Abstract
Chronic fatigue syndrome (CFS) is a complex, multisystem disorder that can be disabling. CFS symptoms can be provoked by increased physical or cognitive activity, and by orthostatic stress. In preliminary work, we noted that CFS symptoms also could be provoked by application of longitudinal neural and soft tissue strain to the limbs and spine of affected individuals. In this study we measured the responses to a straight leg raise neuromuscular strain maneuver in individuals with CFS and healthy controls. We randomly assigned 60 individuals with CFS and 20 healthy controls to either a 15 minute period of passive supine straight leg raise (true neuromuscular strain) or a sham straight leg raise. The primary outcome measure was the symptom intensity difference between the scores during and 24 hours after the study maneuver compared to baseline. Fatigue, body pain, lightheadedness, concentration difficulties, and headache scores were measured individually on a 0–10 scale, and summed to create a composite symptom score. Compared to individuals with CFS in the sham strain group, those with CFS in the true strain group reported significantly increased body pain (P = 0.04) and concentration difficulties (P = 0.02) as well as increased composite symptom scores (all P = 0.03) during the maneuver. After 24 hours, the symptom intensity differences were significantly greater for the CFS true strain group for the individual symptom of lightheadedness (P = 0.001) and for the composite symptom score (P = 0.005). During and 24 hours after the exposure to the true strain maneuver, those with CFS had significantly higher individual and composite symptom intensity changes compared to the healthy controls. We conclude that a longitudinal strain applied to the nerves and soft tissues of the lower limb is capable of increasing symptom intensity in individuals with CFS for up to 24 hours. These findings support our preliminary observations that increased mechanical sensitivity may be a contributor to the provocation of symptoms in this disorder.
Highlights
Chronic fatigue syndrome (CFS), often called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is a complex, multisystem condition that is associated with a substantial impairment in pre-illness levels of activity and quality of life [1,2,3]
Healthy controls were excluded if they had self-reported CFS or fibromyalgia, postural tachycardia syndrome, neurally-mediated hypotension, recurrent syncope, or other health conditions that contribute to pain and fatigue
5 subjects in our study had been enrolled in the pediatric CFS clinic or had participated in prior pediatric CFS studies at Johns Hopkins
Summary
Chronic fatigue syndrome (CFS), often called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is a complex, multisystem condition that is associated with a substantial impairment in pre-illness levels of activity and quality of life [1,2,3]. In pilot work involving exposure to a 12 minute period of progressively increasing supine passive straight leg raise (SLR), two young adults with CFS developed a marked increase in fatigue, cognitive dysfunction, lightheadedness, and visual blurring [10] These findings were extended in a larger study, in which 48 adolescents and young adults with CFS had significantly more areas of abnormal range of motion than healthy controls matched for sex and level of joint hypermobility. In response to physical examination maneuvers that added an elongation strain to the nervous system and related soft tissues, CFS patients were more likely to develop abnormal symptomatic responses to the individual maneuvers and to the overall physical assessment [11] Taken together, these observations are consistent with reduced compliance in the nervous system and its associated connective tissues in subjects with CFS, and with the hypothesis that increased mechanical sensitivity may be a contributor to the generation and exacerbation of CFS symptoms
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