Beyond Myalgic EncephalomyelitisChronic Fatigue Syndrome: Redefining an Illness by Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Author:Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Language: eng
Format: epub
Publisher: The National Academies Press
Published: 2015-03-26T00:00:00+00:00

5

Review of the Evidence on Other ME/CFS Symptoms and Manifestations

This chapter reviews the evidence on symptoms and manifestations of ME/CFS other than the major ones addressed in Chapter 4. Discussed in turn are pain, immune impairment, neuroendocrine manifestations, and infection.

PAIN

Description of Pain in ME/CFS

Pain is a defining characteristic of ME/CFS and is listed as either a required or additional symptom in all case definitions and diagnostic criteria evaluated in this report. The existing ME/CFS case definitions include muscle pain, joint pain, headaches, tender lymph nodes, and sore throat as pain symptoms (Carruthers et al., 2003, 2011; Fukuda et al., 1994; Jason et al., 2010; NICE, 2007). The Canadian Consensus Criteria (CCC), the Revised CCC, and the 2011 International Consensus Criteria for ME (ME-ICC) mention additional symptoms—including abdominal pain, chest pain, hyperalgesia, and stiffness—and such descriptors as myofascial, radiating, and migratory pain. Patients also described chronic pain behind the eyes, neck pain, neuropathic or nerve pain, “full-body ice-cream-headache-like pains,” and feeling like “my brain was going to explode” (FDA, 2013, p. 14).

The majority of ME/CFS patients experience some type of pain, although individual experiences with pain vary widely (FDA, 2013; Meeus et al., 2007; Unger, 2013). In one community-based study, 94 percent of respondents fulfilling the Fukuda definition reported muscle aches and pain, and 84 percent reported joint pain (Jason et al., 1999). Recent preliminary data from the Centers for Disease Control and Prevention’s (CDC’s) Multi-Site Clinical Study of CFS indicate that 80 percent of patients enrolled had experienced pain in the past week (Unger, 2013). Muscle aches and pains were the most common pain complaint (reported by 72 to 79 percent of patients), followed by joint pain (reported by 58 to 60 percent of patients) and headaches (reported by 48 to 56 percent of patients). Less common pain complaints included tender lymph nodes (37 to 39 percent), abdominal pain (32 percent), sore throat (25 to 28 percent), eye pain (23 percent), and chest pain (15 percent).1,2

Pain interferes similarly in the life of someone with ME/CFS and someone with spinal cord injury, muscular dystrophy, or multiple sclerosis3 (Unger, 2013). More severely disabled ME/CFS patients may experience more pain (Marshall et al., 2010). Regardless of the definitions used, the presence of chronic regional and widespread pain in individuals with ME/CFS is associated with poor general health, physical functioning, and sleep quality independently of ME/CFS (Aaron et al., 2002). In a systematic review of chronic musculoskeletal pain in ME/CFS (which included studies using various ME/CFS diagnostic criteria), Meeus and colleagues (2007) concluded that there is no consensus on the definition of chronic widespread pain in ME/CFS, and while there is no strong proof of its exact cause or prevalence, this pain is strongly disabling and not necessarily related to depression.

Patients diagnosed with ME/CFS experience more pain than the general population (Ickmans et al., 2013; Jason et al., 2013b). Employing moderate thresholds for frequency and severity, Jason and colleagues (2013b) found that a greater percentage of ME/CFS patients experienced pain symptoms relative to healthy controls (see Figure 5-1).

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.