Friday, April 11, 2008

Biological Link between Pain and Fatigue  

A recent University of Iowa study reveals a biological link between pain and fatigue and may help explain why more women than men are diagnosed with chronic pain and fatigue conditions like fibromyalgia and chronic fatigue syndrome.

Working with mice, the researchers, led by Kathleen Sluka, Ph.D., professor in the Graduate Program in Physical Therapy and Rehabilitation Science in the UI Roy J. and Lucille A. Carver College of Medicine, found that a protein involved in muscle pain works in conjunction with the male hormone testosterone to protect against muscle fatigue.

Chronic pain and fatigue often occur together -- as many as three in four people with chronic, widespread musculoskeletal pain report having fatigue; and as many as 94 percent of people with chronic fatigue syndromes report muscle pain. Women make up the majority of patients with these conditions.

To probe the link between pain and fatigue, and the influence of sex, the UI team compared exercise-induced muscle fatigue in male and female mice with and without ASIC3 -- an acid-activated ion channel protein that the team has shown to be involved in musculoskeletal pain.

A task involving three one-hour runs produced different levels of fatigue in the different groups of mice as measured by the temporary loss of muscle strength caused by the exercise.

Male mice with ASIC3 were less fatigued by the task than female mice. However, male mice without the ASIC3 protein showed levels of fatigue that were similar to the female mice and were greater than for the normal males.

In addition, when female mice with ASIC3 were given testosterone, their muscles became as resistant to fatigue as the normal male mice. In contrast, the muscle strength of female mice without the protein was not boosted by testosterone.

"The differences in fatigue between males and females depends on both the presence of testosterone and the activation of ASIC3 channels, which suggests that they are interacting somehow to protect against fatigue," Sluka said. "These differences may help explain some of the underlying differences we see in chronic pain conditions that include fatigue with respect to the predominance of women over men."

The study, which was published in the Feb. 28 issue of the American Journal of Physiology -- Regulatory, Integrative and Comparative Physiology, indicates that muscle pain and fatigue are not independent conditions and may share a common pathway that is disrupted in chronic muscle pain conditions. The team plans to continue their studies and investigate whether pain enhances fatigue more in females than males.

"Our long-term goal is to come up with better treatments for chronic musculoskeletal pain," Sluka said. "But the fatigue that is typically associated with chronic, widespread pain is also a big clinical problem -- it leaves people unable to work or engage in social activities. If we could find a way to reduce fatigue, we could really improve quality of life for these patients."

In addition to Sluka, the UI research team included Lynn Burnes, a research assistant and lead author of the study; Sandra Kolker; Jing Danielson; and Roxanne Walder. The study was funded in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Adapted from materials provided by University of Iowa.

* * *

Doctors have long known that constant pain is exhausting ... though when the misogynists are trying to tell you that CFS/fibro is all in your head, they tend to forget they learned that.

Not only because constant pain keeps you from getting good sleep but because dealing with it all day is taxing.  I blew out my knee as a 17-year-old and learned biofeedback soon afterward for keeping the pain under control.  But I've known all these years that when I'm biofeedbacking, there are things that I can't do ... too much brain bandwidth is taken up with that process.

There's a study cited in Dr. Starlanyl's book (which I'm not up to getting up and finding the citation for right now for precisely the reason that my knee is throbbing) that patients with chronic pain do worse on memory tests for just that reason.  They're so distracted by the pain that they can't form new memories.  Yet, despite this study proving that chronic pain patients do as badly or worse than patients with traumatic brain injuries, there are notes in my records that I must be faking to do as badly on that test as I did!  Gee, I'm in roaring pain, have barely slept for over a year, and no one can figure out why I'm practically brain-dead?  Non-functional as I was, I could figure out why I couldn't think clearly enough to work: pain and sleep deprivation.


Thursday, April 10, 2008

Response to "If it's all in the mind..."


I have responded to the letters page, as below, to this article in
the Financial Times:\=1

Weekend columnist Margaret McCartney
If it's in the mind, it's still the real thing

Published: March 22 2008 02:55

Best wishes

Angela Kennedy


Margaret McCartney has, sadly, chosen to defend a psychiatric
paradigm which is controversial, and heavily contested by
researchers, medics and patients alike. ("If it's in the mind, it's
still the real thing).

`Somatisation' in an unsafe construct (rather like astrology and
faith healing) which at present can neither be proved nor disproved,
and may never be. Belief in `somatization' is an example of `magical
voluntarism', currently rife in psychotherapeutic, medical and
common sense discourses.

A diagnosis of `unexplained illness' should not translate to `non-
organic' precisely because it is not yet `explained', yet many
doctors assume, illogically and uncritically, that `unexplained'
means `non-organic' by default.
Furthermore, there is copious
evidence of `organicity' being found even in `Chronic Fatigue
Syndrome', by scientists internationally, therefore `unexplained`
per se is an inaccurate assumption.

NICE is currently facing a Judicial Review over its guidance, which
focuses on Cognitive Behavioural Therapy and Graded
Exercise `treatments`, neither of which have been found to help
those suffering the most `organicity' and devastating physical
impairment, and for which there is also evidence of harm to
patients. It fails to address the copious scientific evidence
of `organicity'
, therefore failing to offer any useful guidance for
doctors, even of diagnosis of specific physiological problems
associated with illnesses often diagnosed as 'CFS'.

For those wishing to find out more about these issues, there are
various resources available, for example by a search of key terms in
this letter .

Yours faithfully
Angela Kennedy

Psychosocial School and Insurance Companies

The article below is translated from a Dutch review
by Frank Twisk.



ME: the strong ties between the psychosocial
school and insurance companies.

A Conference on "The Evidence-based Approach
of CFS", organized by the Royal Society of
Medicine, will held on April 28, 2008.

Most of the speakers are well-known
representatives of the so-called "psychosocial"
school. Prof. Simon Wessely, the man who
epitomizes this movement, will make an
appearance too.

The often critized patients' organization  "Action
for ME" will be speaking "on behalf of the

Of the medical academics specializing in
ME/CFS - of course - no one has been invited.

Those who suspect that UNUM insurance
and the invited psychosocial specialists
have close ties, will find this confirmed once more
by the conference program.
(aim and agenda of conference).

UNUM  Provident, one of the largest income
insurance companies, is, and has been, since
the nineties, the main driving force behind the
psychosocial approach mentioned above
(e.g. Chronic Fatigue Syndrome Management
Program UNUM, 4th April 1995: "UNUM stands to
lose millions if we do not move quickly to address
this increasing problem"
- "ME/CFS Diagnosis:
Neurosis with a new banner" - ".. an effort to
return the patient/claimant back to maximum
functionality with or without symptoms.").

Once upon a time, not even that long ago, such an
overt conflict of interests would have induced
loud protest and strong condemnation.

But times have changed: the ideology of the open
market has medical science in its grip.

The barrier between evidence-based science
and sales talk is fading away.

The pychosocial meeting (sold as an evidence-
based conference) has filled people with ME/CFS
both in the U.K. and the U.S.A. with dismay. They
will hold a peaceful demonstration outdoors.

Dr. Derek Enlander, a strong supporter of a
medical approach to ME/CFS, has written to the
Dean of the Royal Society of Medicine urging him
to invite medical speakers ("I think it is absurd for
the Royal Society of Medicine to promote a
meeting on Myalgic Encephalomyelitis where the
predominant topic is the psychiatric aspect of this
physical disease.", "Please invite clinicians and
physicians to speak at your meeting on the
medical aspects and medical treatment of M.E..",
"After all, you are a medical and not a psychiatric

This of course is not going to happen.

The political and financial interests are far too

Frank Twisk

Letters From Dr. Enlander


Letter to Editor
Daily Telegraph

21 Mar 2008


Your article this week on Gene research in Myalgic
Encephalomyelitis by Dr Jonathan Kerr in St George's
Hospital was a breath of fresh air in the stale
atmosphere of UK government funded research.
Myalgic Encephalomyelitis and Chronic Fatigue
syndrome are commonly referred to as M.E. and

In 1955 Dr Melvin Ramsay reviewed a cohort of
young doctors and nurses in the Royal Free Hospital
in London and published a report relating to their
massive debilitating fatigue. Over the years it has
been shown to be a physical disease.

The cause is obscure, this obscurity has been
masterfully used by psychiatrists to claim that the
disease is a manifestation of a psychiatric condition,
leading to an imagined problem. What arrogance !

The esteemed Royal Society of Medicine (RSM) plays
to this theme by running a conference next month on
ME / CFS. The speakers are dwelling mainly on
psychiatry, rather peculiar for a Society of Medicine.

Most of the estimated 190,000 patients in the UK
who suffer from this disease are appalled. A large
number of them have applied for a demonstration
permit outside the RSM to bring this wrongful thrust
to the nation's and RSM's attention.

The following week, May 6th, a conference in ME /
CFS will take place at Cambridge University where
the latest methods of diagnosis and treatment will
be defined. Dr Kerr will speak on the Genome in ME /

Dr Klimas, a noted researcher and clinician in Miami
Florida, will speak on new developments and
diagnostic methods and  I will speak on the methods
of treatment both in the UK and the USA.

As far as I know the RSM has not noted these
physical aspects and has not altered its agenda in
the April conference.

The government through NICE continues to waste
money on proven bad methods of treatment, based
on forced exercise therapy which, in a large number
of cases, cause relapse.

Research on the physical basis of the disease has to
be funded by private foundations, CFS Research
Foundation, ME Research UK and patient money.

Surely, by now, the Government should
be embarrassed.

Derek Enlander MD, M.R.C.S., L.R.C.P.
New York



Removal of the Royal patronage
from the Royal Society of Medicine

HRH The Queen
Buckingham Palace

2 April 2008

Your Majesty

I would like to bring your attention to indiscretions
of a Royal Society. The Royal Society of Medicine
has formed an alliance with an insurance
company, UNUM. This company has been held
liable in refusing to compensate patients who are
sick claiming that they are psychiatric.

The Royal Society of Medicine has invited
members of this company to speak at a Chronic
Fatigue Syndrome conference in which they and
others will portray the psychiatric viewpoint to the
exclusion of physical medical research.

Physicians and medical clinicians who treat this
disease are excluded. This is an injustice to
patients who are too ill to battle this insurance
company and the Royal Society of Medicine .

Their actions are egregious, in fact they harm
patients, the actions of the Royal Society of
Medicine are not in keeping with your Majesty's

I would humbly suggest, your Majesty, that you
review the Royal Patent that this society has been
appended and perhaps remove the Royal
privilege from their name.

I, am, your humble servant,

Derek Enlander, M.R.C.S., L.R.C.P.

Cortisol in CFS & Fibro


Data study suggests cortisol could alleviate for chronic fatigue syndrome and
New hope available for the millions suffering from these diseases

   Contact: Julian Teixeira

LOS ANGELES - March 19, 2008 - Chronic fatigue syndrome (CFS) and fibromyalgia
(FM) are two serious and debilitating diseases with no confirmed cause and
limited treatment options. However, results of a new comprehensive literature
study propose a simplified treatment process that could help alleviate symptoms
for patients suffering from these diseases.

Kent Holtorf, M.D., medical director of the Holtorf Medical Group Center for
Endocrine, Neurological and Infection related illness Torrance, Calif., is
advising a simplified treatment process that may help alleviate CFS and FM
symptoms. From an extensive review of more than 50 published studies that
assessed adrenal function in CFS and FM patients, Dr. Holtorf found that that
the majority of CFS and FM patients displayed abnormal adrenal function due to hypothalamic-pituitary dysfunction. The comprehensive review also showed that
the majority of patients could be treated for this adrenal dysfunction. Dr.
Holtorf's analysis, recently published in the Journal of Chronic Fatigue
Syndrome, demonstrated that patients that were given cortisol as part of a
multi-system treatment experienced significant improvement in their symptoms

'My review of existing studies suggests that a treatment protocol of early
administration of cortisol may help improve and reduce the symptoms of chronic
fatigue syndrome and fibromyalgia,' said Dr. Holtorf. 'This research provides a
new understanding that treating the known causes of illness in CFS and FM can
improve the symptoms and quality-of-life of patients who suffer from these

CFS and FM primarily affect women in their 30s and 40s. According to the Centers
for Disease Control and Prevention (CDC) more than one million Americans suffer
from CFS while it is estimate that FM affects about 2 percent of the U.S.
population. Unfortunately, both of these diseases are poorly understood by many
physicians and there is no generally accepted test to accurately detect them. In
addition, many CFS and FM patients express frustration because there is no clear
treatment path for their conditions.

Dr. Holtorf's research was further confirmed in an observational study following
the conditions of 500 patients from his clinic, where of the patients given
cortisol as part of their treatment protocol:
* 94 percent showed improvement by the fourth visit;
* 75 percent noted significant improvement;
* 62 percent reported substantial improvement; and
* Energy levels and a general sense of well-being for patients doubled by the
  fourth visit.

The effectiveness of this multi-system treatment was further confirmed through
the analysis of the cumulative findings of over 40 independent physicians and
over 5,000 patients.

As shown in the Journal of Chronic Fatigue Syndrome study, cortisol doses of
5-to-15mg a day have been shown to be safe, with little or no associated risk
while having the potential for significant benefit for CFS and FM patients.

'Cortisol treatment carries significantly less risk and a greater potential
for benefit than treatments considered to be the standard of care for both
conditions,' Dr. Holtorf explains.

What is Chronic Fatigue Syndrome?

Chronic fatigue syndrome, or CFS, is a debilitating and complex disease
characterized by profound fatigue that is not improved by bed rest and that may
be worsened by physical or mental activity. Persons with CFS most often function
at a substantially lower level of activity than they were capable of before the
onset of illness. In addition, patients report various symptoms, such as
weakness, muscle pain, impaired memory and/or mental concentration, insomnia,
and post-exertional fatigue lasting more than 24 hours. In some cases, CFS can
persist for years. The cause or causes of CFS have not been identified and no
specific diagnostic tests are available.

What is Fibromyalgia?

Fibromyalgia or FM is a chronic pain condition characterized by generalized
muscular pain and fatigue. Fibromyalgia typically involves pain in the muscles,
ligaments and tendons and related sleep and quality of life disturbances. This
condition is often referred to as a 'syndrome' because it is a set of signs and
symptoms that occur together. The disease is often misunderstood because its
symptoms are quite common; however, medical studies have proven that
fibromyalgia does indeed exist.

Kent Holtorf, M.D.

Kent Holtorf, M.D. is an expert in the treatment of chronic fatigue syndrome,
fibromyalgia, complex endocrine dysfunction and chronic infections (including
EBV, HHV6 and Lyme disease). Dr. Holtorf received his doctorate of medicine from
St. Louis University with residency training at UCLA. He has personally trained
numerous physicians across the country to effectively treat chronic fatigue
syndrome, fibromyalgia and chronic infectious diseases. Additionally, Dr.
Holtorf was the founding medical director and developed the protocols for
Fibromyalgia and Fatigue Centers and other centers across the country.

(c) 2008 EurekaAlert

Tuesday, April 8, 2008

RIP Miss Kitty

Miss Kitty was not feeling well this morning and by afternoon it was  obvious
that it was getting worse.  So instead of waiting for our  appointment
tomorrow with Dr. Katie, we took her to the emergency clinic.   By the time we got
her there, she could not even stand up.

Given the speed of deterioration, the doctor was not optimistic.  The  vet
tech came in with an estimate of the charges and while we were discussing  them,
Kitty wet the exam table (which definitely is not the  fastidious Miss Kitty
I know) and started crying in pain.  That made the  decision easy.

Her loving Aunt Kathy, who ironically left us on Miss Kitty's birthday a few years ago, is waiting to take care of her until I get there, so I know she's in good hands.

                RIP  Miss Kitty  9/9/91 - 4/8/08