Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Redefining an Illness (2015) / Chapter Skim
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5 Review of the Evidence on Other ME/CFS Symptoms and Manifestations
5 Review of the Evidence on Other ME/CFS Symptoms and Manifestations
Pages 141-180
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From page 141... ...
PAIN Description of Pain in ME/CFS Pain is a defining characteristic of ME/CFS and is listed as either a required or additional symptom in all case definitions and diagnostic criteria evaluated in this report. The existing ME/CFS case definitions include muscle pain, joint pain, headaches, tender lymph nodes, and sore throat as pain symptoms (Carruthers et al., 2003, 2011; Fukuda et al., 1994; Jason et al., 2010; NICE, 2007)
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From page 142... ...
found that a greater percentage of ME/CFS patients experienced pain symptoms relative to healthy controls (see Figure 5-1) .4 Pain in ME/CFS often is a component of post-exertional malaise (PEM)
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SOURCE: Jason et al., 2013b. been shown to decrease pain threshold, increase pain severity, and worsen global symptoms in patients with ME/CFS compared with healthy controls (Van Oosterwijck et al., 2010; Whiteside et al., 2004)
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From page 144... ...
In various studies, persons fulfilling the CCC,6 a revised definition of ME,7 and ME-ICC were found to have significantly greater disability due to bodily pain (as measured by the bodily pain subscale of the SF-36) than those fulfilling the Fukuda definition (Brown et al., 2013; Jason et al., 2012, 2013a, 2014b)
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. Those fulfilling the ME-ICC reported significantly worse headaches, chest pain, eye pain, muscle pain, pain in multiple joints, and tender/sore lymph nodes than those fulfilling the Fukuda definition (Brown et al., 2013; Jason et al., 2014b)
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From page 146... ...
, having comorbid fibromyalgia was an illness multiplier for patients with ME/CFS: self-ratings of severity of muscle and joint pain were higher and physical function on the SF-36 lower in the ME/CFS + fibromyalgia group; in addition, the rate of lifetime major depressive disorder was 52 percent in the ME/ CFS + fibromyalgia group, approximately twice that seen in the ME/CFSonly group (Ciccone and Natelson, 2003)
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From page 147... ...
The clinical case definition most commonly used in the United States, the Fukuda definition of 1994, includes five symptoms that are sometimes associated with systemic inflammation (tender cervical/axillary lymph nodes, joint pain, muscle pain, headache, and sore throat) , but no specific symptom or group of symptoms is required (Fukuda et al., 1994)
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showed that the presence of tender lymph nodes and sore throat was much greater in ME/CFS patients than in healthy controls (see Figure 5-2)
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From page 149... ...
Furthermore, it is unclear from the description of the methodology of some of the studies whether multiple studies included the same subjects. The largest study compared 176 ME/CFS subjects with 230 healthy controls and found a significant group effect of poorer NK cell function in the ME/CFS cohort (Fletcher et al., 2010)
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From page 150... ...
Research to date has addressed levels of pro-inflammatory cytokines in ME/CFS patients compared with healthy controls. The majority of studies yielded no significant findings (Jammes et al., 2009; Nakamura et al., 2010; Neu et al., 2014; White et al., 2010)
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. Fewer peer-reviewed papers report on functional studies of other aspects of immune function, and these studies yielded less consistent findings.
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. In other studies, ME/CFS or postviral fatigue syndrome patients showed antibodies to smooth muscle (36 percent)
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appetite hands cold gaining or weight shivers FIGURE 5-3 Percentage of ME/CFS patients and healthy controls reporting neuroendocrine manifestations of at least moderate severity that occurred at least half of the time for the past 6 months. NOTE: All patients fulfilled the Fukuda definition for CFS.
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. Researchers also have studied the role of the HP-growth hormone axis in ME/ CFS and measured levels of growth hormone, insulin-like growth factor 1 (IGF-1)
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. Numerous studies found reduced overnight cortisol or 24-hour cortisol in patients compared with healthy controls (Cevik et al., 2004; Cleare et al., 2001; Crofford et al., 2004; Gur et al., 2004; Jerjes et al., 2007; Nater et al., 2008; Roberts et al., 2004)
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Positive autoimmune activity was documented against 5-HT in a significant number of ME/CFS patients compared with chronic fatigue patients and healthy controls (Maes et al., 2013)
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. Summary Patients with ME/CFS may have relatively reduced overnight cortisol, 24-hour urinary cortisol, CRH and/or AVP, and ACTH levels compared with healthy controls.
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, population-based studies using the Fukuda definition showed a predominance of gradual onset over an obvious acute infectious onset (Reyes et al., 2003)
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. The different markers tested to assess abnormalities in the immune function of ME/CFS patients were discussed earlier in the section of this chapter on immune impairment.
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Several studies found that ME/CFS patients have a significantly higher rate of HHV-6 antibodies (either IgG or IgM) compared with healthy controls (Ablashi et al., 2000; Patnaik et al., 1995; Sairenji et al., 1995; Yalcin et al., 1994)
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. A cross-sectional study showed no increased prevalence of ME/CFS in Q-fever patients compared with healthy controls (Strauss et al., 2012)
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2013. Is chronic fatigue syndrome the same illness as fibro myalgia: Evaluating the "single syndrome" hypothesis.
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1998. Secretion of growth hormone in patients with chronic fatigue syndrome.
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2012b. Longitudinal investigation of natural killer cells and cytokines in chronic fatigue syndrome/myalgic encephalomyelitis.
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2010. Acute enterovirus infection followed by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
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2003. Clini cal improvement in chronic fatigue syndrome is associated with enhanced natural killer cell-mediated cytotoxicity: The results of a pilot study with isoprinosine®.
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2010. Biomarkers in chronic fatigue syndrome: Evaluation of natural killer cell function and dipeptidyl peptidase IV/CD26.
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2006. Cytomegalovirus and Epstein-Barr virus infection as a cause of chronic fatigue syndrome in travellers to tropical countries.
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2010. The development of a revised Canadian myalgic encephalomyelitis chronic fatigue syndrome case definition.
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1988. Chronic fatigue syndromes: Relationship to chronic viral infections.
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2011. A paradigm linking herpesvirus immediate-early gene expression apoptosis and myalgic encephalomyelitis chronic fatigue syndrome.
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1998. Dysfunction of natural killer activity in a family with chronic fatigue syndrome.
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2014. Endogenous pain modulation in response to exercise in patients with rheumatoid arthritis, patients with chronic fatigue syndrome and comorbid fibromyalgia, and healthy controls: A double blind randomized controlled trial.
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2007. Chronic fatigue syndrome/ myalgic encephalomyelitis (or encephalopathy)
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in patients with chronic fatigue syndrome. Journal of Infectious Diseases 172(5)
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2001. Fludro cortisone acetate to treat neurally mediated hypotension in chronic fatigue syndrome: A randomized controlled trial.
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and the chronic fatigue syndrome: Normal virus load in blood and normal immunologic reactivity in the EBV regression assay. Clinical Infectious Diseases 20(5)
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1998. Natural killer cells and natural killer cell activity in chronic fatigue syndrome.
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2011. Up regulation of TGF-β1 mRNA expression in peripheral blood mononuclear cells of pa tients with chronic fatigue syndrome.
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