Fatigue in cancer and CFS

Posted on 10/18/2013 by wames

Abstract

BACKGROUND

Androgen deprivation therapy (ADT) often worsens fatigue in patients with prostate cancer, producing symptoms similar to chronic fatigue syndrome (CFS). Comparing expression (mRNA) of many fatigue-related genes in patients with ADT-treated prostate cancer versus with CFS versus healthy controls, and correlating mRNA with fatigue severity may clarify the differing pathways underlying fatigue in these conditions.

METHODS

Quantitative real-time PCR was performed on leukocytes from 30 fatigued, ADT-treated prostate cancer patients (PCF), 39 patients with CFS and 22 controls aged 40-79, together with ratings of fatigue and pain severity. 46 genes from these pathways were included: (1) adrenergic/monoamine/neuropeptides, (2) immune, (3) metabolite-detecting, (4) mitochondrial/energy, (5) transcription factors.

RESULTS

PCF patients showed higher expression than controls or CFS of 2 immune transcription genes (NR3C1 and TLR4), chemokine CXCR4, and mitochondrial gene SOD2. They showed lower expression of 2 vasodilation-related genes (ADRB2 and VIPR2), 2 cytokines (TNF and LTA), and 2 metabolite-detecting receptors (ASIC3 and P2RX7). CFS patients showed higher P2RX7 and lower HSPA2 versus controls and PCF. Correlations with fatigue severity were similar in PCF and CFS for only DBI, the GABA-A receptor modulator (r=-0.50, p<0.005 and r=-0.34, p<0.05). Purinergic P2RY1 was correlated only with PCF fatigue and pain severity (r=+0.43 and +0.59, p=0.025 and p=0.001).

CONCLUSIONS

PCF patients differed from controls and CFS in mean expression of 10 genes from all 5 pathways. Correlations with fatigue severity implicated DBI for both patient groups and P2RY1 for PCF only. These pathways may provide new targets for interventions to reduce fatigue.

Differing leukocyte gene expression profiles associated with fatigue in patients with prostate cancer versus chronic fatigue syndrome, by KC Light et al in Psychoneuroendocrinology, 6 September 2013. [Epub ahead of print]

 

 

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Information processing problems in CFS

Posted on 10/18/2013 by wames

Research abstract

Information processing difficulties are common in patients with chronic fatigue syndrome (CFS).

It has been shown that the time it takes to process a complex cognitive task, rather than error rate, may be the critical variable underlying CFS patients’ cognitive complaints.

The Attention Network Task (ANT) developed by Fan and colleagues may be of clinical utility to assess cognitive function in CFS, because it allows for simultaneous assessment of mental response speed, also called information processing speed, and error rate under three conditions challenging the attention system.

Comparison of data from two groups of CFS patients (those with and without comorbid major depressive disorder; n=19 and 22, respectively) to controls (n=29) consistently showed that error rates did not differ among groups across conditions, but speed of information processing did.

Processing time was prolonged in both CFS groups and most significantly affected in response to the most complex task conditions. For simpler tasks, processing time was only prolonged in CFS participants with depression. The data suggest that the ANT may be a task that could be used clinically to assess information processing deficits in individuals with CFS.

Attention network test: Assessment of cognitive function in chronic fatigue syndrome by Fumiharu Togo, Gudrun Lange, Benjamin H. Natelson, Karen S. Quigley in Journal of Neuropsychology, 24 September 2013 (Epub before print).

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Which symptom would you most want health professionals in Wales to help you with?

Posted on 10/15/2013 by Pixelwave

Which symptom would you most want health professionals in Wales to help you with?

  • Fluctuating Energy (40%, 4 Votes)
  • Cognitive (20%, 2 Votes)
  • Stomach, Bowel, Nausea (20%, 2 Votes)
  • Sleep (10%, 1 Votes)
  • Pain (10%, 1 Votes)
  • Balance (0%, 0 Votes)
  • Psychological (depression, anxiety, low mood etc.) (0%, 0 Votes)
  • Allergies & Sensitivities (0%, 0 Votes)
  • Other (0%, 0 Votes)

Total Voters: 10

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Email us if you chose option 9, or have any comments on this poll.

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No evidence that cervical cancer vaccine causes CFS

Posted on 10/14/2013 by wames

The Medicines and Healthcare products Regulatory Agency (MHRA) has found no evidence that Cervarix – an HPV vaccine which protects against cervical cancer- causes chronic fatigue syndrome, also known as ME.

The MHRA’s scientists conducted their study after reports that some women were suffering from chronic fatigue syndrome following vaccination.

Cervarix vaccine was given to over 2 million young women aged between 12 and 18 years as part of the Government’s human papillomavirus (HPV) vaccination programme. The jabs began in September 2008 and ended in September 2012 when the vaccine was replaced by Gardasil, which protects against both cervical cancer and genital warts.

Both vaccines are licensed in the UK. The NHS currently uses Gardasil to vaccinate girls aged 12 – 13 years old.

Scientists at the MHRA analysed patient records to compare the frequency of fatigue syndromes in young women before and after the start of the vaccination programme and the risk following vaccination compared to other time periods.

The study, published in the journal Vaccine, found no evidence of an increased risk of chronic fatigue syndrome in women after having the Cervarix jab. This supports earlier reporting trends from the MHRA’s own Yellow Card surveillance system which collects information from doctors, other healthcare professionals and patients regarding suspected adverse reactions.

Dr Philip Bryan of the MHRA, who co-authored the study, says in a press release: “We have one of the best HPV vaccination programmes in the world that protects women from cervical cancer.

“Our study found no evidence to implicate Cervarix vaccine in development of chronic fatigue syndrome, and we hope that our findings give further reassurance about the safety of the HPV vaccine.”

Robert Music, Chief Executive of Jo’s Cervical Cancer Trust, says in a prepared statement: “Like all vaccines there are possible side effects to take into consideration and it’s important that those eligible and their guardians make themselves aware of these, but these research findings by the MHRA are very positive and we encourage all those who are eligible to take up the vaccine.

“Cervical cancer is a largely preventable disease thanks in part to the HPV vaccination which prevents 70% of cervical cancers. Indeed researchers have said that an 80% uptake year on year could see a two thirds reduction in cervical cancer incidence in women under 30 by 2025.”

The MHRA says the safety and efficacy of both Cervarix and Gardasil vaccines has been extensively studied in clinical trials before licensing. The most common side-effects are injection-site reactions, fever, headache, fatigue, muscle pain, nausea, vomiting and diarrhoea.

It says Cervarix and Gardasil have now been used in tens of millions of people and their safety is well established. However, as with all vaccines and medicines used in the UK the MHRA will continue to monitor their safety.

Press release

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Brain fog in POTS

Posted on 10/14/2013 by wames

Research abstract

PURPOSE: Adolescents with postural tachycardia syndrome (POTS) often experience ill-defined cognitive impairment referred to by patients as ‘‘brain fog.’’ The objective of this study was to evaluate the symptom of brain fog as a means of gaining further insight into its etiology and potential palliative interventions.

METHODS: Eligible subjects who reported having been diagnosed with POTS were recruited from social media web sites. Subjects were asked to complete a 38-item questionnaire designed for this study, and the Wood mental fatigue inventory (WMFI).

RESULTS: Responses were received from 138 subjects with POTS (88 % female), ranging in age from 14 to 29 years; 132 subjects reported brain fog. WMFI scores correlated with brain fog frequency and severity (P\0.001). The top ranked descriptors of brain fog were ‘‘forgetful,’’ ‘‘cloudy,’’ and ‘‘difficulty focusing, thinking and communicating.’’ The most frequently reported brain fog triggers were fatigue (91 %), lack of sleep (90 %), prolonged standing (87 %), dehydration (86 %), and feeling faint (85 %).

Although aggravated by upright posture, brain fog was reported to persist after assuming a recumbent posture. The most frequently reported interventions for the treatment of brain fog were intravenous saline (77 %), stimulant medications (67 %), salt tablets (54 %), intra-muscular vitamin B-12 injections (48 %), and midodrine (45 %).

CONCLUSIONS: Descriptors for ‘‘brain fog’’ are most consistent with it being a cognitive complaint. Factors other than upright posture may play a role in the persistence of this symptom. Subjects reported a number of therapeutic interventions for brain fog not typically used in the treatment of POTS that may warrant further investigation.

What is brain fog? An evaluation of the symptom in postural tachycardia syndrome, by Amanda J. Ross, Marvin S. Medow, Peter C. Rowe, Julian M. Stewart in Clin Auton Res. 2013 Sep 3. [Epub ahead of print]

 

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Post-exertion malaise in CFS: symptoms & gene expression

Posted on 10/13/2013 by wames

Research abstract

BACKGROUND

A primary complaint of chronic fatigue syndrome (CFS) patients is post-exertion malaise, which is a worsening of symptoms following activities such as exercise.

PURPOSE

To examine the link between gene expression for metabolite, adrenergic, immune, and glucocorticoid receptors on leukocytes and symptoms (pain, fatigue, and mood) following a maximal exercise test.

METHODS

Thirteen CFS patients and 11 healthy participants matched on age and fitness underwent blood draws and completed questionnaires immediately before, and 15 minutes, 48 hours, and 72 hours following, maximal exercise.

Symptom and genetic measures collected before and after exercise were compared using a doubly multivariate repeated-measures analysis of variance. Results: This comparison of CFS and healthy participants resulted in a significant multivariate main effect for Group (p < 0.05). Univariate analyses indicated group differences for adrenergic α-2A and glucocorticoid (NR3C1) receptor messenger ribonucleic acid and symptoms of fatigue and confusion. Changes in gene expression were significantly correlated with symptoms.

CONCLUSIONS

Results suggest that increased glucocorticoid sensitivity may contribute to the symptoms of post-exertion malaise in CFS. As NR3C1 interacts with other transcription factors, investigating the resulting cascades may lead to greater understanding of the biological mechanism of post-exertion malaise. This finding, if confirmed, could lead to novel approaches to prevent symptom exacerbation in CFS.

Post-exertion malaise in chronic fatigue syndrome: symptoms and gene expression, by Jacob D. Meyer,, Alan R. Light, Sanjay K. Shukla, Derek Clevidence, Steven Yale, Aaron J. Stegner & Dane B. Cook

 

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Acupuncture is moderately helpful in CFS

Posted on 09/25/2013 by wames

Research abstract

CONTEXT:

Given that the etiology of chronic fatigue syndrome (CFS) is believed to be multidimensional, interventions generally have been nonspecific and typically produce only mild to moderate effects. In medical practice, treatment for CFS remains largely symptomatic. Preliminary evidence of the efficacy of acupuncture for CFS is available, but the field has lacked high-quality trials.

OBJECTIVE:

The research team conducted the study to determine the efficacy of acupuncture for CFS.

DESIGN:

A two-arm, randomized, controlled, singleblinded design was adopted.

SETTING:

The study took place in a teaching laboratory at the School of Chinese Medicine at the University of Hong Kong, Hong Kong, China.

PARTICIPANTS:

Recruited through press publicity in Hong Kong, 127 individuals–40 men and 87 women–participated in the study. Intervention Through careful implementation of sham acupuncture in the control group (CG), the study blinded all participants with regard to their experimental or control status. The treatment regime was 2 sessions/wk for 4 consecutive wk.

OUTCOME MEASURES:

Measures of fatigue (Chalder’s Fatigue Scale), health-related quality of life (SF-12), and general mental health (GH Q-12) were taken at baseline and upon completion of treatment.

RESULTS:

Ninety-nine participants completed the interventions, with 50 and 49 participants in the experimental group (EG) and CG respectively. Repeated measures ANOVA revealed a significant decrease in physical (F(1,93) = 4.327; P = .040) and mental fatigue (F(1,96) = 10.451; P = .002) and improvement in the physical component score of SF-12 (F(1,93) = 4.774; P = .031). Considerable effects with Cohen’s d were observed in the sham-control group: 0.92, 0.78, and 0.38 for the three scores, respectively. These positive effects could have included some therapeutic effects due to pressure on the acupuncture points from the sham needles in addition to normal placebo effects. The EG showed moderate net effect sizes with Cohen’s d: 0.52, 0.63, and 0.54 for the three outcome measures, respectively.

CONCLUSION:

Despite considerable positive effects for the CG, the EG demonstrated significant net-effect sizes at a moderate magnitude in physical and mental fatigue and in the physical component of health-related quality of life. The impacts on general mental health outcomes appeared to be smaller.

Acupuncture for chronic fatigue syndrome: a randomized, sham-controlled trial with single-blinded design.  Ng SM, Yiu YM in Altern Ther Health Med. 2013 Jul-Aug;19(4):21-6.

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How to improve therapeutic relationships in ME/CFS

Posted on 09/25/2013 by wames

Abstract

Background: Clinical practice and the medical literature abound with reports of mutual dissatisfaction between individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and health care practitioners.

Purpose:

In this paper we:

1) formulate and describe the common therapeutic challenges in the care of patients with ME/CFS and

2) present a patient-centered, collaborative practice model that may mitigate these challenges.

Method:

We have combined clinical experience with hundreds of patients, a thorough review of the medical and psychotherapy literature and comments from patients and colleagues to arrive at our proposed practice model.

Findings and Discussion:

We have identified six common therapeutic challenges listed below. From our experience and the psychotherapy literature we have identified a relatively simple patient-centered intervention for each therapeutic challenge. These interventions are recommended for health care practitioners who find themselves in difficulty while working with patients with ME/CFS.

  1. Disagreement about the validity and severity of ME/CFS – Validate the patient’s experience and openly discuss differences of opinion.
  2. Disagreement about the etiology and best management of ME/CFS – Find and validate the truth in the patient’s position.
  3. Frustration due to lack of improvement – Collaboratively search for hope.
  4. Altered power balance between practitioner and patient – Clarify and increase practitioner expertise.
  5. Working with patients who feel unheard – Listen to the whole story.
  6. Gap between needed and available services – Build a coalition to access needed services.

Conclusions:

Therapeutic relationships with patients with ME/CFS can be rewarding and enjoyable. The interventions highlighted in this paper may assist practitioners who feel otherwise.

Improving the therapeutic relationships between patients with ME/CFS and health care practitioners  Eleanor Stein MD, FRCP(C), Eva Stormorken RN, CRNA, MNSc, Bengt Karlsson RN

 

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MS and ME similarities

Posted on 09/22/2013 by wames

Review abstract

Background

‘Encephalomyelitis disseminata’ (multiple sclerosis) and myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) are both classified as diseases of the central nervous system by the World Health Organization. This review aims to compare the phenomenological and neuroimmune characteristics of MS with those of ME/CFS.

Discussion

There are remarkable phenomenological and neuroimmune overlaps between both disorders. Patients with ME/CFS and MS both experience severe levels of disabling fatigue and a worsening of symptoms following exercise and resort to energy conservation strategies in an attempt to meet the energy demands of day-to-day living. Debilitating autonomic symptoms, diminished cardiac responses to exercise, orthostatic intolerance and postural hypotension are experienced by patients with both illnesses.

Both disorders show a relapsing-remitting or progressive course, while infections and psychosocial stress play a large part in worsening of fatigue symptoms. Activated immunoinflammatory, oxidative and nitrosative (O+NS) pathways and autoimmunity occur in both illnesses. The consequences of O+NS damage to self-epitopes is evidenced by the almost bewildering and almost identical array of autoantibodies formed against damaged epitopes seen in both illnesses. Mitochondrial dysfunctions, including lowered levels of ATP, decreased phosphocreatine synthesis and impaired oxidative phosphorylation, are heavily involved in the pathophysiology of both MS and ME/CFS.

The findings produced by neuroimaging techniques are quite similar in both illnesses and show decreased cerebral blood flow, atrophy, gray matter reduction, white matter hyperintensities, increased cerebral lactate and choline signaling and lowered acetyl-aspartate levels.

Summary

This review shows that there are neuroimmune similarities between MS and ME/CFS. This further substantiates the view that ME/CFS is a neuroimmune illness and that patients with MS are immunologically primed to develop symptoms of ME/CFS.

Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics, by Gerwyn Morris and Michael Maes BMC Medicine 2013, 11:205

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Probiotic can reduce pro-inflammatory cytokines in ME/CFS

Posted on 09/03/2013 by wames

Research abstract

Certain therapeutic microbes, including Bifidobacteria infantis (B. infantis) 35624 exert beneficial immunoregulatory effects by mimicking commensal-immune interactions; however, the value of these effects in patients with non-gastrointestinal inflammatory conditions remains unclear.

Method:

In this study, we assessed the impact of oral administration of B. infantis 35624, for 6?8 weeks on inflammatory biomarker and plasma cytokine levels in patients with ulcerative colitis (UC) (n = 22), chronic fatigue syndrome (CFS) (n = 48) and psoriasis (n = 26) in three separate randomized, double-blind, placebo-controlled interventions. Additionally, the effect of B. infantis 35624 on immunological biomarkers in healthy subjects (n = 22) was assessed.

At baseline, both gastrointestinal (UC) and non-gastrointestinal (CFS and psoriasis) patients had significantly increased plasma levels of C-reactive protein (CRP) and the pro-inflammatory cytokines tumor necrosis factor ? (TNF-?) and interleukin-6 (IL-6) compared with healthy volunteers. B. infantis 35624 feeding resulted in reduced plasma CRP levels in all three inflammatory disorders compared with placebo.

Results:

Interestingly, plasma TNF-? was reduced in CFS and psoriasis while IL-6 was reduced in UC and CFS. Furthermore, in healthy subjects, LPS-stimulated TNF-? and IL-6 secretion by peripheral blood mononuclear cells (PBMCs) was significantly reduced in the B. infantis 35624-treated groups compared with placebo following eight weeks of feeding.

Conclusion:

These results demonstrate the ability of this microbe to reduce systemic pro-inflammatory biomarkers in both gastrointestinal and non-gastrointestinal conditions. In conclusion, these data show that the immunomodulatory effects of the microbiota in humans are not limited to the mucosal immune system but extend to the systemic immune system.

Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the gut by David Groeger et al. in Gut Microbes, Vol 4, Issue 4, July/Aug 2013.

 

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