Randomized controlled clinical trials of acupuncture and moxibustion treatment of chronic fatigue syndrome patients

Abstract:

OBJECTIVE: To observe the therapeutic effect of acupuncture and moxibustion interventions in the treatment of chronic fatigue syndrome (CFS).

METHODS: A total of 133 CFS patients were randomized into acupuncture group (47 cases), warm-needling group (44 cases) and non-acupoint group (42 cases). Manual acupuncture (MA) stimulation was applied to Baihui (GV 20), Danzhong (CV 17), Qihai (CV 6), Guanyuan (CV 4), bilateral Zusanli (ST 36), Hegu (LI 4), Taichong (LR 3) and Sanyinjiao (SP 6) for patients in the acupuncture group. For patients in the warm-needling group, moxa-heated needle was applied to Baihui (GV 20), Qihai (CV 6), Guanyuan (CV 4) and bilateral Zusanli (ST 36). Non-acupoints were located about 1-2 cm beside the Baihui (GV 20), Danzhong (CV 17), Qihai (CV 6), Guanyuan (CV 4), Zusanli (ST 36), Taichong (LR 3), Sanyinjiao (SP 6) and Hegu (LI 4). The treatment was given once daily for 20 days. The Chalder Fatigue Scale (14-item fatigue scale) was adopted to evaluate the changes of CFS before and after the treatment.

RESULTS: In comparison with pre-treatment, the scores of Chalder Fatigue Scale including physical and mental fatigue and total score were significantly decreased in both acupuncture and warm-needling groups (P < 0.05, P < 0.01), but not in the non-acupoint group (P > 0.05) except physical score (P < 0.05). The physical, mental and total scores of the acupuncture and warm-needling groups were significantly lower than those of the non-acupoint group (P < 0.05, P < 0.01), while the physical and total scores of the warm-needling group were markedly lower than those of the acupuncture group (P < 0.05). After the treatment, the CFS patients’ satisfactory rates of the acupuncture, warm-needling and non-acupoint groups were 36.2% (17/47), 72.7% (32/44) and 35.7% (15/42), respectively.

CONCLUSION: Both MA and warm-needling interventions have a good therapeutic effect in the treatment of CFS patients, while the latter is obviously better.

 

Source: Lu C, Yang XJ, Hu J. Randomized controlled clinical trials of acupuncture and moxibustion treatment of chronic fatigue syndrome patients. Zhen Ci Yan Jiu. 2014 Aug;39(4):313-7. [Article in Chinese] https://www.ncbi.nlm.nih.gov/pubmed/25219128

 

Pilot study investigating the utility of a specialized online symptom management program for individuals with myalgic encephalomyelitis/chronic fatigue syndrome as compared to an online meditation program

Abstract:

BACKGROUND: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term, debilitating condition that impacts numerous areas of individuals’ lives. The two predominant treatment options for ME/CFS are cognitive behavioral therapy and graded exercise therapy; however, many people have found these techniques unacceptable or even damaging. This pilot study aimed to evaluate the utility of a specialized online symptom management program for ME/CFS in comparison to an online meditation program in an effort to ascertain whether this tool could be a further option for those with ME/CFS.

METHODS: THIS EXPERIMENTAL DESIGN CONSISTED OF TWO INTERVENTIONS: a specialized online symptoms management program (N=19) and a control intervention based on an online meditation website (N=9). A battery of questionnaires, including measures of multidimensional fatigue, illness-specific symptoms, perceived control, and mindful awareness, were completed before the participants commenced use of the programs and following 8 weeks’ use.

RESULTS: Significant differences were found in the areas of chance and powerful others’ locus of control, and sleeping difficulties, but not in ME/CFS symptomatology overall.

CONCLUSION: The specialized online program described in this study warrants further investigation, as it appears to influence perceived control and key ME/CFS symptoms over time.

 

Source: Arroll MA, Attree EA, Marshall CL, Dancey CP. Pilot study investigating the utility of a specialized online symptom management program for individuals with myalgic encephalomyelitis/chronic fatigue syndrome as compared to an online meditation program. Psychol Res Behav Manag. 2014 Sep 2;7:213-21. doi: 10.2147/PRBM.S63193. ECollection 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159366/ (Full article)

 

The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review

Abstract:

OBJECTIVE: To establish the effects of relaxation therapy on autonomic function, pain, fatigue and daily functioning in patients with chronic fatigue syndrome or fibromyalgia.

METHOD: A systematic literature study was performed. Using specific keywords related to fibromyalgia or chronic fatigue syndrome and relaxation therapy, the electronic databases PubMed and Web of Science were searched. Included articles were assessed for their risk of bias and relevant information regarding relaxation was extracted. The review was conducted and reported according to the PRISMA-statement.

RESULTS: Thirteen randomized clinical trials of sufficient quality were included, resulting in a total of 650 fibromyalgia patients (11 studies) and 88 chronic fatigue syndrome patients (3 studies). None of the studies reported effects on autonomic function. Six studies reported the effect of guided imagery on pain and daily functioning in fibromyalgia. The acute effect of a single session of guided imagery was studied in two studies and seems beneficial for pain relief. For other relaxation techniques (eg. muscle relaxation, autogenic training) no conclusive evidence was found for the effect on pain and functioning in fibromyalgia patients comparison to multimodal treatment programs. For fatigue a multimodal approach seemed better than relaxation, as shown in the sole three studies on chronic fatigue syndrome patients.

CONCLUSION: There is moderate evidence for the acute effect of guided imagery on pain, although the content of the visualization is a matter of debate. Other relaxation formats and the effects on functionality and autonomic function require further study.

© The Author(s) 2014.

 

Source: Meeus M, Nijs J, Vanderheiden T, Baert I, Descheemaeker F, Struyf F. The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review. Clin Rehabil. 2015 Mar;29(3):221-33. doi: 10.1177/0269215514542635. Epub 2014 Sep 8. https://www.ncbi.nlm.nih.gov/pubmed/25200878

 

High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents

Abstract:

Postural orthostatic tachycardia syndrome (POTS) is characterized by chronic fatigue and dizziness and affected individuals by definition have orthostatic intolerance and tachycardia. There is considerable overlap of symptoms in patients with POTS and chronic fatigue syndrome (CFS), prompting speculation that POTS is akin to a deconditioned state.

We previously showed that adolescents with postural orthostatic tachycardia syndrome (POTS) have excessive heart rate (HR) during, and slower HR recovery after, exercise – hallmarks of deconditioning. We also noted exaggerated cardiac output during exercise which led us to hypothesize that tachycardia could be a manifestation of a high output state rather than a consequence of deconditioning.

We audited records of adolescents presenting with long-standing history of any mix of fatigue, dizziness, nausea, who underwent both head-up tilt table test and maximal exercise testing with measurement of cardiac output at rest plus 2-3 levels of exercise, and determined the cardiac output () versus oxygen uptake () relationship. Subjects with chronic fatigue were diagnosed with POTS if their HR rose ≥40 beat·min(-1) with head-up tilt.

Among 107 POTS patients the distribution of slopes for the , relationship was skewed toward higher slopes but showed two peaks with a split at ~7.0 L·min(-1) per L·min(-1), designated as normal (5.08 ± 1.17, N = 66) and hyperkinetic (8.99 ± 1.31, N = 41) subgroups. In contrast, cardiac output rose appropriately with in 141 patients with chronic fatigue but without POTS, exhibiting a normal distribution and an average slope of 6.10 ± 2.09 L·min(-1) per L·min(-1). Mean arterial blood pressure and pulse pressure from rest to exercise rose similarly in both groups.

We conclude that 40% of POTS adolescents demonstrate a hyperkinetic circulation during exercise. We attribute this to failure of normal regional vasoconstriction during exercise, such that patients must increase flow through an inappropriately vasodilated systemic circulation to maintain perfusion pressure.

© 2014 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

 

Source: Pianosi PT, Goodloe AH, Soma D, Parker KO, Brands CK, Fischer PR. High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents. Physiol Rep. 2014 Aug 28;2(8). pii: e12122. doi: 10.14814/phy2.12122. Print 2014 Aug 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246579/ (Full article)

 

Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials

Abstract:

BACKGROUND: There is no curative treatment for chronic fatigue syndrome (CFS). Traditional Chinese medicine (TCM) is widely used in the treatment of CFS in China.

OBJECTIVE: To evaluate the effectiveness and safety of TCM for CFS.

METHODS: The protocol of this review is registered at PROSPERO. We searched six main databases for randomized clinical trials (RCTs) on TCM for CFS from their inception to September 2013. The Cochrane risk of bias tool was used to assess the methodological quality. We used RevMan 5.1 to synthesize the results.

RESULTS: 23 RCTs involving 1776 participants were identified. The risk of bias of the included studies was high. The types of TCM interventions varied, including Chinese herbal medicine, acupuncture, qigong, moxibustion, and acupoint application. The results of meta-analyses and several individual studies showed that TCM alone or in combination with other interventions significantly alleviated fatigue symptoms as measured by Chalder’s fatigue scale, fatigue severity scale, fatigue assessment instrument by Joseph E. Schwartz, Bell’s fatigue scale, and guiding principle of clinical research on new drugs of TCM for fatigue symptom. There was no enough evidence that TCM could improve the quality of life for CFS patients. The included studies did not report serious adverse events.

CONCLUSIONS: TCM appears to be effective to alleviate the fatigue symptom for people with CFS. However, due to the high risk of bias of the included studies, larger, well-designed studies are needed to confirm the potential benefit in the future.

Copyright © 2014 Elsevier Ltd. All rights reserved.

 

Source: Wang YY, Li XX, Liu JP, Luo H, Ma LX, Alraek T. Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials. Complement Ther Med. 2014 Aug;22(4):826-33. doi: 10.1016/j.ctim.2014.06.004. Epub 2014 Jun 30. https://www.ncbi.nlm.nih.gov/pubmed/25146086

 

DNA methylation modifications associated with chronic fatigue syndrome

Abstract:

Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis, is a complex multifactorial disease that is characterized by the persistent presence of fatigue and other particular symptoms for a minimum of 6 months. Symptoms fail to dissipate after sufficient rest and have major effects on the daily functioning of CFS sufferers. CFS is a multi-system disease with a heterogeneous patient population showing a wide variety of functional disabilities and its biological basis remains poorly understood.

Stable alterations in gene function in the immune system have been reported in several studies of CFS. Epigenetic modifications have been implicated in long-term effects on gene function, however, to our knowledge, genome-wide epigenetic modifications associated with CFS have not been explored. We examined the DNA methylome in peripheral blood mononuclear cells isolated from CFS patients and healthy controls using the Illumina HumanMethylation450 BeadChip array, controlling for invariant probes and probes overlapping polymorphic sequences. Gene ontology (GO) and network analysis of differentially methylated genes was performed to determine potential biological pathways showing changes in DNA methylation in CFS.

We found an increased abundance of differentially methylated genes related to the immune response, cellular metabolism, and kinase activity. Genes associated with immune cell regulation, the largest coordinated enrichment of differentially methylated pathways, showed hypomethylation within promoters and other gene regulatory elements in CFS. These data are consistent with evidence of multisystem dysregulation in CFS and implicate the involvement of DNA modifications in CFS pathology.

 

Source: de Vega WC, Vernon SD, McGowan PO. DNA methylation modifications associated with chronic fatigue syndrome. PLoS One. 2014 Aug 11;9(8):e104757. doi: 10.1371/journal.pone.0104757. ECollection 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4128721/ (Full article)

 

Characterization of fatigue states in medicine and psychiatry by structured interview

Abstract:

CONTEXT: Unexplained fatigue states are prevalent, with uncertain diagnostic boundaries.

OBJECTIVE: Patients with fatigue-related illnesses were investigated by questionnaire and a novel semistructured interview to identify discriminatory features.

METHODS: Cross-sectional samples of women from specialist practices with chronic fatigue syndrome (n = 20), postcancer fatigue (PCF; n = 20), or major depression (n = 16) were recruited. Additionally, two longitudinal samples were studied: women with fatigue associated with acute infection who subsequently developed postinfective fatigue syndrome (n = 20) or recovered uneventfully (n = 21), and women undergoing adjuvant therapy for breast cancer experiencing treatment-related fatigue who subsequently developed PCF (n = 16) or recovered uneventfully (n = 16). Patients completed self-report questionnaires, and trained interviewers applied the Semi-structured Clinical Interview for Neurasthenia. The receiver operating characteristics curves of the interview were measured against clinician-designated diagnoses. Cluster analyses were performed to empirically partition participants by symptom characteristics.

RESULTS: The interview had good internal consistency (Cronbach alpha “fatigue” = .83), and diagnostic sensitivity and specificity for chronic fatigue syndrome (100% and 83%) and major depression (100% and 72%), with reasonable parameters for PCF (72% and 58%). Empirical clustering by “fatigue” or “neurocognitive difficulties” items allocated most patients to one group, whereas “mood disturbance” items correctly classified patients with depression only.

CONCLUSIONS: The Semi-structured Clinical Interview for Neurasthenia offers reliable diagnostic use in assessing fatigue-related conditions. The symptom domains of fatigue and neurocognitive difficulties are shared across medical and psychiatric boundaries, whereas symptoms of depression such as anhedonia are distinguishing.

 

Source: Bennett BK, Goldstein D, Chen M, Davenport TA, Vollmer-Conna U, Scott EM, Hickie IB, Lloyd AR. Characterization of fatigue states in medicine and psychiatry by structured interview. Psychosom Med. 2014 Jun;76(5):379-88. https://www.ncbi.nlm.nih.gov/pubmed/25076512

 

Stress management skills, cortisol awakening response, and post-exertional malaise in Chronic Fatigue Syndrome

Abstract:

Chronic Fatigue Syndrome (CFS) is characterized in part by debilitating fatigue typically exacerbated by cognitive and/or physical exertion, referred to as post-exertional malaise (PEM). In a variety of populations, the cortisol awakening response (CAR) has stood out as a marker of endocrine dysregulation relevant to the experience of fatigue, and may therefore be particularly relevant in CFS.

This is the first study to examine PEM and the CAR in a sample of individuals with CFS. The CAR has also been established as a stress-sensitive measure of HPA axis functioning. It follows that better management of stress could modulate the CAR, and in turn PEM. In this cross-sectional study, we hypothesized that greater Perceived Stress Management Skills (PSMS) would relate to lower reports of PEM, via the impact of PSMS on the CAR.

A total of 117 adults (72% female) with a CFS diagnosis completed self-report measures of PSMS and PEM symptomatology and a two-day protocol of saliva collection. Cortisol values from awakening and 30 min post-awakening were used to compute the CAR. Regression analyses revealed that greater PSMS related to greater CAR and greater CAR related to less PEM severity. Bootstrapped analyses revealed an indirect effect of PSMS on PEM via the CAR, such that greater PSMS related to less PEM, via a greater CAR. Future research should examine these trends longitudinally and whether interventions directed at improving stress management skills are accompanied by improved cortisol regulation and less PEM in individuals with CFS.

Copyright © 2014 Elsevier Ltd. All rights reserved.

 

Source: Hall DL, Lattie EG, Antoni MH, Fletcher MA, Czaja S, Perdomo D, Klimas NG. Stress management skills, cortisol awakening response, and post-exertional malaise in Chronic Fatigue Syndrome. Psychoneuroendocrinology. 2014 Nov;49:26-31. doi: 10.1016/j.psyneuen.2014.06.021. Epub 2014 Jul 6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165790/ (Full article)

 

Fibromyalgia and chronic fatigue syndrome caused by non-celiac gluten sensitivity

Dear Editor:

Sensitivity to gluten with negative celiac disease testing or non-celiac sensitivity to gluten is a recently recognized problem with clinical manifestations that are superimposed with those of fibromyalgia, chronic fatigue and irritable bowel syndrome.

We present the case of a 40-year-old woman who came to the clinic with a 7-year history of generalized pain and chronic fatigue. She had been diagnosed with fibromyalgia by several rheumatologists and complied with the 1990 American College or Rheumatology criteria. She also presented chronic fatigue syndrome criteria. She had concentration and memory problems, «foggy mind», and intermittent diarrhea. The severity of the affection led to limitation in her daily activities which limited her to bed rest in spite of several visits to specialists in rheumatology, gastroenterology and alternative medicine/homeopathy. In addition to the typical symptoms of fibromyalgia, chronic fatigue and intermittent diarrhea, she had oral ulcers, autoimmune hypothyroidism and a history of iron deficiency. She had undergone multiple studies with normal findings, including anti-transglutaminase IgA antibodies to rule out celiac disease.

We suspected sensitivity to gluten and more studies were performed. Laboratory studies showed iron deficiency and low vitamin D levels. On a screening test for anti-transglutaminase and anti-deaminated gliadin peptide antibodies, both IgG and IgA were negative. HLA typing showed the presence of DQ2 (DQA1*05 DQB1*02). Gastroscopy showed small erythematous lesions on the duodenal bulb. Duodenal biopsies showed normal villi structure and lymphocytic duodenitis with apical redistribution, 28 CD3 lymphocytes for every 100 enterocytes (stage I Marsh lesions). Urease testing for Helicobacter pylori was positive. Celiac disease was ruled out due to the absence of specific antibodies or intestinal villi atrophy, though we still suspected sensitivity to gluten. A gluten-free diet was recommended without treating the infection by Helicobacter pylori.

You can read the rest of this letter here: http://www.reumatologiaclinica.org/en/fibromyalgia-chronic-fatigue-syndrome-caused/articulo/S2173574314001403/

Comment in

 

Source: Isasi C, Tejerina E, Fernandez-Puga N, Serrano-Vela JI. Fibromyalgia and chronic fatigue syndrome caused by non-celiac gluten sensitivity. Reumatol Clin. 2015 Jan-Feb;11(1):56-7. doi: 10.1016/j.reuma.2014.06.005. Epub 2014 Jul 19. [Article in English, Spanish] http://www.reumatologiaclinica.org/es/linkresolver/fibromialgia-fatiga-cronica-causada-por/S1699258X14001326/ (Full article)

How is paediatric chronic fatigue syndrome/myalgic encephalomyelitis diagnosed and managed by paediatricians? An Australian Paediatric Research Network Study

Abstract:

AIM: The diagnosis and management of paediatric chronic fatigue syndrome/myalgic encepnalomyelitis (CFS/ME) represent ongoing challenges for paediatricians. A better understanding of current approaches at a national level is important in informing where research and education could improve treatment outcomes. We aimed to examine current diagnosis and management practices for CFS/ME by Australian paediatricians.

METHOD: An online survey was sent to members of the Australian Paediatric Research Network. The primary outcomes of interest included diagnostic criteria used, medical investigations and management practices in paediatric CFS/ME.

RESULTS: One hundred seventy-eight (41%) of 430 eligible paediatricians responded, with 70 of the 178 (39%) reporting that they diagnose and manage CFS/ME as part of their practice. Medical investigations used for diagnosis were variable. Conditions that more than half of the paediatricians reported as commonly co-occurring (i.e. present in >50% of cases) included somatisation disorders, anxiety, depression and fibromyalgia. There was wide variation in behavioural and pharmacological management strategies but most paediatricians commonly engaged a school teacher, physiotherapist and/or psychologist as part of their management.

CONCLUSION: The diagnostic and management practices of paediatricians for CFS/ME within Australia vary widely. This likely reflects a paucity of paediatric-specific guidelines, together with limited evidence to guide best practice and limited training in this area. There is a need for guidance and education for the diagnosis and management of paediatric CFS/ME in Australia.

© 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

 

Source: Knight S, Harvey A, Towns S, Payne D, Lubitz L, Rowe K, Reveley C, Hennel S, Hiscock H, Scheinberg A. How is paediatric chronic fatigue syndrome/myalgic encephalomyelitis diagnosed and managed by paediatricians? An Australian Paediatric Research Network Study. J Paediatr Child Health. 2014 Dec;50(12):1000-7. doi: 10.1111/jpc.12677. Epub 2014 Jul 10. https://www.ncbi.nlm.nih.gov/pubmed/25041646