Understanding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and the Emerging Osteopathic Approach: A Narrative Review

Larrimore, Christopher; Ramnot, Amanda; Jaghab, Annmarie; Sarduy, Sofia; Guerrero, George; Troccoli, Peter; Hilton, Kelly; Bested, Alison

doi:10.7556/jaoa.2019.081

Cited by 3 publications

(4 citation statements)

References 67 publications

(52 reference statements)

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“…Whilst the cause of CFS remains unknown, popular hypotheses include infectious triggers, microbiome disruption, immune response dysregulation, endocrine abnormalities and intracellular dysfunction such as in the mitochondria (8). However, these various hypotheses hold the common belief that the onset of dysfunction leading to ME/CFS occurs in an already genetically susceptible population (6). It is possible that all of these hypotheses play a role in the etiology of ME/CFS and perhaps there are further subsets of ME/CFS that have yet to be described.…”

Section: Epidemiologymentioning

confidence: 99%

“…However, a shared ability to establish persistent infections and often be detected in healthy individuals provides further clues on ME/CFS etiology (12,13). For this reason, the risk of ME/CFS is likely more so related to the presence of an underlying genetic predisposition that upon infection, allows for a dysregulated response and impaired clearance, suggesting ME/CFS etiology is more likely a result of the host's dysregulated immune response rather than the infection itself (6). Individuals with inflammatory bowel disease (IBD) have been shown to be at increased risk of ME/CFS compared to the general population (14).…”

Section: Infectious Triggers and Immune Dysregulationmentioning

confidence: 99%

“…CFS is a diagnosis of exclusion where it is important to rule out active diseases that share similar symptoms (1). Common presenting medical symptoms include pathological fatigue, malaise after exertion, muscle weakness, cramps, defective stress tolerance, sleep disturbances, autonomic dysfunction, pain, and neuroendocrine abnormalities (6). Diagnosing CFS is further complicated due to symptoms overlap with mental conditions such as anxiety and depression, which can become more intense with duration of time (5).…”

Section: Diagnosismentioning

confidence: 99%

“…Despite seemingly similar features, there are clinical distinctions between experiencing fatigue (ICF) and suffering from chronic fatigue syndrome (ME/CFS). According to the Institute of Medicine Diagnostic Criteria, ME/CFS requires the presence of one or more of the following: cognitive impairment and/or orthostatic intolerance (6). In contrast, little to none of these symptoms are reported in ICF (2).…”

mentioning

confidence: 99%

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A Comprehensive Update of the Current Understanding of Chronic Fatigue Syndrome

et al. 2021

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: This is a comprehensive literature review of chronic fatigue syndrome (CFS). We provide a description of the background, etiology, pathogenesis, diagnosis, and management regarding CFS. CFS is a multifaceted illness that has many symptoms and a wide array of clinical presentations. As of recent, CFS has been merged with myalgic encephalomyelitis (ME). Much of the difficulty in its management has stemmed from a lack of a concrete understanding of its etiology and pathogenesis. There is a potential association between dysfunction of the autoimmune, neuroendocrine, or autonomic nervous systems and the development of CFS. Possible triggering events, such as infections followed by an immune dysregulation resulting have also been proposed. In fact, ME/CFS was first described following Epstein Barr virus (EBV) infections, but it was later determined that it was not always preceded by EBV infection. Patient diagnosed with CFS have shown a noticeably earlier activation of anaerobic metabolism as a source of energy, which is suggestive of impaired oxygen consumption. The differential diagnoses range from tick-borne illnesses to psychiatric disorders to thyroid gland dysfunction. Given the many overlapping symptoms of CFS with other illnesses makes diagnosing it far from an easy task. The Centers for Disease Control and Prevention (CDC) considers it a diagnosing of exclusion, stating that self-reported fatigue for at minimum of six months and four of the following symptoms are necessary for a proper diagnosis: memory problems, sore throat, post-exertion malaise, tender cervical or axillary lymph nodes, myalgia, multi-joint pain, headaches, and troubled sleep. In turn, management of CFS is just as difficult. Treatment ranges from conservative, such as cognitive behavioral therapy (CBT) and antidepressants, to minimally invasive management. Minimally invasive management involving ranscutaneous electrical acupoint stimulation of target points has demonstrated significant improvement in fatigue and associated symptoms in a 2017 randomized controlled study. The understanding of CFS is evolving before us as we continue to learn more about it. As further reliable studies are conducted, providing a better grasp of what the syndrome encompasses, we will be able to improve our diagnosis and management of it.

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Section: Epidemiologymentioning

confidence: 99%

Section: Infectious Triggers and Immune Dysregulationmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

mentioning

confidence: 99%

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A Comprehensive Update of the Current Understanding of Chronic Fatigue Syndrome

et al. 2021

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Radiation exposure and mitochondrial insufficiency in chronic fatigue and immune dysfunction syndrome

Rusin

Cocchetto

et al. 2021

Medical Hypotheses

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Effectiveness of osteopathic manipulative applications on hypothalamic–pituitary–adrenal (HPA) axis in youth with major depressive disorder: a randomized double-blind, placebo-controlled trial

Pala,

Çıtaker,

Güney

et al. 2024

Journal of Osteopathic Medicine

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Context Osteopathic treatments regulate the neurovegetative system through joint mobilizations and manipulations, and myofascial and craniosacral techniques. Despite the growing body of research, the precise impact of osteopathic medicine on the autonomic nervous system (ANS) is not yet fully elucidated. As to Kuchera's techniques, the stimulation of the sympathetic trunk and prevertebral ganglia contributed to harmonization of the sympathetic activity. However, potential relationships between the harmonization of the sympathetic nervous system (SNS) and the hypothalamic–pituitary–adrenal (HPA) axis largely remain uncertain and warrant further exploration. Objectives This study was designed to evaluate the effectiveness of the osteopathic sympathetic harmonization (OSH) on the SNS and the HPA axis in youth with major depressive disorder (MDD). Methods The study included 39 youths aged 15–21 years and diagnosed with MDD. The participants were randomly assigned into either the OSH or the placebo group. Stimulation was performed on the sympathetic truncus and prevertebral ganglia in the OSH group. The stimulation of the placebo group was performed with a lighter touch and a shorter duration in similar areas. Each participant completed the Beck Depression Inventory (BDI) and the State and Trait Anxiety Inventory (SAI and TAI) before the application. Blood pressure (BP) and pulse measurements were made, and saliva samples were taken before, immediately after, and 20 min after application. Results The baseline BDI (p=0.617) and TAI (p=0.322) scores were similar in both groups. Although the SAI scores decreased in both groups postintervention, no statistically significant difference was found between the two groups. Subjects who received OSH had a decrease in α-amylase level (p=0.028) and an increase in cortisol level (p=0.009) 20 min after the procedure. Conclusions Following OSH application in depressed youth, SNS activity may decrease, whereas HPA axis activity may increase. Future studies may examine the therapeutic efficacy of repeated OSH applications in depressed individuals.

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Understanding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and the Emerging Osteopathic Approach: A Narrative Review

Cited by 3 publications

References 67 publications

A Comprehensive Update of the Current Understanding of Chronic Fatigue Syndrome

A Comprehensive Update of the Current Understanding of Chronic Fatigue Syndrome

Radiation exposure and mitochondrial insufficiency in chronic fatigue and immune dysfunction syndrome

Effectiveness of osteopathic manipulative applications on hypothalamic–pituitary–adrenal (HPA) axis in youth with major depressive disorder: a randomized double-blind, placebo-controlled trial

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