Prevalence & treatment of CFS/ME & co-morbid severe health anxiety

Prevalence and treatment of Chronic Fatigue Syndrome/ME and co-morbid severe health Anxiety, by Jolene Daniels, Paul Salkovskis, Hannah Parker  in Journal of the International Neuropsychological Society, Nov 2019

 

Research abstract:

Background: Chronic Fatigue Syndrome/ME (CFS/ME) is a debilitating condition that affects 0.2–0.4% of the population.

Health focussed anxiety is common across medical conditions, and may be relevant in CFS/ME. This study sought to identify the prevalence and impact of health anxiety (HA) in CFS/ME and evaluate the effectiveness of Cognitive Behavioural Therapy for HA in CFS/ME.

Method: Cross sectional questionnaire methods and case-series design were used to achieve study aims.

Results: Analysis indicated that 41.9% of the CFS/ME clinic sample experienced threshold levels of health anxiety, which was associated with elevated symptom severity across several dimensions.  Stepwise multiple regression indicated physical functioning and depression accounted for 23.8% of variance in fatigue; depression, fatigue and HA, accounted for 32.9% of variance in physical functioning. Large effect sizes and clinically significant changes were generated in the treatment study.

Conclusion: HA is common in CFS/ME and likely to exacerbate fatigue and physical functioning. This study identifies HA as an important target for treatment, trial findings should be further replicated on a larger scale.

Posted in News | Tagged , , , , , | Comments Off on Prevalence & treatment of CFS/ME & co-morbid severe health anxiety

Modification of immunological parameters, oxidative stress markers, mood symptoms, & well-being status in CFS patients after probiotic intake

Modification of immunological parameters, oxidative stress markers, mood symptoms, and well-being status in CFS patients after probiotic intake: observations from a pilot study, by Letizia Venturini, Sara Bacchi, Enrica Capelli, Lorenzo Lorusso, Giovanni Ricevuti, and Chiara Cusa in Oxidative Medicine and Cellular Longevity Vol 2019, 10 pages, 23 November 2019 [https://doi.org/10.1155/2019/1684198]

 

Research abstract:

The present study discusses about the effects of a combination of probiotics able to stimulate the immune system of patients affected by Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME).

To this purpose, patients diagnosed according to Fukuda’s criteria and treated with probiotics were analyzed by means of clinical and laboratory evaluations, before and after probiotic administrations. Probiotics were selected considering the possible pathogenic mechanisms of ME/CFS syndrome, which has been associated with an impaired immune response, dysregulation of Th1/Th2 ratio, and high oxidative stress with exhaustion of antioxidant reserve due to severe mitochondrial dysfunction.

Immune and oxidative dysfunction could be related with the gastrointestinal (GI) chronic low-grade inflammation in the lamina propria and intestinal mucosal surface associated with dysbiosis, leaky gut, bacterial translocation, and immune and oxidative dysfunction.

Literature data demonstrate that bacterial species are able to modulate the functions of the immune and oxidative systems and that the administration of some probiotics can improve mucosal barrier function, modulating the release of proinflammatory cytokines, in CFS/ME patients.

This study represents a preliminary investigation to verifying the safety and efficacy of a certain combination of probiotics in CFS/ME patients.

The results suggest that probiotics can modify the well-being status as well as inflammatory and oxidative indexes in CFS/ME patients. No adverse effects were observed except for one patient, which displayed a flare-up of symptoms, although all inflammatory parameters (i.e., cytokines, fecal calprotectin, ESR, and immunoglobulins) were reduced after probiotic intake. The reactivation of fatigue symptoms in this patient, whose clinical history reported the onset of CFS/ME following mononucleosis, could be related to an abnormal stimulation of the immune system as suggested by a recent study describing an exaggerated immune activation associated with chronic fatigue.

Posted in News | Tagged , , , , , , , , , | Comments Off on Modification of immunological parameters, oxidative stress markers, mood symptoms, & well-being status in CFS patients after probiotic intake

Understanding neuromuscular disorders in CFS

Understanding neuromuscular disorders in chronic fatigue syndrome, by Yves Jammes, Frédérique Retornaz in F1000Research 2019, 8:2020 (https://doi.org/10.12688/f1000research.18660.1)

 

Review abstract:

Muscle failure has been demonstrated in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Neurophysiological tools demonstrate the existence of both central and peripheral fatigue in these patients. Central fatigue is deduced from the reduced amplitude of myopotentials evoked by transcranial magnetic stimulation of the motor cortex as well as by the muscle response to interpolated twitches during sustained fatiguing efforts.

An impaired muscle membrane conduction velocity assessed by the reduced amplitude and lengthened duration of myopotentials evoked by direct muscle stimulation is the defining feature of peripheral fatigue.

Some patients with ME/CFS show an increased oxidative stress response to exercise. The formation of lipid hydroperoxides in the sarcolemma, which alters ionic fluxes, could explain the reduction of muscle membrane excitability and potassium outflow often measured in these patients.

In patients with ME/CFS, the formation of heat shock proteins (HSPs) is also reduced. Because HSPs protect muscle cells against the deleterious effects of reactive oxygen species, the lack of their production could explain the augmented oxidative stress and the consecutive alterations of myopotentials which could open a way for future treatment of ME/CFS.

Posted in News | Tagged , , , , , , , | Comments Off on Understanding neuromuscular disorders in CFS

‘The real me shining through M.E.’: visualizing masculinity & identity threat in men with ME/CFS

‘The real me shining through M.E.’: Visualizing masculinity and identity threat in men with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome using photovoice and IPA, by Lucina Wilde, Kerry Quincey, I.R Williamson in Psychology of Men & Masculinity, April 30, 2019

 

Research abstract:

Phenomenological research in the context of Myalgic Encephalomyelitis (M.E.) or Chronic Fatigue Syndrome (CFS) has predominantly explored women’s accounts. Due to the paucity of research highlighting men’s experiences of living with M.E./CFS, the aim of this research was to explore their visual and verbal accounts to gain a more in-depth understanding of how they make sense of their diagnosis and dual identity as a man with a stigmatized and often misunderstood chronic illness.

Working within a critical health psychology framework the study utilised a phenomenological approach and an adapted version of Photovoice to gather and interrogate self-authored photographs and interview accounts from ten men living with M.E./CFS.

An Interpretative Phenomenological Analysis of the integrated visual and verbal data led to the development of three themes:

  • ‘Loss of Masculine Identity as Man with M.E./CFS’,
  • ‘Marginalization attached to M.E./CFS and Masculinity’ and
  • ‘Coping with Dual Identity by Adjustments, Assimilation and Acceptance’.

The findings show how men with CFS cope with identity threat across personal, social, and cultural contexts, whilst making adaptations in their perceptions and performances of masculinity. We argue that participant-authored photographs could be used by researchers, activists and practitioners to facilitate increased understanding of and support for men with M.E./CFS.

Posted in News | Tagged , , , , , , | Comments Off on ‘The real me shining through M.E.’: visualizing masculinity & identity threat in men with ME/CFS

CFS/ME & FM: the foundation of a relationship

Chronic fatigue syndrome (CFS)/Myalgic Encephalomyelitis (ME) and Fibromyalgia (FM): the foundation of a relationship, by Pamela G Mckay, Colin R Martin, Helen Walker, Mick Fleming in British Journal of Pain Oct 2019 [doi.org/10.1177/2049463719875164]

Research abstract:

Introduction:
Chronic fatigue syndrome (CFS)/Myalgic Encephalomyelitis (ME) and fibromyalgia (FM) are both debilitating syndromes with complex polysymptomatology. Early research infers that a relationship may exist even though the diagnosis provided may influence the management trajectory. In the absence of a diagnostic test and treatment, this study aims to confirm the symptoms and their severity, which may infer a relationship and influence future research.

Method:
A quasi-experimental design was utilised, using Internet-based self-assessment questionnaires focusing on nine symptom areas: criteria, pain, sleep, fatigue, anxiety and depression, health-related quality of life, self-esteem and locus of control.

The questionnaires used for data collection are as follows: the American Centre for Disease Control and Prevention Symptom Inventory for CFS/ME (American CDC Symptom Inventory); the American College of Rheumatology (ACR) Criteria for FM; Fibromyalgia Impact Questionnaire (FIQ); McGill Pain Questionnaire (MPQ); Multidimensional Fatigue Inventory (MFI); Pittsburgh Sleep Quality Index (PSQI); Health-Related Quality of Life SF-36 V2 (HRQoL SF-36 V2); Hospital Anxiety and Depression Scale (HADS); Multidimensional Health Locus of Control (MHLOC) and the Rosenberg Self-Esteem Scale (RSES).

Setting and participants:
Participants were recruited from two distinct community groups, namely CFS/ME (n = 101) and FM (n = 107). Participants were male and female aged 17 (CFS/ME mean age 45.5 years; FM mean age 47.2 years).

Results:
All participants in the CFS/ME and FM groups satisfied the requirements of their individual criteria. Results confirmed that both groups experienced the debilitating symptoms measured, with the exception of anxiety and depression, impacting on their quality of life. Results suggest a relationship between CFS/ME and FM, indicating the requirement for future research.

Read full paper

Posted in News | Tagged , , , , , , , , , , | Comments Off on CFS/ME & FM: the foundation of a relationship

Low-dose naltrexone in the treatment of ME/CFS

Low-dose naltrexone in the treatment of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), by Olli Polo, Pia Pesonen, Essi Tuominen in Fatigue: Biomedicine, Health & Behavior Nov 19, 2019 [doi/full/10.1080/21641846.2019.1692770]

 

Research 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.

Read full paper

Posted in News | Tagged , , , , , | Comments Off on Low-dose naltrexone in the treatment of ME/CFS

Relationship satisfaction, communication self-efficacy & CFS

Relationship satisfaction, communication self-efficacy, and chronic fatigue syndrome-related fatigue, by Sara F Milrad, Daniel L Hall, Devika R Jutagir, Emily G Lattie, Sara J Czaja, Dolores M Perdomo, Gail Ironson, Brian D Doss, Armando Mendez, Mary Ann Fletcher, Nancy Klimas, Michael H Antonia in Social Science & Medicine Vol 237, Sep 2019 [https://doi.org/10.1016/j.socscimed.2019.112392]

 

Research highlights:

  • Relationship satisfaction and depression can impact CFS-related fatigue.
  • Patient symptom disclosure satisfaction (PSDS) is a hypothesized intermediate.
  • Depression and PSDS were examined as intermediary variables of this relationship.
  • Relationship satisfaction was related to fatigue severity via depression and PSDS.
  • This underscores the importance of considering these factors in the context of CFS.

Research abstract:

Rationale
Relationship dissatisfaction has been linked with worse health outcomes in many patient populations, though the mechanism(s) underlying this effect are unclear. Among patients with chronic fatigue syndrome (CFS) and their partners, there is evidence for a bi-directional association between poorer relationship satisfaction and the severity of CFS-related fatigue.

Objective
Here, we hypothesized that relationship dissatisfaction negatively impacts fatigue severity through greater depression and less patient satisfaction about communication about symptoms to partners.

Method
Baseline data were drawn from diagnosed CFS patients (N = 150) participating in a trial testing the efficacy of a stress management intervention. Data derived from fatigue severity (Fatigue Symptom Index, FSI), depression (Center for Epidemiologic Survey-Depression, CES-D), relationship quality (Dyadic Adjustment Scale, DAS) and communication satisfaction (Patient Symptom Disclosure Satisfaction, PSDS) questionnaires were used for bootstrapped indirect effect analyses using parallel mediation structural equation modeling in Mplus (v8). Age and BMI were entered as covariates.

Results
Greater relationship satisfaction predicted greater communication satisfaction (p < 0.01) and lower CES-D scores (p < 0.01), which in turn were each significantly related to greater fatigue severity (p < 0.05). Tests of the indirect paths indicated that relationship satisfaction had a significant effect on fatigue severity through both constructs, but primarily via depression. There was no direct association between relationship satisfaction and fatigue severity after the intermediate variables (depression, communication satisfaction) were included in the model.

Conclusion
Results highlight the importance of considering depression and communication-related factors when examining the effects of relationship satisfaction on CFS symptoms such as fatigue. Further mechanism-based, longitudinal research might identify relationship-related mediating variables that can be targeted therapeutically.

Read full paper

Posted in News | Tagged , , , , , , , , , , , , , , | Comments Off on Relationship satisfaction, communication self-efficacy & CFS

Assessing CFS: self-reported physical functioning & correlations with physical testing

Assessing chronic fatigue syndrome: Self-reported physical functioning and correlations with physical testing, by  Jan Eyskens, Jela Illegems, Luc De Nil, Jo Nijs, Jarl K Kampen, Greta Moorkens in Journal of Bodywork and Movement Therapies Vol 23, No. 3, Jul 2019, pp 598-603 [https://doi.org/10.1016/j.jbmt.2019.03.006]

 

Abstract of Cross-Sectional Study:

The pathophysiology of chronic fatigue syndrome (CFS) remains unclear; no biomarkers have thus far been identified or physical tests designed to underpin its diagnosis. Assessment mainly uses Fukuda’s criteria and is based on the exclusion of symptoms related to other diseases/syndromes, subjective self-reporting, and outcomes of self-report questionnaires.

In order to improve the baseline assessment and progress evaluation of individuals suspected of CFS and using an association-oriented research strategy and a cross-correlational design, this study investigates possible associations between the performance on two physical tests, i.e. ‘Timed Loaded Standing’ (TLS), assessing trunk-arm endurance, and the ‘Stops Walking with Eyes Closed while performing a secondary Cognitive Task’ (SWECCT), measuring impaired automaticity of gait, and the results of two self-report questionnaires, the Checklist Individual Strength (CIS, total score and fatigue subscale score) and the physical functioning and vitality subscales of the Short Form Health Survey (SF-36) to gauge the participants’ subjective feelings of fatigue and beliefs regarding their abilities to perform daily-life activities.

Comparisons of the outcomes obtained in 27 female patients with a confirmed diagnosis of CFS revealed that trunk-arm endurance as measured with the TLS correlated with the SF-36 physical functioning subscale only (raw p value: 0.004).

None of the other correlations were statistically significant. It is concluded that the TLS may have potential as an objective assessment tool to support the diagnosis and monitoring of treatment effects in CFS.

Read full paper

 

Posted in News | Tagged , , , , , , , , , , , , , | Comments Off on Assessing CFS: self-reported physical functioning & correlations with physical testing

ME/CFS as a hyper-regulated immune system driven by an interplay between regulatory T cells & chronic human herpesvirus infections

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome as a hyper-regulated immune system driven by an interplay between regulatory T cells and chronic human herpesvirus infections, by Nuno Sepúlveda,  Jorge Carneiro,  Eliana M Lacerda and  Luis C Nacul in Front. Immunol. 21 Nov 2019 [https://doi.org/10.3389/fimmu.2019.02684]

 

Hypothesis & theory article abstract:

Conceptual scheme of the cross-regulation model

Autoimmunity and chronic viral infections are recurrent clinical observations in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), a complex disease with an unknown cause.

Given these observations, the regulatory CD4+ T cells (Tregs) show promise to be good candidates for the underlying pathology due to their known capacity to suppress the immune responses not only to body components but also against infections. Here we discussed the overlooked role of these cells in the chronicity of Human Herpes Virus 6 (HHV6), Herpes Simplex 1 (HSV1) and Epstein-Barr virus (EBV), as often reported as triggers of ME/CFS.

Using simulations of the Cross-regulation model for the dynamics of Tregs, we illustrated that mild infections might lead to a chronically activated immune responses under control of Tregs if the responding clone has a high autoimmune potential. Such infections promote persistent inflammation and possibly fatigue.

We then hypothesized that ME/CFS is a condition characterized by a predominance of this type of infections under control of Tregs. In contrast, healthy individuals are hypothesized to trigger immune responses of a virus-specific clone with a low autoimmune potential.

According to this hypothesis, simple model simulations of the CD4+ T-cell repertoire could reproduce the increased density and percentages of Tregs observed in patients suffering from the disease when compared to healthy controls. A deeper analysis of Tregs in the pathogenesis of ME/CFS will help to assess the validity of this hypothesis.

A Never-Ending Immune Battle in ME/CFS? The Regulatory T-cell / Herpesvirus Hypothesis

Posted in News | Tagged , , , , , , , , , , , | 1 Comment

A systematic review of natural killer cells profile & cytotoxic function in ME/CFS

A systematic review of natural killer cells profile and cytotoxic function in myalgic encephalomyelitis/chronic fatigue syndrome, by Natalie Eaton-Fitch, Stanley du Preez, Hélène Cabanas, Donald Staines & Sonya Marshall-Gradisnik in Systematic Reviews vol 8, no: 279 (2019)

 

Review abstract:

Background:
Compromised natural killer (NK) cell cytotoxic function is a well-documented and consistent feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Other outcomes evaluated in NK cells of ME/CFS patients, however, remain equivocal. The aim of this study was to conduct a systematic review of the literature regarding NK cell phenotype, receptor expression, cytokine production and cytotoxicity in ME/CFS patients and determine the appropriateness as a model for ME/CFS.

Methods:
Medline (EBSCOHost), Scopus, EMBASE and PubMed databases were systematically searched to source relevant papers published between 1994 and March 2018. This review included studies examining NK cells’ features in ME/CFS patients compared with HC following administration of specific inclusion and exclusion criteria. Secondary outcomes included genetic analysis in isolated NK cells or quality of life assessment. Quality assessment was completed using the Downs and Black checklist in addition to The Joanna Briggs Institute checklist.

Results:
Seventeen eligible publications were included in this review. All studies were observational case control studies. Of these, 11 investigated NK cell cytotoxicity, 14 investigated NK cell phenotype and receptor profiles, three examined NK cell cytokine production, six investigated NK cell lytic protein levels and four investigated NK cell degranulation. Impaired NK cell cytotoxicity remained the most consistent immunological report across all publications. Other outcomes investigated differed between studies.

Conclusion:
A consistent finding among all papers included in this review was impaired NK cell cytotoxicity, suggesting that it is a reliable and appropriate cellular model for continued research in ME/CFS patients. Aberrations in NK cell lytic protein levels were also reported. Although additional research is recommended, current research provides a foundation for subsequent investigations. It is possible that NK cell abnormalities can be used to characterise a subset of ME/CFS due to the heterogeneity of both the illness itself and findings between studies investigating specific features of NK function.

Posted in News | Tagged , , , , , | Comments Off on A systematic review of natural killer cells profile & cytotoxic function in ME/CFS