Compression Stockings Improve Cardiac Output and Cerebral Blood Flow during Tilt Testing in ME/CFS (van Campen et al., 2021)

Pyrrhus

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Another study from van Campen, Rowe, and Visser!


Compression Stockings Improve Cardiac Output and Cerebral Blood Flow during Tilt Testing in ME/CFS (van Campen et al., 2021)
https://doi.org/10.3390/medicina58010051

Main points:
  • Without compression stockings, patients experienced a 25% drop in blood flow to the brain during tilt-table testing.
  • With compression stockings on, patients experienced only a 14% drop in blood flow to the brain during tilt-table testing.
Abstract:
Background and Objectives:
Orthostatic intolerance (OI) is a clinical condition in which symptoms worsen upon assuming and maintaining upright posture and are ameliorated by recumbency. OI has a high prevalence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Limited data are available to guide the treatment of OI in ME/CFS patients. We and others have previously described patient-reported subjective improvement in symptoms using compression stockings. We hypothesized that these subjective reports would be accompanied by objective hemodynamic improvements.

Materials and Methods:
We performed a randomized crossover trial in 16 ME/CFS patients. Each underwent two 15-min head-up tilt table tests, one with and one without wearing knee-high compression stockings that provided 20–25 mm Hg compression. The order of the tests was randomized. We measured heart rate and blood pressure as well as cardiac output and cerebral blood flow (CBF) using extracranial Doppler of the internal carotid and vertebral arteries.

Results:
There were no differences in supine measurements between the 2 baseline measurements. There were no differences in heart rate and blood pressure at either end-tilt testing period. Compared to the test with the stockings off, the mean percentage reduction in cardiac output during the test with compression stockings on was lower, 15 (4)% versus 27 (6)% (p < 0.0001), as was the mean percentage CBF reduction, 14 (4)% versus 25 (5)% (p < 0.0001).

Conclusion:
In ME/CFS patients with orthostatic intolerance symptoms, cardiac output and CBF are significantly reduced during a tilt test. These abnormalities were present without demonstrable heart rate and blood pressure changes and were ameliorated by the use of compression stockings.
 

Pyrrhus

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And for those who are wondering just how wearing tight socks could improve blood flow to the brain in people with orthostatic intolerance, note that tight socks physically push blood up out of the legs, reducing blood pooling:

1641093172566.png



For more information:

Orthostatic Intolerance Basics: Dysautonomia of Blood Vessels, Low Blood Volume, and Baroreflexes
https://forums.phoenixrising.me/thr...sels-low-blood-volume-and-baroreflexes.86445/
 
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Violeta

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The test was done with just knee high socks, those aren't as hard to put on as the stockings that go up to the waist.

I have compressions socks that are helping and not so impossible to put on. I have to look up what the compression number is. They are from Bombas, 20-30mmHg. The pants I have aren't the extreme compression type, either, just from places like Pact, Gap, or Sketchers. They do help.
 

Pyrrhus

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They hursts my legs so much…
Me too. Due to the small fiber neuropathy (SFN) in my calf and feet I can't wear compression stockings.

I can't even wear regular socks. I have to wear very loose "diabetic" socks with weaker elastic, to avoid the pain.

Nba players all use something similar now, wanted to mention it for those who don’t watch. It might be less tight but still might help.
Performance-enhancing undergarments! :wide-eyed:

Maybe being in water every day could be an idea if the water presses the blood upwards as well.
I have often wondered that as well...
 

junkcrap50

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Maybe being in water every day could be an idea if the water presses the blood upwards as well. Also i wonder if either that or wearing the stockings would have an impact on PEM (and ofc energy in general).
Yes. Very might be. There are several studies on body-temperature "hot tubs" (called "'neutral temperature' therapy pool") relieving fibromyalgia pain. The theory is that yes, the hydrostatic pressure of the water compresses the entire body. Also, the think that the neutral temperature also helps reset the autonomic nervous system.

See this article for more information: https://www.healthrising.org/blog/2...way-decades-trying-help-allodynia-nerve-pain/
 

Pyrrhus

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There are several studies on body-temperature "hot tubs" (called "'neutral temperature' therapy pool") relieving fibromyalgia pain. The theory is that yes, the hydrostatic pressure of the water compresses the entire body.
Yes, I can certainly see how the hydrostatic pressure of the body-temperature water - which compresses the entire body - might gently increase circulation, thereby relieving muscle soreness. The article that you linked to also describes some notable autonomic nervous system effects, which doubtlessly contribute to the therapeutic potential of submersion in body-temperature water.

We can compare this with the case of hot baths (higher than body-temperature) which have the additional autonomic nervous system effect of dilating certain arteries to increase blood flow to the skin. Some patients find that such a hot bath opens up blood vessels leading to tissues where blood flow may be restricted, reducing pain. But this may also mean less blood left over for pumping up into the brain - worsening orthostatic intolerance - which means that many patients can not tolerate hot baths due to worsened orthostatic intolerance.

I have also wondered if there might be an ancient evolutionarily-programmed autonomic nervous system response just to the hydrostatic pressure of water on the body. Although humans are not sea mammals, humans do have some programmed autonomic responses to submersion in water. Some of these responses are only present in babies, which might be why it is easier to teach babies to swim than it is to teach older children to swim. Specifically, if you place a baby's face in water, it triggers an autonomic nervous system response called the "diving reflex":
https://en.wikipedia.org/wiki/Diving_reflex

A bit of a tangent:
A small 2018 study suggested that a hot bath might normalize Heart Rate Variability in ME:
Effects of warm water immersion on blood pressure, heart rate and heart rate variability in CFS
https://forums.phoenixrising.me/thr...rate-and-heart-rate-variability-in-cfs.61488/
 
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My feet crave tight socks, I discovered plantar fasciitis socks ...low cut ones and my feet just love them. (Sockwell. brand)

Thought I'd mention that I developed elbow bursitis following some ME induced stomach crisis. Both elbows and my heels became totally intolerant of hot baths. My whole body is craving hot baths but those two locations can't tolerate it and feel creepy awful. (also the elbows hate the emf from the lap top)

I finally cleared the elbow bursitis (for now) and its stopped and my heels also stopped.

these are all these odd things doctors don't understand and nobody can explain. Elbows correspond with heels.

The difficulty with putting on the compression hose

1) my weak fingernails get destroyed every time

2) my husband needs them for other reasons, but he has many hand problems....including genetic ones...he developed this connective tissue disorder...famous in Scandanavians. It affects his hands- but his connective tissue is messed up in his whole body, the last few years.....the doctor never says anything bout these major physical problems...its so odd how they ignore you.

how is it I have ME-connective tissue issues ( missing fingerprints, collagen, etc)? and I'm married to connective tissue issues? For entirely different reasons?

I showed my husband the 100$ device for putting on compression hose. We laughed. Maybe?
 

Violeta

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My feet crave tight socks, I discovered plantar fasciitis socks ...low cut ones and my feet just love them. (Sockwell. brand)

Thought I'd mention that I developed elbow bursitis following some ME induced stomach crisis. Both elbows and my heels became totally intolerant of hot baths. My whole body is craving hot baths but those two locations can't tolerate it and feel creepy awful. (also the elbows hate the emf from the lap top)

I finally cleared the elbow bursitis (for now) and its stopped and my heels also stopped.

these are all these odd things doctors don't understand and nobody can explain. Elbows correspond with heels.

The difficulty with putting on the compression hose

1) my weak fingernails get destroyed every time

2) my husband needs them for other reasons, but he has many hand problems....including genetic ones...he developed this connective tissue disorder...famous in Scandanavians. It affects his hands- but his connective tissue is messed up in his whole body, the last few years.....the doctor never says anything bout these major physical problems...its so odd how they ignore you.

how is it I have ME-connective tissue issues ( missing fingerprints, collagen, etc)? and I'm married to connective tissue issues? For entirely different reasons?

I showed my husband the 100$ device for putting on compression hose. We laughed. Maybe?
How did you clear up the elbow bursitis?

It is really odd how doctors don't care about issues like that.

I am trying to imagine what a device for putting on compression hose would look like before looking it up online. I can't picture anything that wouldn't harm the body.
 
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How did you clear up the elbow bursitis?

It is really odd how doctors don't care about issues like that.

Elbow bursitis: something inflammatory....which then in theory maybe I injured my elbows leaning on them throwing up 100s of times. So then one had alot of fluid built up and the other never had fluid.

My doctor drained the one with fluid, not a big deal. It probably took a couple of years to clear out. I was really careful last month with the stomach issue again, to be really careful about the elbows and I seem OK.

I assume it could return.

But this tissue is so sensitive to emf......

The bursa (a sac with some fluid in it)...must exist to cushion the outer elbow....

I did soak them in chinese herbs, it felt better but took more time to clear out. (months)