Powerful Evidence That Chronic Fatigue Syndrome (CFS) And Fibromyalgia (FM) Are Real And Mainly Physical


Key ArticleLight, A et. al. Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome. J Intern Med. 2012 Jan;271(1):64-81*  Web address for complete paper is HERE
Alan Light, Ph.D, Lucinda Bateman, M.D. and colleagues from the University of Utah School of Medicine measured messenger RNA output from 13 selected genes both before and  over 48 hours after 25 minutes of exercise on a stationary bicycle.
The subjects included 48 patients with CFS-ME with or without co-occurring FM, 18 Patients who had FM but not CFS and 49 healthy controls. The 13 genes monitored relate to sensory nerve signaling, cytokine and immune function and the sympathetic nervous system.  Gene activity was inferred from the level of messenger RNA derived from each gene as expressed on the subjects’ white blood cells.
Results: CFS and FM patients reported increased symptoms of pain or fatigue throughout the 48 hours post exercise. In controls, there was no reported fatigue and no significant change in gene expression. In 71% of patients with CFS, whether with or without co-occurring FM, moderate exercise increased  messenger RNA output from 12 of the 13 genes. 
In the other 29% of CFS patients exercise caused decreased transcription of messenger RNA from an adrenalin related gene. Many of these patients had a clinical history of orthostatic intolerance. In contrast, the FM-only patients showed no post exercise changes in gene expression. However, their baseline level for several key genes were already abnormal at rest.
SignificanceThis is one of very few studies that identified an objective laboratory marker which closely correlates with the patients’ complaints of a prolonged increase symptoms after modest exertion. This is very important both politically and as a guide toward future research. Two different subgroups of CFS patients were identified. FM co-occurring with CFS may be mechanistically different from FM that occurs without major fatigue.
Personal Opinion: After considerable effort Dr. Light has obtained a modest research grant from NIH. If our goal is to make research money productive, I’d say that further support for Dr. Light’s work should be a priority.
Richard Podell, M.D
Clinical Professor
Dept of Family Medicine
Robert Wood Johnson Medical School

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