Possible involvement of the autonomic nervous system in cervical muscles of patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS)

Hiroshi Kawaguchi,Kazuhiro Hara,Yuzo Endo,Nobuyuki Shitara,Hideoki Fukuoka,Shuntaro Hojo,Masaki Matsui,Takayoshi Matsui,Makoto Iwata

doi:10.1186/s12891-021-04293-7

Abstract

BackgroundPatients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) sometimes present with stiffness of the cervical muscles. To investigate the pathophysiology of ME/CFS, this observational study compared patients with versus without recovery from ME/CFS through local modulation of the cervical muscles.MethodsOver a period of 11 years, a total of 1226 inpatients with ME/CFS who did not respond to outpatient care were enrolled in this study. All patients received daily cervical muscle physical therapy during hospitalization. Self-rated records documenting the presence or absence of ME/CFS, as well as the representative eight symptoms that frequently accompany it at admission and discharge, were compared. Pupil diameter was also measured to examine autonomic nervous system function involvement.ResultsThe recovery rate of ME/CFS after local therapy was 55.5%, and did not differ significantly by sex, age strata, and hospitalization period. The recovery rates of the eight symptoms were variable (36.6–86.9%); however, those of ME/CFS in the symptom subpopulations were similar (52.3–55.8%). The recovery rates of all symptoms showed strong associations with that of ME/CFS (p < 0.001). The pupil diameter was more constricted in the ME/CFS-recovered patients than in the ME/CFS-unrecovered patients in the total population and the subpopulations stratified by sex, age, and hospitalization period.ConclusionsThere was a strong association between the recovery of ME/CFS and other related whole-body symptoms. The recovery of ME/CFS may be partly linked to amelioration of the autonomic nervous system in the cervical muscles.Trial registrationUMIN000036634. Registered 1 May 2019 - Retrospectively registered.

Highlights

Patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) sometimes present with stiffness of the cervical muscles
A total of 1363 patients who were diagnosed with Myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) according to the definition above [13] and hospitalized in our institutions were initially enrolled in this study
137 were excluded after enrollment. This includes 42 who were discharged after less than 5 days; 14 who were hospitalized for more than 120 days; 59 who were diagnosed with specific diseases in other organs after admission; seven who were transferred to other hospitals for treatment of specific diseases; five who refused to undergo pupil diameter measurement; and 10 who discharged themselves from the hospital based on their own judgement with unknown reasons

Summary

Introduction

Patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) sometimes present with stiffness of the cervical muscles. To investigate the pathophysiology of ME/CFS, this observational study compared patients with versus without recovery from ME/CFS through local modulation of the cervical muscles. Myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) is a serious, chronic, and complex disease that occasionally affects the lives of patients due to debilitating fatigue [1,2,3,4]. It is frequently accompanied by various symptoms, such as headache, cervical stiffness, vertigo, cardiovascular and gastrointestinal disorders, fever of unknown etiology, and psychological disorders. Treatment remains symptom-based, multidimensional, and tailored to the needs of the individual patient [15, 16]

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