Low Self-Esteem in the Context of Pediatric Chronic Fatigue Syndrome (CFS/ME): A Case Study, by M Loades in J Child Adolesc Psychiatr Nurs. 2015 Oct 16 [Epub ahead of print]
