Low back pain and chronic fatigue in hospital staff in Turkey

Posted on 07/25/2015 by wames

Research abstract:

OBJECTIVES:

This study aimed to investigate the occurrence of low back pain in hospital employees during the previous year and its correlation with demographic data, occupational factors and chronic fatigue syndrome.

METHODS:

All participants provided information on their socio-demographic background, occupational characteristics, their experience of low back pain during the previous year, and chronic fatigue syndrome.

RESULTS:

The study included 365 volunteers (221 male and 144 female). The mean age was 33.1±7.2. Of the 365 participants, 218 (59.7%) had experienced low back pain in the last year. No statistically significant difference was detected in age, height, weight, level of education, smoking habits, occupation, professional working hours, shift work or levels of income between the groups with and without low back pain. Low back pain was more frequent (p<0.05) in male workers. Chronic fatigue syndrome was statistically significant in the group suffering from low back pain (p<0.05), of whom 21.5% had chronic fatigue syndrome. We detected a statistically significant relationship (p<0.05) between chronic fatigue syndrome, occupational duration and shift work.

CONCLUSION:

To the best of our knowledge, this is the first to show the relationship between low back pain and chronic fatigue syndrome in hospital employees. Shift work and length of time in occupation are risk factors for chronic fatigue syndrome.

[The prevalence of low back pain in hospital staff and its relationship with chronic fatigue syndrome and occupational factors], by R Terzi, F Altin in Agri. 2015 Jul;27(3):149-54 [Article in Turkish]

Posted in News | Tagged | Comments Off on Low back pain and chronic fatigue in hospital staff in Turkey

Muscle weakness in arms & trunk in ME/CFS

Posted on 07/24/2015 by wames

ME Research UK comments on research into muscle weakness, July 21 2015:

One of the key difficulties that ME/CFS patients face is standing (orthostasis), particularly standing still. For them, simply being upright can trigger a cluster of symptoms, such as dizziness, altered vision, nausea, fatigue, headache or sweating. This ‘orthostatic intolerance’ can have many causes (see our article, “Standing up for ME”), but a lack of endurance in the muscles of the trunk, which maintain the upright position, could be a contributing factor, as a new study shows.

For the investigation, researchers at Antwerp University Hospital recruited 72 women with ME/CFS, 30 women with osteoporosis (who also have standing problems) and 55 healthy women. All underwent a timed-loaded standing test which measures how long a person­­­­­­ can hold a 1 kg dumbbell in each hand in front of her with straight arms.

This test assesses combined trunk and arm endurance, and is intended to simulate the performance of the torso during everyday activities. As expected, timed-loaded standing was significantly shorter in patients with osteoporosis (84.5 seconds on average) than in the healthy women (165 seconds).

In women with ME/CFS, however, timed-loaded standing was significantly lower (50 seconds) than in either of these groups. The authors note that problems with standing upright and physical activity are similar in ME/CFS and osteoporosis patients – both groups have problems keeping their spines vertical (read the report). This, and the specific biomechanical weakness identified in the women with ME/CFS, certainly needs further investigation.

This research group in Belgium had previously examined upper limb muscle recovery – a feature that had never been subjected to research in ME/CFS patients, despite the fact that these muscles are most frequently used for everyday activities, such as combing and washing hair, ironing and cooking (report).

After an exercise challenge consisting of 18 maximal contractions and a recovery phase of 45 minutes, muscle recovery was significantly slower in ME/CFS patients than healthy people (muscle strength was still recovering 30-45 minutes after the exercise).

Intriguingly, this was only true for patients who also fulfilled the 2010 criteria for fibromyalgia, i.e. who had a high degree of “widespread pain” as well as the symptoms shared with ME/CFS. As many ME/CFS patients fall into this category (see our funded study ‘Pain characteristics’), the test could be a simple way of objectively measuring muscle impairment in a substantial number of people. The fact that muscle recovery of the upper limb muscles was NOT delayed in an equivalent experiment in multiple sclerosis patients makes the findings even more intriguing (read more).

Both investigations show that relatively simple, easy-to-perform measurements – such as the endurance of the muscles in the trunk and arms, or the change in upper arm strength over a short period – can yield potentially important clinical information about biomechanical weakness in ME/CFS. Historically, muscle fatigability and weakness, often in response to minor degrees of exercise, was a characteristic feature of ME (read more), and muscle cramps, fasciculations (twitching) and extreme muscle tenderness were also common findings (read more). These aspects are rarely discussed in the modern literature and are largely ignored by healthcare professionals today. Just how many ME/CFS patients have had a proper clinical examination of their affected muscles? Probably very few, if any – and this needs to change.

Sources

Timed loaded standing in female chronic fatigue syndrome compared with other populations. Eyskens JB, et al. JRRD, 2015; 52 (1).21-30. Read more (full text).
Recovery of upper limb muscle function in chronic fatigue syndrome with and without fibromyalgia. Ickmans K, et al. Eur J Clin Invest, 2014 Feb; 44(2): 153–9. Read more (abstract).
The Specificity of the C D C-1994 criteria for chronic fatigue syndrome: comparison of health status in three groups of patients who fulfill the criteria. Kennedy G, et al. Annals of Epidemiology, 2004 Feb; 14(2): 95–100. Read more (essay).
Ramsay AM. Epidemic neuromyasthenia 1955-1978. Postgraduate Medical Journal 1978; 54: 718-721. Read more (full text).

Muscle weakness in arms and trunk in ME/CFS

Posted in News | Tagged , , , | Comments Off on Muscle weakness in arms & trunk in ME/CFS

Mindfulness and ME/CFS

Posted on 07/24/2015 by wames

Research abstract:

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is  associated with physical, cognitive and emotional challenges, and much  research suggests that mindfulness-based interventions (MBIs) can be  helpful for these difficulties. It is reasonable to assume that living with ME/CFS influences how people experience MBIs.

However, existing literature provides little insight into what it is like to attend an MBI if experiencing ME/CFS and thus there is a paucity of information to guide intervention. The current research aimed to elucidate this experience by applying Interpretative Phenomenological Analysis to eight interview transcripts.

Four master themes – ‘The gift of mindfulness’, ‘Struggling with doubts and understanding’, ‘The vulnerable self’, and ‘Healing relationships’ – emerged.

Individuals gave complex reports of MBIs which encompassed both positive and
negative accounts. Throughout these accounts, ME/CFS appeared at the forefront of individuals’ perceptions as if it were a lens they viewed their experiences through. For some, mindfulness gifted acceptance, ways of self-soothing and methods of regaining control. Many participants struggled with mindfulness however, fighting with their
own internal barriers and finding the guidance they were given confusing.

Being at the MBIs seemed to automatically place individuals in a vulnerable position. Participants reported that it was essential for them to ‘be on guard’, to monitor their activity and environment in regards to illness exacerbation. Indeed, many individuals seemed to expect the worst from the MBIs, particularly from the attitudes of their course peers and facilitators.

In contrast to participants’ expectations, individuals commonly reported that their facilitators and peers understood their 15 conditions and experiences. This sense
of being validated and of belonging was reported to be therapeutic. Moreover, relationships with others on the course were found to elicit a sense of hope and helped individuals engage with the mindfulness material.

Best practice recommendations include reducing participants’ anxieties and managing expectations around MBIs as well as harnessing the power of the group. Future research might further explore discourses around MBIs, the group dynamics involved, hope, demographic differences, and the potential utility of Acceptance and Commitment
Therapy for ME/CFS.

A pluralistic approach to medically unexplained symptoms, by Jennifer Ellen Dayes, City University London, September 2014. Online: May 5, 2015

Posted in News | Tagged , | Comments Off on Mindfulness and ME/CFS

Amitriptyline helpful for neuropathic pain for some adults

Posted on 07/21/2015 by wames

Review abstract:

BACKGROUND:

This is an updated version of the original Cochrane review published in Issue 12, 2012. That review considered both fibromyalgia and neuropathic pain, but the effects of amitriptyline for fibromyalgia are now dealt with in a separate review. Amitriptyline is a tricyclic antidepressant that is widely used to treat chronic neuropathic pain (pain due to nerve damage). It is recommended as a first line treatment in many guidelines. Neuropathic pain can be treated with antidepressant drugs in doses below those at which the drugs act as antidepressants.

OBJECTIVES:

To assess the analgesic efficacy of amitriptyline for relief of chronic neuropathic pain, and the adverse events associated with its use in clinical trials.

SEARCH METHODS:

We searched CENTRAL, MEDLINE, and EMBASE to March 2015, together with two clinical trial registries, and the reference lists of retrieved papers, previous systematic reviews, and other reviews; we also used our own hand searched database for older studies.

SELECTION CRITERIA:

We included randomised, double-blind studies of at least four weeks’ duration comparing amitriptyline with placebo or another active treatment in chronic neuropathic pain conditions.

DATA COLLECTION AND ANALYSIS:

We performed analysis using three tiers of evidence. First tier evidence derived from data meeting current best standards and subject to minimal risk of bias (outcome equivalent to substantial pain intensity reduction, intention-to-treat analysis without imputation for dropouts; at least 200 participants in the comparison, 8 to 12 weeks’ duration, parallel design), second tier from data that failed to meet one or more of these criteria and were considered at some risk of bias but with adequate numbers in the comparison, and third tier from data involving small numbers of participants that were considered very likely to be biased or used outcomes of limited clinical utility, or both.

MAIN RESULTS:

We included 15 studies from the earlier review and two new studies (17 studies, 1342 participants) in seven neuropathic pain conditions. Eight cross-over studies with 302 participants had a median of 36 participants, and nine parallel group studies with 1040 participants had a median of 84 participants. Study quality was modest, though most studies were at high risk of bias due to small size.There was no first-tier or second-tier evidence for amitriptyline in treating any neuropathic pain condition. Only third-tier evidence was available. For only two of seven studies reporting useful efficacy data was amitriptyline significantly better than placebo (very low quality evidence).More participants experienced at least one adverse event; 55% of participants taking amitriptyline and 36% taking placebo. The risk ratio (RR) was 1.5 (95% confidence interval (CI) 1.3 to 1.8) and the number needed to treat for an additional harmful outcome was 5.2 (3.6 to 9.1) (low quality evidence). Serious adverse events were rare. Adverse event and all-cause withdrawals were not different, but were rarely reported (very low quality evidence).

AUTHORS’ CONCLUSIONS:

Amitriptyline has been a first-line treatment for neuropathic pain for many years. The fact that there is no supportive unbiased evidence for a beneficial effect is disappointing, but has to be balanced against decades of successful treatment in many people with neuropathic pain. There is no good evidence of a lack of effect; rather our concern should be of overestimation of treatment effect. Amitriptyline should continue to be used as part of the treatment of neuropathic pain, but only a minority of people will achieve satisfactory pain relief. Limited information suggests that failure with one antidepressant does not mean failure with all.

Amitriptyline for neuropathic pain in adults by RA Moore et al. in Cochrane Database Syst Rev, 2015 Jul 6; 7

 

Posted in News | Tagged , , , | Comments Off on Amitriptyline helpful for neuropathic pain for some adults

Dr Lucinda Bateman on antivirals for ME/CFS?

Posted on 07/21/2015 by wames

Dr. Lucinda Bateman answers the question

Q: I hear about treating with antivirals like Valcyte, Valtrex and Famvir. My doctor says there’s no evidence that these help. Others claim great results? I don’t know what to think.

A: The term “no evidence” means specifically that there aren’t high quality published studies showing evidence or proof – and unfortunately, this is true for antivirals and ME/CFS. From my perspective, there are some people who respond, at least temporarily, to antiviral regimens, but the majority of people do not, at least using the commonly available and affordable antiviral drugs. That likely explains the varied claims.

Even as an experienced clinician, I’m not sure how to predict who will benefit and who will not. In my own clinic, I may try an antiviral regimen when there is substantial clinical evidence of reactivating herpes-virus infections.  For example, if the patient has frequent outbreaks of oral or genital herpes simplex, a history of shingles, and/or onset of their post-viral syndrome (ME/CFS) associated with EBV mono, I certainly wouldn’t hesitate to give antivirals a try. We do not have solid scientific evidence behind any specific viral pathogen or any antiviral regimen.

Ask the Doctor: Do Antivirals Work for ME/CFS? by Dr Lucinda Bateman in ProHealth.com July 12, 2015

Posted in News | Tagged , | Comments Off on Dr Lucinda Bateman on antivirals for ME/CFS?

Dr Leonard Jason’s reflections on SEID

Posted on 07/21/2015 by wames

Article abstract:

The Institute of Medicine (IOM) in the US has recently proposed that the term Systemic Exertion Intolerance Disease (SEID) replace Chronic Fatigue Syndrome (CFS).  In addition, the IOM proposed a new case definition for SEID, which includes substantial reductions or impairments in the ability to engage in pre-illness activities, unrefreshing sleep, post-exertional malaise, and either cognitive impairment or orthostatic intolerance.

Unfortunately, these recommendations for a name change were not vetted with patient and professional audiences, and the new criteria were not evaluated with data sets of patients and controls. A recent poll suggests that the majority of patients reject this new name. In addition, studies have found that prevalence rates will dramatically increase with the new criteria, particularly due to the ambiguity revolving around exclusionary illnesses.

Findings suggest that the new criteria select more patients who have less impairment and fewer symptoms than several other criteria. The implications of these findings are discussed.

Reflections on the IOM’s systemic exertion intolerance disease, by Leonard A.Jason,
Madison Sunnquist, Abigail Brown, Stephanie McManimen, Jacob Furst in Pol Arch Med Wewn. Published online: July 15, 2015

 

 

Posted in News | Tagged , , , , | Comments Off on Dr Leonard Jason’s reflections on SEID

Fatigue & depression levels higher in CFS than cancer

Posted on 07/20/2015 by wames

Research abstract:

OBJECTIVE: Persistent fatigue and depressive symptoms are both highly prevalent among patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) as well as breast cancer survivors. This study aimed to assess and directly compare perceptions of fatigue as highly interfering in one’s daily functioning in both patient populations to better understand their relationships with depressed mood.

METHODS: Participants were 95 female CFS/ME patients and 67 females who were approximately 5 years post-treatment for stage 0-III breast cancer presenting with clinically elevated fatigue severity. Self-report measures were obtained on participants’ fatigue-related interference in daily functioning and fatigue severity as well as depressed mood. Hierarchical regression was used to test effects controlling for relevant demographic, psychosocial, and medical covariates.

RESULTS: CFS/ME patients endorsed greater depressed mood and fatigue interference than did fatigued breast cancer survivors, p’s<.001. These factors were significantly positively correlated among CFS/ME patients (β=.36, p<.001), but not the fatigued breast cancer survivors (β=.18, p=.19).

CONCLUSIONS: CFS/ME patients reported elevated fatigue symptoms and depression relative to fatigued breast cancer survivors. In the former group, greater depressed mood was highly and significantly associated with greater fatigue-related inference in daily activities. Potential targets for cognitive behavioral interventions are discussed.

Perceived fatigue interference and depressed mood: comparison of chronic fatigue syndrome/myalgic encephalomyelitis patients with fatigued breast cancer survivors, by Daniel L. Hall, Michael H. Antonia, Emily G. Lattie, Devika R. Jutagir, Sara J. Czajac, Dolores Perdomo, Suzanne C. Lechner, Jamie M. Stagl, Laura C. Bouchard, Lisa M. Gudenkauf, Lara Traeger, Mary Ann Fletcher & Nancy G. Klimas et al. in Fatigue, 2015; 3(3): 142-155

Posted in News | Tagged , , , , , | Comments Off on Fatigue & depression levels higher in CFS than cancer

Colostrum MAF – promising therapy for CFS

Posted on 07/20/2015 by wames

 Research abstract:

Background: Gc protein-derived macrophage-activating factor (GcMAF) immunotherapy has been steadily advancing over the last two decades.

Oral colostrum macrophage-activating factor (MAF) produced from bovine colostrum has shown high macrophage phagocytic activity. GcMAF-based immunotherapy has a wide application for use in treating many diseases via macrophage activation or for use as supportive therapy.

Results: Three case studies demonstrate that oral colostrum MAF can be used for serious infection and chronic fatigue syndrome (CFS) without adverse effects.

Conclusion: We demonstrate that colostrum MAF shows promising clinical results in patients with infectious diseases and for symptoms of fatigue, which is common in many chronic diseases.

Oral colostrum macrophage-activating factor for serious infection and chronic fatigue syndrome: three case reports. T Inui, et al. in Anticancer Res, 2015 Aug; 35(8): 4545-9.

Posted in News | Tagged , , , | Comments Off on Colostrum MAF – promising therapy for CFS

Dr Jacob Teitelbaum overview of research into CFS & ME

Posted on 07/17/2015 by wames

Numerous studies, including research on immunologic and hormonal changes, confirm that fibromyalgia and chronic fatigue syndrome (CFS) are painfully real illnesses. Though many insurance companies continue to deny that science so they can avoid paying healthcare and disability costs, this research should help speed up understanding of these conditions.

New developments include:

• Widespread changes in the immune system. Numerous cytokine changes have been seen, showing patterns that may be used for diagnostic testing. Natural killer cell activity is also down.

• Thyroid, adrenal, and testosterone deficiencies are common.

• Central sensitization, where chronic pain causes the body to amplify the pain signal.

Work underway by Dr. Mark Sivieri in Maryland is showing that there are common and critical deficiencies in critical IgG antibodies that may be contributing to immune dysfunction. And these deficiencies may be treatable.

Our experience is corroborating his findings.

Antibodies are like the chemical warfare arm of our immune systems, fighting a wide array of infections. The IgG arm of our immune systems are made up of four branches, called IgG 1, IgG 2, IgG 3, and IgG 4.

Branches 1 and 3 are often compromised in cases CFS and fibromyalgia. This often correlates with pain, called small fiber neuropathy.

It also ties into problems with blood pressure and gut function, called autonomic dysfunction.  So we are now seeing a potential “missing link” between the immune dysfunction, pain, and the autonomic dysfunctions commonly seen in CFS and fibromyalgia.

Interestingly, all three of these symptoms respond to treatment with intravenous gamma globulin. Indeed, it has been helpful in the 10 to 15 percent of our patients who have the most severe forms of the illnesses; they are often bedridden and do not respond to other treatments.

Unfortunately, gamma globulin can cost as much as $50,000 per year, and it is difficult to get it covered by insurance.

Our placebo-controlled study shows that, on a scale of 0 to 10 (with 0 being “dead” and 10 being “perfectly healthy”), the average CFS and fibromyalgia patient improved from a 3.5 to a 6.2 score at three months and to almost a 7 score at two years — by which time most people had improved to where they could wean off most treatments.

Treatment was based on our “S.H.I.N.E. Protocol.” Our free Energy Analysis Program at www.endfatigue.com can determine what treatments will help YOU optimize your energy and feel the best, as specific treatments vary quite a bit from person to person.

Since this study was published, our research has also shown that a special nutrient called ribose increased energy an average of 61 percent at three weeks (taking 5 grams three times a day).

There is good reason for hope in this new research, and the good news is that there is also a lot that you can do now.
Getting to the bottom of CFS and Fibromyalgia, by Jacob Teitelbaum MD, in Newsmax Health, 15 Jun 2015

 

Posted in News | Tagged , , , , , , , | Comments Off on Dr Jacob Teitelbaum overview of research into CFS & ME

ME/CFS – predisposed to inflammation?

Posted on 07/17/2015 by wames

Inflammation is a hot topic in ME/CFS yet no one has taken a comprehensive look at its possible genetic roots. The CDC just did that – and out popped one very specific part of the immune system.

Exercise studies that have highlighted the same part of the immune system make the finding even more intriguing. Could the CDC have identified a key part of ME/CFS? Check it out in Predisposed to Inflammation? CDC Zeroes In on Innate Immune System  by Cort Johnson, in Health Rising, July 9

 

Posted in News | Tagged , , | Comments Off on ME/CFS – predisposed to inflammation?