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The delayed fatigue effect in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

Bob

Senior Member
Messages
16,455
Location
England (south coast)
The delayed fatigue effect in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
Megan A. Arroll, Elizabeth A. Attree, John M. O'Leary, Christine P. Dancey
Fatigue: Biomedicine, Health & Behavior
Vol. 2, Iss. 2, 2014
Published online: 23 Apr 2014
http://dx.doi.org/10.1080/21641846.2014.892755


Abstract

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating, long-term condition characterised by extreme fatigue (worsened by exertion), muscle and joint pain, and sleep disturbance. Post-exertional fatigue has been demonstrated previously following physical exercise, but not from mental exertion alone.

Purpose: The aim of this exploratory study was to assess the ‘delayed fatigue effect,’ in this instance fatigue two days post-challenge, following a cognitively fatiguing task.

Methods: Thirty-two participants (23 women; mean age 44, SD = 11.24; mean illness duration nine years, SD = 7.32) completed the Cambridge Neuropsychological Test Automated Battery, which acted as the cognitive challenge. Self-report measures were also completed that assessed fatigue (Multidimensional Fatigue Inventory; MFI), and anxiety and depression (Hospital Anxiety and Depression Scale; HADS) pre- and two days post-testing.

Results: Significant differences were found between pre- and post-test measures in three MFI sub-scales of fatigue (general, mental, and physical) and on the depression scale of the HADS. However, there were no significant changes in motivation, activity level, or self-reported anxiety scores.

Conclusions: These findings are suggestive of post-exertional symptom exacerbation following mental effort. This may have implications for working environments that present cognitive demands to individuals with ME/CFS.
 

Bob

Senior Member
Messages
16,455
Location
England (south coast)
From the abstract, this looks like it could be a helpful paper (apart from the use of the HADS depression scale), and I originally thought that it nicely backs-up the recent CPET paper.

Then I noticed the principal author is Megan Arroll, who has been discussed on the forum recently, in negative terms.

Perhaps it is a helpful paper - We'd need to read the full paper to find out.



I recently spotted another paper by Megan Arroll which also seems helpful when you start reading the abstract, but then it gets progressively worse as you read on:

Allostatic overload in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
Megan Anne Arroll
September 2013
Medical Hypotheses Volume 81, Issue 3 , Pages 506-508
http://www.medical-hypotheses.com/article/S0306-9877(13)00313-7/abstract

Abstract

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterised by diverse symptoms such as fatigue, pain, sleep disturbance and autonomic dysfunction.

There remains to be a singular biomarker identified for this illness, hence numerous theories about its development and perpetuation have been posited in the literature.

This brief report presents the model of ‘allostasis’ as a framework for understanding ME/CFS, specifically the notion that the physiological mechanisms employed in the body to deal with stress termed here as ‘allostatic states’ (e.g. elevation of inflammatory cytokines), may in and of themselves contribute to the perpetuation of the disorder.

This theoretical assertion has important consequences for the understanding of ME/CFS and treatment; rather than searching for a singular pathogen responsible for this condition, ME/CFS can be conceptualised as a maladaptive stress disorder and interventions aimed at addressing the allostatic states may be incorporated into current symptom management programmes.

This is the psycho-social theory whereby they acknowledge an abnormal level of measurable cytokine levels in ME/CFS patients but then blame this on a maladaptive stress response that can be treated with cognitive-behavioural therapies etc.


So I'll reserve judgement on the new paper until i've read it in full.
 
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SOC

Senior Member
Messages
7,849
It's probably the psychogenic thing -- "Yes, we see you have real measurable symptoms. You are creating them with your dysfunctional thought process."

Easy to say without any evidence to explain the actual physical mechanism by which patients mentally cause testable physical dysfunction, and puts the impossible burden on the patients to prove that they're not "thinking themselves sick". It's pseudoscience and quackery at it's best.

Us and our special super-secret mental powers. :ninja: :rolleyes: :rofl:
 

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
The delayed fatigue effect in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
Megan A. Arroll, Elizabeth A. Attree, John M. O'Leary, Christine P. Dancey
Fatigue: Biomedicine, Health & Behavior
Vol. 2, Iss. 2, 2014
Published online: 23 Apr 2014
http://dx.doi.org/10.1080/21641846.2014.892755
Results: Significant differences were found between pre- and post-test measures in three MFI sub-scales of fatigue (general, mental, and physical) and on the depression scale of the HADS. However, there were no significant changes in motivation, activity level, or self-reported anxiety scores.
Interestingly, this mirrors the finding by Susan Cockshell using a different set of cognitive tests: Cognitive testing causes mental exhaustion lasting days

However, it's odd not to have a control group: if Cockshell's study is anything to go by, controls get fatigued by the tests too, but recover faster.

I recently spotted another paper by Megan Arroll which also seems helpful when you start reading the abstract, but then it gets progressively worse as you read on:

Allostatic overload in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
Megan Anne Arroll
September 2013
Medical Hypotheses Volume 81, Issue 3 , Pages 506-508
This brief report presents the model of ‘allostasis’ as a framework for understanding ME/CFS, specifically the notion that the physiological mechanisms employed in the body to deal with stress termed here as ‘allostatic states’ (e.g. elevation of inflammatory cytokines), may in and of themselves contribute to the perpetuation of the disorder.

This theoretical assertion has important consequences for the understanding of ME/CFS and treatment; rather than searching for a singular pathogen responsible for this condition, ME/CFS can be conceptualised as a maladaptive stress disorder and interventions aimed at addressing the allostatic states may be incorporated into current symptom management programmes.
http://www.medical-hypotheses.com/article/S0306-9877(13)00313-7/abstract

This is the psycho-social theory whereby they acknowledge an abnormal level of measurable cytokine levels in ME/CFS patients but then blame this on a maladaptive stress response that can be treated with cognitive-behavioural therapies etc.
Odd this is in medical hypotheses - the CDC were pushing the Allostasis theory for CFS around 2007 (mainly using empiric criteria for diagnosis...

I'd also like to see the evidence that stress leads to a substantial increase in pro-inflammatory cytokines; a quick googling suggested rather flaky research.
 

Snowdrop

Rebel without a biscuit
Messages
2,933
"This is the psycho-social theory whereby they acknowledge an abnormal level of measurable cytokine levels in ME/CFS patients but then blame this on a maladaptive stress response that can be treated with cognitive-behavioural therapies etc."

Will it never end! :rolleyes: :bang-head:
 

A.B.

Senior Member
Messages
3,780
If stress and trauma are contributing to the cause of ME/CFS, why did the generation of holocaust survivors not come down in mass with it?

Obviously because CFS patients are morally defective, pretentious and generally just not decent human beings whereas holocaust survivors are heroes.

(of course I'm joking here)

There is a moralistic aspect to the concept of psychosomatic illness. Those who have illnesses considered psychosomatic are seen as bad people. This is not a coincidence, the term psychosomatic was coined in the early 19th century by a German physician who believed that unethical, sinful or immoral behavior was directly responsible for some illnesses.
http://en.wikipedia.org/wiki/Johann_Christian_August_Heinroth
 
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Messages
15,786
There is a moralistic aspect to the concept of psychosomatic illness. Those who have illnesses considered psychosomatic are seen as bad people. This is not a coincidence, the term psychosomatic was coined in the early 19th century by a German physician who believed that unethical, sinful or immoral behavior was directly responsible for some illnesses.
It is odd that people with a presumed psychosomatic disorder are treated in a manner that would be considered completely unacceptable for mainstream psychiatric patients. There is a strong element of contempt, even from the very "experts" who moan about how poorly psychiatric practitioners and their patients are treated.

They would say it's unacceptable to withhold medical care for co-existing diagnosis, or benefits, or any other appropriate assistance from traditional psychiatric patients, yet gleefully advocate withholding all of the above from presumed psychosomatic patients. It doesn't make sense ... sometimes I wonder if they just want to exact vengeance upon whatever non-psychiatric patients they can get away with doing it to.