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Novel approach to Chronic Fatigue and Pain Syndromes

Chronic Fatigue Syndrome (CFS) or Systemic Exertion Intolerance Disease (SEID) or Myalgic encephalomyelitis (ME) is defined by Center of Disease Control (CDC) as a serious, long-term illness that affects multiple organ systems. Those suffering from it have significant physical limitations in performing activities of daily living. In addition to fatigue, these individuals may also have sleep disturbances, dizziness, difficulty with concentration and memory, muscle and joint pains, sore throat, tender lymph nodes, headaches and digestive issues.

 

According to an Institute of Medicine (IOM) report published in 2015, upto 2.5 million Americans suffer from CFS,and most of them are undiagnosed.

 

Chronic Pain Syndrome (CPS) is defined as pain lasting for longer than 6 months. Almost 50 million Americans are partially or completely disabled due to chronic pain. These individuals suffer from complications such as fatigue, depression, and poor sleep quality. They are also at very high risk of developing dependence to pain medications such as opioids and alcohol.

 

Conventional Medicine has no specific tests to diagnose these conditions and does not offer much treatment except for medications for symptom relief which are often unsuccessful.

 

On the other hand a functional integrative approach to CFS and CPS addresses the root causes that lead to development of these syndromes.

 

Root Causes

 

Four root causes that are common to both syndromes

 

  1. Inflammation

  2. Nutritional deficiencies

  3. Imbalanced Neurotransmitters and hormones

  4. Oxidative Stress

Inflammation

 

Researchers at Stanford University School of Medicine in California found that inflammatory proteins such as interleukin-4 and leptin in the blood of patients with CFS. Similarly inflammatory proteins such as IL 2, IL 6 and TNF alpha were also identified in the blood of those with CPS.

 

Inflammation can manifest itself in multiple ways and effects organs throughout the body. This is the reason why people who present with multiple organ involvement clearly have underlying inflammation. The logical approach to these syndromes is to address what is the primary cause of the inflammation.

 

Research indicates that physical, emotional, and chemical trauma lead to chronic inflammation.

 

  • Examples of physical trauma would be concussion, bacterial, viral and fungal infections.

 

  • Emotional trauma includes different types of abuse, unsafe home environment, persistent or excessive mental stress.

  • Chemical stress includes exposure to different types of toxins such as antibiotics, steroids, immunosuppressant medications, metal toxins such as mercury, and persistent organic pollutants (POPs)

 

Low dose Naltrexone (LDN), Oxytocin (a hormone) as well as Cannabidiol (CBD) have shown very positive results in patients with chronic inflammation, fatigue and chronic pain.


Nutritional Deficiencies

 

A review of the scientific literature shows the presence of multiple nutritional deficiencies in individuals with chronic fatigue syndrome. These include deficiencies of vitamin C, B vitamins, Magnesium, Zinc, -tryptophan, L-carnitine, coenzyme Q10, and essential fatty acids. These deficiencies play an important role in causing symptoms as well as delaying the healing. In addition, it is difficult for patients to overcome these deficiencies through food or oral supplements if they have digestive issues, malabsorption, celiac disease or pathogens such as small intestinal bacterial overgrowth, leaky gut, Candida and parasites etc.

 

Vitamin D deficiency has been shown to play a very important role in modulating joint and muscle pains as well as fatigue. Rather all chronic diseases are associated with nutritional deficiencies which limit the ability of the body to overcome inflammation and there is a vicious circle whereby the deficiencies perpetuate the symptoms.

 

In a randomized control trial, intravenous micronutrient therapy resulted in a significant improvement of tender points, pain, depression, and quality of life. Dr. Alan Gaby published a paper that described all the chronic conditions that can be treated with intravenous therapy including Asthma, Migraine, fatigue, depression and chronic urticaria.

 

Hormonal and Neurotransmitter imbalances

 

A study by Romano et al. showed that 70% of patients with the fibromyalgia syndrome had a low growth hormone. Treatment with growth hormone resulted in improvement in perceived energy levels, body image, and pain level and cognition. Deficiency of growth hormone manifest itself as poor memory, depression, anxiety, fatigue, obesity as well as decreased muscle and bone mass. Similarly, the hormone Cortisol is a pro-inflammatory hormone that plays an important role in fatigue and pain. High dose intravenous ascorbic acid haelos significantly with adrenal fatigue.

 

Low levels of neurotransmitters such as Serotonin and Norepinephrine are found in patients with chronic pain, fatigue, depression, insomnia and premenstrual syndrome. Assessing and addressing hormones and neurotransmitters is a key step in helping patients reverse their disease and symptoms.

 

Oxidative Stress

 

Normal activities such as eating, breathing and moving requires the use of oxygen. When oxygen is used by the cells of the body, it leads to production of free radicals. Our bodies have anti-oxidants that prevent these radicals from causing damage. The oxygen radicals are highly reactive and can produce significant damage to different structures of cell.  Isoprostanes, superoxide dismutase and Glutathione peroxidase are established markers of oxidative stress and can  be measured in the urine. Patients with chronic fatigue and pain have elevated markers of oxidative stress and the degree of elevation correlates with the severity of symptoms. Patients with chronic diseases that have significant oxidant stress benefit from high dose intravenous antioxidants such as Glutathione and alpha lipoic acid.

 

Conclusion

 

An integrative functional approach provides an opportunity to replete the body with missing nutrients, balance hormones, overcome inflammation and oxidative stress in an attempt to help the body recover and heal. This is a long term, effective and comprehensive approach that can be personalized according to the patient’s genetic make-up, exposures, risks, environment and lifestyle.

References

 

  1. Sibille KT et al. Pain Research and Management, Volume 2016, Investigating the Burden of Chronic Pain: An Inflammatory and Metabolic Composite.

  2. Goh EL et al. Burns Trauma. 2017 Jan 19;5:2. Complex regional pain syndrome: a recent update.

  3. Werbach MR et al. Altern Med Rev. 2000 Apr;5(2):93-108. Nutritional strategies for treating chronic fatigue syndrome.

  4. Fletcher RH et al. JAMA. 2002 Jun 19;287(23):3127-9. Vitamins for chronic disease prevention in adults: clinical applications.

  5. Ali A. et al. J Altern Complement Med. 2009 Mar; 15(3): 247–257. Intravenous Micronutrient Therapy (Myers' Cocktail) for Fibromyalgia: A Placebo-Controlled Pilot Study.

  6. Book Nutritional Medicine by Dr. Alan Gaby 2nd edition 2017.

  7. Romano T. et al. Pain Practice Issue. 2009 Mar;9(Sup 1):118. Adult growth hormone deficiency in fibromyalgia.

  8. Sathiavageeswaran M. et al. Eur J Endocrinol. 2007;156:439–47. Effects of GH on cognitive function in elderly patients with adult-onset GH deficiency: A placebo-controlled 12-month study.

  9. Vishal Gupta et al. Indian J Endocrinol Metab. 2011 Sep; 15 (Suppl 3): S197–S202. Adult growth hormone deficiency

  10. Wilson JL. et al. Advances in Integrative Medicine. May 2014 Volume 1, Issue 2, Pages 93–96. Clinical perspective on stress, cortisol and adrenal fatigue.

  11. Kara E. Hannibal et al. Phys Ther. 2014 Dec;94(12):1816-25. Epub 2014 July. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation.

  12. Marks DM et al. Curr Neuropharmacol. 2009 Dec;7(4):331-6. Serotonin-norepinephrine reuptake inhibitors for pain control: premise and promise.

  13. Davis JM. et al. Am J Clin Nutr. 2000 Aug;72(2 Suppl):573S-8S. Serotonin and central nervous system fatigue: nutritional considerations.

  14. Kennedy G. et al. Free Radic Biol Med. 2005 Sep 1;39(5):584-9. Oxidative stress levels are raised in chronic fatigue syndrome and are associated with clinical symptoms.

  15. Kolberg C. et al. J Manipulative Physiol Ther. 2015 Feb;38(2):119-29. Peripheral Oxidative Stress Blood Markers in Patients With Chronic Back or Neck Pain Treated With High-Velocity, Low-Amplitude Manipulation.

  16. Sendur OF et al. Rheumatol Int. 2009 Apr;29(6):629-33. Serum antioxidants and nitric oxide levels in fibromyalgia: a controlled study.