Aerobic fitness in adolescents with chronic pain or chronic fatigue: parallels and mechanisms?

[Dolphin]

Free full text: https://www.medicaljournals.se/jrm/content_files/download.php?doi=10.2340/16501977-2221
https://www.medicaljournals.se/jrm/content/abstract/10.2340/16501977-2221

(Not a recommendation)

Aerobic fitness in adolescents with chronic pain or chronic fatigue: parallels and mechanisms?
Paolo T. Pianosi, Eric Emerling, Kristin C. Mara, Amy L. Weaver, Philip R. Fischer
Pediatric & Adolescent Medicine, Mayo Clinic, 55905 Rochester, USA. E-mail: pianosi.paolo@mayo.edu

DOI: 10.2340/16501977-2221
Abstract

Objective:

Chronic fatigue and chronic pain both deter people from participating in exercise, even though exercise is often a key component of treatment. While reasons for this may seem obvious, the extent and mechanism(s) of reduced exercise performance among affected individuals, particularly those with chronic pain, are not well described. We hypothesized that patients with chronic fatigue are more deconditioned than those with chronic pain, due to the nature of their illness or disability.

Design:

Retrospective chart audit June 2012 to December 2014.

Subjects:

Adolescents with chronic fatigue (320, 73 males) or chronic pain (158, 30 males).

Methods:

Maximal cardiopulmonary exercise test to determine peak oxygen uptake (V̇O2) and work efficiency.
Results: Mean (standard deviation (SD)) peakV̇O2 was similar between patients with chronic fatigue and chronic pain: males 36.5 (SD 8.3) vs 34.2 (SD 7.3) ml/kg/min (p = 0.17); females 27.3 (SD 6.1) vs 27.6 (SD 6.6) ml/kg/min (p = 0.67). PeakV̇O2 was < 90% predicted in 80% and 75% of females, or 77% and 83% of males, with chronic fatigue and
chronic pain, respectively. Peak O2pulse and work efficiency were likewise similar.

Conclusion:

Patients in both groups manifest exercise responses typical of cardiopulmonary deconditioning and to similar extent. Failure to detect unique cardiopulmonary or muscle pathophysiology suggests a shared pathway to low aerobic work capacity.

 

[trishrhymes]

PIty they didn't think to do a 2 day CPET test. What a wasted opportunity. Don't reseachers ever read other people's work before they start a trial.

 

[Mohawk1995]

PIty they didn't think to do a 2 day CPET test. What a wasted opportunity. Don't reseachers ever read other people's work before they start a trial.

There are some similarities that I have seen between those with chronic pain and those with ME. They both can have "crashes" (pain for chronic pain and PEM for ME) after exertion, but I would agree that a 2 day CPET test would probably delineate the differences between the two. I do not think that either group's results are primarily driven by deconditioning. Rather I am of the opinion that both are driven by Neurophysiological intolerance to exertion. ME because of metabolic reasons and Chronic pain because of Neuro-inflamatory reasons.

Definitely agree with your point about researchers reading other's work. Unfortunately many in research have tunnel vision and already have a theory they are attempting to prove. At least in this case, the researchers were willing to admit their initial hypothesis was incorrect.

 

[Snow Leopard]

The "common pathway"? How about: people with pain or fatigue (due to chronic illness) exercise less as a result of their impairment!?!

They are confusing cause with effect.

Secondly, their ignorance as to the differences between the diagnostic criteria (eg the studies by Jason and others) as well as the 2 day CPET studies just shows you that they care more about pushing their biased hypothesis, than choosing the theory that bests fits the data.

 

[TenuousGrip]

When scientists ask the wrong question, it's seldom surprising when they come up with the wrong answer.

The ones who are looking at more granular biomarkers (eg, CSF, gene expression, immune, inflammatory, anti-inflammatory, neuroinflammatory, intestinal microbiota, etc.) are seeing things in a radically different way.

[I agree with others asking why Mayo seems to be blissfully unaware of other research on the subject]

Mayo may as well be asking if our hair gets any more messed up by a breeze than HC's (Healthy Controls).

In two visits, I spent more than a month of my life at the MN Mayo Clinic. I -- like many others -- crawled away roundly unimpressed (and much poorer).

 

[JaimeS]

PIty they didn't think to do a 2 day CPET test. What a wasted opportunity. Don't reseachers ever read other people's work before they start a trial.

Why? their ideas are perfect as they are...

 

[Sean]

When scientists ask the wrong question, it's seldom surprising when they come up with the wrong answer.

As somebody said, you don't win a science Nobel prize for getting the right answer, but for asking the right question.

 

[Keela Too]

Sounds like they are attempting to find more evidence for blaming the patient!

I mean why else would they NOT look at 2 day testing?

I really cannot believe they are not aware of the research using 2 day testing. So we can discount that reason (or if they aren't aware of the work with the 2 day test, they don't deserve to have any credibility).

So that leaves 'exclusion by intent' in my view.

So why would they intentionally exclude the 2 Day CPET?

Oh right that wouldn't help push the meme that ME patients are just a deconditioned population, and need to be persuaded to do more exercise!!

 

[Sean]

So that leaves 'exclusion by intent' in my view.

There is absolutely no excuse for them to not know about PEM, nor take it properly into account when designing studies and testing outcomes.

 

[Barry53]

When scientists ask the wrong question, it's seldom surprising when they come up with the wrong answer.

So very true in engineering also. There is an innate tendency sometimes to home in on questions that "are more suitable". As a slightly amusing aside, I recall Margaret Thatcher being interviewed and was asked a tricky question, which she successfully fended off by responding along the lines of (cannot recall the detail): "That is not the question you should be asking, the question you should be asking is ..."; she then proceeded to confidently answer her self-posed question.

 

[Barry53]

So why would they intentionally exclude the 2 Day CPET?

Oh right that wouldn't help push the meme that ME patients are just a deconditioned population, and need to be persuaded to do more exercise!!

You are such a cynic! ... . (Just in case anyone is in doubt, I fully agree with @Keela Too).

 

[JaimeS]

Perhaps they would not look at 2-day CPET because they only read the literature written by people they already know they will agree with. One of the best things about PR is that we post (and presumably read) studies that go against our own view of the illness.

I'll add this additional perspective: I have probably read more literature on ME/CFS than many scientists who work on it. There is a unique impetus when you yourself are suffering that cannot be replicated by all the scholarly fervor in the world.

When asked malice or stupidity/ignorance of the facts, I usually choose the latter.