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CFS within IOM Lyme report (2011)



Many (but not all) CFS-related statements, as follows (emphasis/links added):
Knowledge Gaps and Research Opportunities—There are a number of research opportunities to begin to answer questions regarding outstanding issues associated with Lyme disease:

Conduct broad-based studies of chronic Lyme disease, fibromyalgia, chronic fatigue syndrome, and other medically unexplained syndromes, free of any preconceived ideas on cause, perhaps led by the Institute of General Medical Sciences. [p.5-5]

One clinician participant noted that chronic fatigue syndrome is a clinical condition of prolonged and severe fatigue of at least 6 months duration for which other causes have been excluded. He stated that in his clinical experience there is a relationship between chronic fatigue syndrome and Lyme disease in which some patients who meet the case definition for chronic fatigue syndrome may have seronegative Lyme disease. This was identified as a research gap. [p.5-8]

Charting a scientific inquiry into the nature of post-Lyme disease may rely on understanding the symptoms of the condition, which include arthralgias, musculoskeletal pain, radicular pain, paresthesia, fatigue, neurocognitive impairment, and mood disturbances. These symptoms are the very same symptoms observed in conditions such as fibromyalgia and chronic fatigue syndrome, which are currently thought to result from disturbances in the central nervous system processing of sensory information. These conditions are frequently referred to as ‘central sensitivity’ syndromes.… [p.7-8]
(See also: http://chronicfatigue.about.com/od/whyfmscfsarelinked/a/Central-Sensitivity-Syndromes.htm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268359/ - CJ Woolf 2012, "Central Sensitization..."
Nijs et al. 2014, "Treatment of Central Sensitization...")

By contrast, central fatigue is more cognitive in nature and is attributed to central nervous system dysfunction. Classic examples of central fatigue include chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, although central fatigue can also accompany rheumatoid arthritis, lupus, and cancer. Importantly, the difficulty with memory and concentration reported by a myriad of patients with various systemic diseases may be a function of central fatigue.

As with many other medical conditions, a stress-diathesis model [http://en.wikipedia.org/wiki/Diathesis–stress_model] for the etiology of central sensitivity syndromes is widely accepted. [p.7-9]

Similarly, various TBDs [tick-borne diseases] appear to trigger some central sensitivity syndromes. For example, approximately 39 percent of patients with human anaplasmosis developed chronic fatigue syndrome despite no serological evidence of persistent infection (Ramsey et al., 2002)… A recent study showed a decrease in natural killer cell cytotoxicity, and three different measures of CD26—an antigen located on cellular surfaces associated with immune regulation—accurately discriminated chronic fatigue syndrome patients from controls (Fletcher et al., 2010). [p.7-9]

As most individuals will agree, the diagnosis of acute Lyme disease is relatively straightforward. The challenges arise in the diagnosis of “chronic Lyme disease” or “post-Lyme disease.” The criteria for chronic disease include fatigue, musculoskeletal symptoms, and neurocognitive impairments involving memory, concentration, and mood. Minor criteria include an array of non-specific symptoms such as headaches, eye and/or ear symptoms, jaw/tooth pain, Bell’s palsy, disequilibrium, dyspnea, and others.

One difficulty that clinicians face is the absence of objective, measurable evidence for these symptoms. Unless a patient has an observable sign such as Bell’s palsy, a swollen joint, or a rash (EM), the clinician cannot easily attribute the patient’s symptoms to Lyme disease.

A second difficulty arises in distinguishing the array of symptoms from those associated with other multisymptom illnesses such as chronic fatigue syndrome (CFS), fibromyalgia, or Gulf War syndrome. Clinicians are hard pressed to say whether a patient’s complex of symptoms is caused by Lyme disease or some other etiology. [p.7-13]

A participant observed that it seems as if the numbers of children experiencing symptoms and being diagnosed with illnesses such as fibromyalgia or chronic fatigue syndrome have risen since the last generation… [p.7-21]

Donta noted that there are changes in the severity of symptoms experienced by women not only with Lyme disease but also with various chronic conditions, such as chronic fatigue syndrome, as hormone levels fluctuate. In addition there is a gender difference in Lyme disease, perhaps related to the presence of estrogen and progesterone receptors in glial and neural cells. [p.7-22]

Lyme borreliosis is often not considered in the differential diagnosis of a patient’s worsening symptoms. Rather, patients are offered a diagnosis such as chronic fatigue syndrome or fibromyalgia, conditions for which there is no known cause or cure. [p.A-70]

Edit: Additional info regarding this text has been shared here: http://www.mecfsforums.com/index.php/topic,20930.msg164455.html#msg164455
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