Chronic Fatigue Syndrome (CFS): a hypothesis focusing on the autonomic nervous system

Chronic fatigue syndrome is a debilitating illness of unknown

aetiology, with estimated levels of prevalence of up to about

8. 7/100 000 in the U.S.A. Like pain fatigue it is a personal,

emotionally rich experience, which may originate from

peripheral or central sites (or both). The nature of the

symptoms is complex and reflects the interaction of the

patient with the environment and cultural milieu. Accordingly

the common use of the same terminology for different types of

fatigue may be misleading. Autonomic activation is a key

component of both real and simulated physical exercise.

Alterations in autonomic nervous system activity are a key

component of several physiopathological conditions.

In chronic

fatigue syndrome disturbances in autonomic activity, and in

other homoeostatic mechanisms, such as the hormonal and immune

systems, have been reported recently. In this review we

followed the hypothesis that in chronic fatigue syndrome the

paradoxical condition of disturbing somatic symptoms in the

absence of organic evidence of disease might be addressed by

focusing on attending functional correlates. In particular we

addressed possible alterations in cardiovascular autonomic

control, as can be assessed by spectral analysis of R-R

interval and systolic arterial pressure variability. With this

approach, in subjects complaining of unexplained fatigue, we

obtained data suggesting a condition of prevailing sympathetic

modulation of the sino-atrial node at rest, and reduced

responsiveness to excitatory stimuli.

Far from considering the

issue resolved, we propose that in the context of the multiple

physiological and psychological interactions involved in the

perception and self-reporting of symptoms, attendant changes

in physiological equivalents might furnish a convenient

assessment independent from subjective components. Indices of

sympathetic modulation could, accordingly, provide

quantifiable signs of the interaction between subject’s

efforts and environmental demands, independently of self

descriptions, which could provide convenient measurable

outcomes, both for diagnosis and treatment titration in

chronic fatigue syndrome.

Pagani M, Lucini D

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