Fatigue Intervention by Nurses Evaluation–the FINE Trial. A randomised controlled trial of nurse led self-help treatment for patients in primary care with chronic fatigue syndrome: study protocol.[ISRCTN74156610]

Abstract:

BACKGROUND: Chronic fatigue syndrome, also known as ME (CFS/ME), is a condition characterised primarily by severe, disabling fatigue, of unknown origin, which has a poor prognosis and serious personal and economic consequences. Evidence for the effectiveness of any treatment for CFS/ME in primary care, where most patients are seen, is sparse. Recently, a brief, pragmatic treatment for CFS/ME, based on a physiological dysregulation model of the condition, was shown to be successful in improving fatigue and physical functioning in patients in secondary care. The treatment involves providing patients with a readily understandable explanation of their symptoms, from which flows the rationale for a graded rehabilitative plan, developed collaboratively with the therapist. The present trial will test the effectiveness and cost-effectiveness of pragmatic rehabilitation when delivered by specially trained general nurses in primary care. We selected a client-centred counselling intervention, called supportive listening, as a comparison treatment. Counselling has been shown to be as effective as cognitive behaviour therapy for treating fatigue in primary care, is more readily available, and controls for supportive therapist contact time. Our control condition is treatment as usual by the general practitioner (GP).

METHODS AND DESIGN: This study protocol describes the design of an ongoing, single-blind, pragmatic randomized controlled trial of a brief (18 week) self-help treatment, pragmatic rehabilitation, delivered by specially trained nurse-therapists in patients’ homes, compared with nurse-therapist delivered supportive listening and treatment as usual by the GP. An economic evaluation, taking a societal viewpoint, is being carried out alongside the clinical trial. Three adult general nurses were trained over a six month period to deliver the two interventions. Patients aged over 18 and fulfilling the Oxford criteria for CFS are assessed at baseline, after the intervention, and again one year later. Primary outcomes are self-reported physical functioning and fatigue at one year, and will be analysed on an intention-to-treat basis. A qualitative study will examine the interventions’ mechanisms of change, and also GPs’ drivers and barriers towards referral.

 

Source: Wearden AJ, Riste L, Dowrick C, Chew-Graham C, Bentall RP, Morriss RK, Peters S, Dunn G, Richardson G, Lovell K, Powell P. Fatigue Intervention by Nurses Evaluation–the FINE Trial. A randomised controlled trial of nurse led self-help treatment for patients in primary care with chronic fatigue syndrome: study protocol. [ISRCTN74156610]. BMC Med. 2006 Apr 7;4:9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1456982/ (Full article)

 

Efficacy of neurotropin in chronic fatigue syndrome: a case report

Abstract:

Chronic fatigue syndrome (CFS) is a disorder that causes general fatigue and chronic widespread pain. A 28-year-old male visited an outpatient department due to general fatigue and pain involving the entire body. He did not suffer from fibromyalgia, but he was diagnosed with CFS. At the initial visit, he complained of lack of concentration, memory decline, frequent urination, insomnia and occasional difficulty of emotional control, as well as general fatigue and pain involving the entire body. Four tablets of Neurotropin per day alone were administered.

General fatigue and pain were gradually alleviated one week later. His sleep condition, concentration power, and memory also improved two weeks later. Medication was discontinued from 11 weeks based on the patient’s judgment as he felt little general fatigue and pain involving the entire body. Treatment was completed 3 months later. The symptoms disappeared and did not recur five months after the discontinuation of Neurotropin. He was looking for a job without fatigue and pain 8 months later (5 months after the cessation of treatment). The functional mechanisms of Neurotropin in CFS are unknown.

 

Source: Toda K, Kimura H. Efficacy of neurotropin in chronic fatigue syndrome: a case report. Hiroshima J Med Sci. 2006 Mar;55(1):35-7. https://www.ncbi.nlm.nih.gov/pubmed/16594551

 

Psychiatric comorbidity and chronic fatigue syndrome

Prins et al (2005) assessed psychiatric comorbidity in chronic fatigue syndrome (CFS) using the Structured Clinical Interview for DSM–III–R. Comorbidity was remarkably low compared with similar investigations, and in particular the apparent absence of current post-traumatic stress disorder (PTSD) was striking. The authors speculated that the low comorbidity rates might result mainly from a lack of ‘psychiatric bias’ of the examiners. They also found that psychiatric comorbidity did not predict the outcome of cognitive–behavioural therapy.

You can read the rest of this comment here: http://bjp.rcpsych.org/content/188/4/395.2.long

 

Source: Van Houdenhove B. Psychiatric comorbidity and chronic fatigue syndrome. Br J Psychiatry. 2006 Apr;188:395; author reply 396. http://bjp.rcpsych.org/content/188/4/395.2.long (Full article)

 

 

Fibromyalgia and chronic fatigue syndrome: an update for athletic trainers

Abstract:

OBJECTIVE: Primary fibromyalgia syndrome (PFS) and chronic fatigue syndrome (CFS) are clinical conditions characterized by a variety of symptoms, including prominent fatigue, myalgia, and sleep disturbances. Although the incidence of these syndromes is infrequent, when manifested, they can completely disrupt the life and career of those affected. When they are manifested within the physically active population, they can jeopardize the futures of the most promising athletes.

DATA SOURCES: Public documents available from the U. S. Department of Health and Human Services, Public Health Services, and the National Institutes of Health were researched. MEDLINE and CINAHL were researched back to 1988 with the following key words: chronic fatigue syndrome, primary fibromyalgia syndrome, sports participant, physically active, mononucleosis, myalgia, rehabilitation, reconditioning, athlete, and sports medicine.

DATA SYNTHESIS: The definition of CFS in 1988 included disabling fatigue of unknown case of at least 6 months’ duration. Primary fibromyalgia syndrome was once considered a subsyndrome of CFS. PFS is diagnostically characterized as a nonarticular rheumatism. The “yuppie flu” was a catch phrase of the 1980s for CFS, which was then named chronic Epstein-Barr virus syndrome. Initially the condition was thought of as simple infectious mononucleosis, but we now have a medically defined set of symptoms to describe what are called CFS and PFS. Training interruptions, feelings of loss of control, and concerns over possible psychologic or psychiatric referral can occur. Relaxation therapy, exercise, image therapy, serotonin supplementation, and antiviral therapy are in clinical trials now as the best options for management of CFS and PFS.

CONCLUSIONS/RECOMMENDATIONS: Current statistics on those affected by CFS and PFS in the general population are less than 2% for CFS and 2% for PFS. Comprehensive documentation of signs, symptoms, and complaints, along with judicious physician follow-up, are important during the course of treatment leading up to and following a diagnosis of CFS or PFS. Professional evaluation of the affected player’s neuropsychological status is important and necessary as a care plan is developed.

 

Source: Cramer CR. Fibromyalgia and chronic fatigue syndrome: an update for athletic trainers. J Athl Train. 1998 Oct;33(4):359-61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320588/ (Full article)

 

Beneficial effect of brewers’ yeast extract on daily activity in a murine model of chronic fatigue syndrome

Abstract:

The aim of this study was to assess the effect of Brewers’ yeast extract (BYE) on daily activity in a mouse model of chronic fatigue syndrome (CFS). CFS was induced by repeated injection of Brucella abortus (BA) antigen every 2 weeks. BYE was orally administered to mice in a dose of 2 g per kg per day for 2 weeks before injecting BA and for 4 weeks thereafter. We evaluated daily running activity in mice receiving BYE as compared with that in untreated mice.

Weekly variation of body weight (BW) and survival in both groups was monitored during the observation period. Spleen weight (SW), SW/BW ratio, percent splenic follicular area and expression levels of interferon-gamma (IFN-gamma) and interleukin-10 (IL-10) mRNA in spleen were determined in both groups at the time of sacrifice. The daily activity during 2 weeks after the second BA injection was significantly higher in the treated group than in the control. There was no difference in BW between both groups through the experimental course. Two mice in the control died 2 and 7 days after the second injection, whereas no mice in the treated group died. Significantly decreased SW and SW/BW ratio were observed in the treated mice together with elevation of splenic follicular area.

There were suppressed IFN-gamma and IL-10 mRNA levels in spleens from the treated mice. Our results suggest that BYE might have a protective effect on the marked reduction in activity following repeated BA injection via normalization of host immune responses.

 

Source: Takahashi T, Yu F, Zhu SJ, Moriya J, Sumino H, Morimoto S, Yamaguchi N, Kanda T. Beneficial effect of brewers’ yeast extract on daily activity in a murine model of chronic fatigue syndrome. Evid Based Complement Alternat Med. 2006 Mar;3(1):109-15. Epub 2006 Jan 23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1375235/ (Full article)

 

The association between experimental and clinical pain measures among persons with fibromyalgia and chronic fatigue syndrome

Abstract:

Evoked or experimental pain is often used as a model for the study of clinical pain, yet there are little data regarding the relationship between the two. In addition, there are few data regarding the types of stimuli and stimulus intensities that are most closely related to clinical pain. In this study, 36 subjects with fibromyalgia (FM), chronic fatigue syndrome (CFS), or both syndromes were administered measures of clinical pain and underwent a dolorimetry evaluation. Subjects also underwent experimental pain testing utilizing heat and pressure stimulation.

Stimulation levels evoking low, moderate and high sensory intensity, and comparable levels of unpleasantness, were determined for both types of stimuli using random staircase methods. Clinical pain was assessed using visual analogue ratings and the short form of the McGill Pain Questionnaire (MPQ). Ratings of heat pain sensation were not significantly associated with clinical pain ratings, with the exception of unpleasantness ratings at high stimulus intensities. Pain threshold and tolerance as assessed by dolorimetry were significantly associated with average measures of clinical pain.

Both intensity and unpleasantness ratings of pressure delivered using random staircase methods were significantly associated with clinical pain at low, moderate and high levels, and the strength of the association was greater at increasingly noxious stimulus intensities. These findings suggest that random pressure stimulation as an experimental pain model in these populations more closely reflects the clinical pain for these conditions. These findings merit consideration when designing experimental studies of clinical pain associated with FM and CFS.

 

Source: Geisser ME, Gracely RH, Giesecke T, Petzke FW, Williams DA, Clauw DJ. The association between experimental and clinical pain measures among persons with fibromyalgia and chronic fatigue syndrome. Eur J Pain. 2007 Feb;11(2):202-7. Epub 2006 Mar 20. https://www.ncbi.nlm.nih.gov/pubmed/16546424

 

On the important role of Siguan points in treatment of chronic fatigue syndrome

Abstract:

OBJECTIVE: To probe into the role of Siguan points in treatment of chronic fatigue syndrome.

METHODS: Based on diagnosis, pathogenesis and etiology of chronic fatigue syndrome in TCM, the role of Siguan points in treatment of chronic fatigue syndrome were induced by means of relative literatures of Siguan points in recent 10 years from 3 aspects.

CONCLUSION: Acupuncture at Siguan as main points has a better therapeutic effect on chronic fatigue syndrome.

 

Source: Wang JJ, Meng H, Cui CB, Song YJ, Wang XH, Wu ZC. On the important role of Siguan points in treatment of chronic fatigue syndrome. Zhongguo Zhen Jiu. 2006 Feb;26(2):116-9. [Article in Chinese] https://www.ncbi.nlm.nih.gov/pubmed/16541862

 

The Spanish version of the FibroFatigue Scale: validation of a questionnaire for the observer’s assessment of fibromyalgia and chronic fatigue syndrome

Abstract:

OBJECTIVE: To examine some of the psychometric properties of the Spanish version of the FibroFatigue Scale (FFS).

METHODS: FFS was administered to 120 patients diagnosed with fibromyalgia and chronic fatigue syndrome. Internal consistency was evaluated by using Cronbach’s alpha, test-retest reliability with weighted kappa and construct validity by correlations among FFS, the Fibromyalgia Impact Questionnaire (FIQ), the EuroQol 5D (EQ-5D) and the Hospital Anxiety and Depression Scale (HADS). The interrater reliability was tested using analysis of variance with patients and raters as independent factors.

RESULTS: Internal consistency (alpha) was .88, test-retest reliability was .91, and interrater reliability was .93. Significant correlations were obtained between overall FFS and the FIQ (.55, P<.01), the EQ-5D (-.48, P<.01) and the HADS depression subscale (.25, P<.01), but not with the HADS anxiety subscale.

CONCLUSION: These results support the reliability and validity of the data obtained with the Spanish version of the FSS.

 

Source: García-Campayo J, Pascual A, Alda M, Marzo J, Magallon R, Fortes S. The Spanish version of the FibroFatigue Scale: validation of a questionnaire for the observer’s assessment of fibromyalgia and chronic fatigue syndrome. Gen Hosp Psychiatry. 2006 Mar-Apr;28(2):154-60. https://www.ncbi.nlm.nih.gov/pubmed/16516066

 

Challenges for molecular profiling of chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome (CFS) is prevalent, disabling and costly. Despite extensive literature describing the epidemiology and clinical aspects of CFS, it has been recalcitrant to diagnostic biomarker discovery and therapeutic intervention. This is due to the fact that CFS is a complex illness defined by self-reported symptoms and diagnosed by the exclusion of medical and psychiatric diseases that may explain the symptoms.

Studies attempting to dissect the pathophysiology are challenging to design as CFS affects multiple body systems, making the choice of which system to study dependent on an investigators area of expertise. However, the peripheral blood appears to be facilitating the molecular profiling of several diseases, such as CFS, that involve bodywide perturbations that are mediated by the CNS. Successful molecular profiling of CFS will require the integration of genetic, genomic and proteomic data with environmental and behavioral data to define the heterogeneity in order to optimize intervention.

 

Source: Vernon SD, Whistler T, Aslakson E, Rajeevan M, Reeves WC. Challenges for molecular profiling of chronic fatigue syndrome. Pharmacogenomics. 2006 Mar;7(2):211-8. https://www.ncbi.nlm.nih.gov/pubmed/16515400

 

Reduced responsiveness is an essential feature of chronic fatigue syndrome: a fMRI study

Abstract:

BACKGROUND: Although the neural mechanism of chronic fatigue syndrome has been investigated by a number of researchers, it remains poorly understood.

METHODS: Using functional magnetic resonance imaging, we studied brain responsiveness in 6 male chronic fatigue syndrome patients and in 7 age-matched male healthy volunteers. Responsiveness of auditory cortices to transient, short-lived, noise reduction was measured while subjects performed a fatigue-inducing continual visual search task.

RESULTS: Responsiveness of the task-dependent brain regions was decreased after the fatigue-inducing task in the normal and chronic fatigue syndrome subjects and the decrement of the responsiveness was equivalent between the 2 groups. In contrast, during the fatigue-inducing period, although responsiveness of auditory cortices remained constant in the normal subjects, it was attenuated in the chronic fatigue syndrome patients. In addition, the rate of this attenuation was positively correlated with the subjective sensation of fatigue as measured using a fatigue visual analogue scale, immediately before the magnetic resonance imaging session.

CONCLUSION: Chronic fatigue syndrome may be characterised by attenuation of the responsiveness to stimuli not directly related to the fatigue-inducing task.

 

Source: Tanaka M, Sadato N, Okada T, Mizuno K, Sasabe T, Tanabe HC, Saito DN, Onoe H, Kuratsune H, Watanabe Y. BMC Neurol. 2006 Feb 22;6:9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1397862/ (Full article)