Mar 4 2010 Severity of symptom flare after moderate exercise is linked to cytokine

Dolphin

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PEM is not DOMS - completely different thing
What distinction have you got in mind?

If one looks at:
Vanness JM, Stevens SR, Bateman L, Stiles TL, Snell CR. Postexertional Malaise in Women with Chronic Fatigue Syndrome. J Womens Health (Larchmt). 2010 Jan 24.
(summary at: http://www.cfids.org/cfidslink/2010/020302.asp ), it looks at lots of symptoms straight away after the exercise, 24 hour later and 7 days later in the graph. For a few of these including muscular/joint pain, the graph is biggest at 7 days and for lots it's bigger at 7 days and 1 day than straight after the exercise.

(For anyone confused: DOMS=Delayed Onset Muscle Soreness PEM=Post-exertional Malaise)
 

gracenote

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tom,

I have not seen that spelled out before but, from my experience, I would say that DOMS and PEM are separate things. I wouldn't describe my PEM symptoms as muscle soreness at all. PEM to me is an increase in flu-like symptoms, cognitive malfunctions, autonomic and central nervous system out-of-whackness. Misery, to say the least.

Here is a quote from the article Postexertional Malaise in Women with Chronic Fatigue Syndrome. Great article, by the way.

Written questionnaires revealed that within 24 hours of the test, 85% of controls indicated full recovery, in contrast to 0 CFS patients. The remaining 15% of controls recovered within 48 hours of the test. In contrast, only 1 CFS patient recovered within 48 hours. Symptoms reported after the exercise test included fatigue, light-headedness, muscular/joint pain, cognitive dysfunction, headache, nausea, physical weakness, trembling/instability, insomnia, and sore throat/glands. A significant multivariate effect for the SF-36 responses (p<0.001) indicated lower functioning among the CFS patients, which was most pronounced for items measuring physiological function.
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ETA: tomk, I notice that you responded before I got my post up.
 

Dolphin

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tom,

I have not seen that spelled out before but, from my experience, I would say that DOMS and PEM are separate things. I wouldn't describe my PEM symptoms as muscle soreness at all. PEM to me is an increase in flu-like symptoms, cognitive malfunctions, autonomic and central nervous system out-of-whackness.
Would flu-like symptoms not include muscle soreness? I think they would for a lot of people.

http://en.wikipedia.org/wiki/Influenza
The most common symptoms of the disease are chills, fever, sore throat, muscle pains, severe headache, coughing, weakness/fatigue and general discomfort.
BTW, this discussion was prompted by: http://www.forums.aboutmecfs.org/sh...nked-to-cytokine&p=64208&viewfull=1#post64208 i.e. not an observation by me.

ETA: Actually, as you'll see later, Wonko was replying to: http://www.forums.aboutmecfs.org/sh...nked-to-cytokine&p=63199&viewfull=1#post63199 and so we were talking about different things.
 

Wonko

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DOMS
muscle ache, stiffness, weakness - muscle feels empty - if not severe will wear off if you warm up the muscle but occassionally can cause sharp pains if used
PEM (on local muscle)
muscle ache, fever,both stiffness and looseness (sometimes both at the same time), extreme weakness, ongoing variable pain, inflamation etc.

in a short descriptiont they may sound the same but apart from broad category descriptions like "muscle ache" - enough to make someone who hasnt experienced both think thats the same - they arent the same - they feel completely different - more than the difference between the simplistic description of PEM's being flu like and actually having the flu - even apart from the cog effects they are completely different things as experienced rather than how described
 

Dolphin

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DOMS
muscle ache, stiffness, weakness - muscle feels empty - if not severe will wear off if you warm up the muscle but occassionally can cause sharp pians if used
PEM (on local muscle)
muscle ache, fever,both stiffness and looseness (sometimes both at the same time), extreme weakness, ongoing variable pain, inflamation etc.

in a short descriptiont they may sound the same but apart from broad category descriptions like "muscle ache" - enough to make someone who hasnt experienced both think thats the same - they arent the same - they feel completely different - more than the difference between the simplistic description of PEM's being flu like and actually having the flu
But it is you are putting the label DOMS on Mithriel's description.
The symptoms she was feeing was part of a "package" after exertion - she didn't say she just had muscle symptoms, she also said she felt "worse than usual".
 

PoetInSF

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PEM vs DOMS

I've read a study that examined PEM with MRI and found that there was no DOMS in PEM. I don't have to link anymore but I'll post it when I found.

Usually you will get PEM way before you develop DOMS: it takes very little to trigger PEM for majority of CFS patients. However, DOMS can develop into PEM in some those who can exert enough before triggering PEM.

My annecdote: I walked 1.5m in the morning and then 1.5mi in the afternoon up 200 ft hill a few days ago. Next day, I developed a fantastic case of DOMS as if I walked up Mt. Diablo for 15 miles. The day after, DOMS turned into a mild PEM involving unpleasant fatigue, weakness and head pressure in addition to muscular soreness of DOMS.
 

Wonko

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The other side.
But it is you are putting the label DOMS on Mithriel's description.
The symptoms she was feeing was part of a "package" after exertion - she didn't say she just had muscle symptoms, she also said she felt "worse than usual".
sorry for the confusion- I was replyign to this
Some biopsychosocialists appear to claim that post-exertional malaise and/or symptom exacerbation is just the normal "delayed-onset muscle soreness" that healthy people get
one of our brains isnt functioning at 100% lol

given that others seem to be interpretting me the same way you did would imply it's mine -I'll stop posting for a bit
 

PoetInSF

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DOMS
muscle ache, stiffness, weakness - muscle feels empty - if not severe will wear off if you warm up the muscle but occassionally can cause sharp pains if used
DOMS involve micro tears of the muscle fiber, I think. You should be able to exam muscle with MRI or microscope to objectively identify DOMS. PEM, on the other hand, does not involve mucular damage.
 

redo

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Nice find Frank.

Severity of symptom flare after moderate exercise is linked to cytokine activity in chronic fatigue syndrome.

White AT, Light AR, Hughen RW, Bateman L, Martins TB, Hill HR, Light KC.

Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah, USA.

Abstract Chronic fatigue syndrome (CFS) patients often report symptom flare (SF) for >24 h after moderate exercise (post-ex). We hypothesized that SF is linked to increases in circulating cytokines and CD40 Ligand (CD40L). In 19 CFS patients and 17 controls, mental and physical fatigue and pain symptom ratings were obtained together with serum for 11 cytokines and CD40L before and at 0.5, 8, 24, and 48 h post-ex. Before exercise, CFS had lower CD40L (p<.05) but similar cytokines versus controls. In subgroups based on SF at 48 h, high SF patients (n=11) increased in IL-1beta, IL-12, IL-6, IL-8, IL-10, and IL-13 (p<.05) 8 h post-ex. Low SF patients (n=8) showed post-ex decreases in IL-10, IL-13, and CD40L, and controls decreased in IL-10, CD40L, and TNFalpha (p<.05). Thus, in CFS, cytokine activity may vary directly with SF, which may explain prior inconsistent findings.

http://www.ncbi.nlm.nih.gov/pubmed/20230500
This seems to be a bit opposite of the findings of the WPI findings:
"Before exercise, CFS had lower CD40L (p<.05) but similar cytokines versus controls. "
In the WPI study the CFS patients had marked higher levels of inflammatory cytokines compared with controls...

I think it's very interesting to see that symptom flares after exercise is related to cytokine acitivity.
I am one of those cases who don't get PEM. It might be that I have got a different expression (on one or more) of the cytokines.
Low SF patients (n=8) showed post-ex decreases in IL-10, IL-13, and CD40L
 

lucy

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PoetInSF - I too have fantastic kind of DOMS. I am better with fatigue, it wears off in about 2-4 hours after my walks. But the next day DOMS kicks in. I would moan when I felt it in my first steps while getting out of the bed and it would not gett better, 48 hrs is the peak pain.

Once, when focusing on how to walk so that it does not cause pain, I caught myself thinking "It is just pain", I couldnot understand myself, then I realized, that in my head, fatigue is much worse. What is interesting that after a course of antibiotics for blastocystis, I did not have DOMS. I still have to test with more excercise but even two walks without subsequent pain per year is great for me.
I am now believing that some kind of kinins are circulating in our bodies. For example, bradykinin is a vasodilator, also increases NO, and NO is said to set the hellish NO-ONOO cycle spinning over and over. This in turn damages mitos, and the body cannot repair.

I am still in search for how protozoa such as blastocystis is related to kinins, but apparently there are other kinds of parasites/bacteria, which will release such substances as their survival is improved. Vasodilation is consistent with orthostatic intolerance, but maybe not so much with decreased cardiac output. Cytokines such as IL-6 and TNF alpha are also vasodilators.

In summary my theory of my case is there is first the Krebbs TPA cycle which is damaged. Then on the top there is the NO-ONOO cycle spinning. Then the damaged Kallikrein-kinin cycle spins the NO-ONOO. Probably there are a few more steps in this saga until the beast is reached. Or maybe the beasts are dancing around the fire in a circle.

For the relation between DOMS and bradykinin, just google or scholar for bradykinin muscle pain. Also, Bradykinin has Arginine as its part, so supplementation with Arginine can boost bradykinin and NO. My childish speculations are a result of overreading :) But even if pain is just pain, we would feel better without it, this probably justifies our hours spent in front of the computer and not in the fresh air.
 

lucy

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I was thinking about it too. But regarding the fact, that Alzheimer patients get NGF directly injected into brain as potential treatment, maybe by producing lots of NGF our body is trying to protect us from brain deterioration which is happening because of open blood-brain-barrier. Instead, other directions could be bradykinin antagonists, or angiotensin I-converting enzymes. The only thing I found which is available as food source is bromelain, bradykinin antagonist, reduces inflammation. Its best source is pineapple, and as it also is good against parasites, helps digestion and rupturing up biofilms, seems to me like a good choice.

The most interesting thing would be to know if there are people who found correlation between blood pressure and fatigue. This line of thinking would say the lower the pressure the worse one feels. I had also noticed that at my worst times, if I had to climb a set of stairs, my heart wasn't reacting as in normal ppl - it wasn't beating any faster, increasing the pressure.

I also found this article about blood brain barrier: http://www.nature.com/nrn/journal/v7/n1/full/nrn1824.html
It is way beyond my understanding, but pictures and tables could be of use. As the list of substances opening BBB contains several items, it could mean there are multiple pathways to open it, therefore many illnesses with same symptoms. For example, in my case it could be blasto related interleukins (so far I am the point of reading that blasto is evil on il-8, and il-8 modulates bradykinin), for some others lyme bacteria produced chemicals and for others XMRV.