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Posted to Co-Cure Mon, 21 Aug 2000 23:04:35 -0400 by Fred Springfield

Coping Styles, Anger, Social Support, and Suicide Risk of Women with FMS

Coping Styles, Anger, Social Support, and Suicide Risk of Women with Fibromyalgia Syndrome.
Journal of Musculoskeletal Pain Vol.8, No. 3, 2000, pp. 7-20
Marianne Amir, Ph.D.; Lily Neumann, Ph.D.; Orley Bor, M.A.; Yoram Shir, M.D.; Alan Rubinow, M.D.; Dan Buskila, M.D.
Objectives: Previous studies have shown that fibromyalgia [FMS] patients have certain personality characteristics. The objective of the present study was to examine a number of personality traits in these patients.

Methods: Four groups of female patients participated in the study, 51 FMS patients, 51 rheumatoid arthritis patients, 50 lower back patients and 50 healthy women. The participants were administered a battery of self-report paper-and-pencil instruments measuring coping styles, state and trait anger, suicide risk, and social support.

Results: The results showed that the personality traits studied here were similar between the three chronic pain patient groups. These patients scored significantly higher in the coping style of avoidance and on the measure of anger than the healthy women. Concerning the other variables no differences were observed. Specifically, the FMS group did not differ significantly from the other patient groups on any of the variables.

Conclusions: The findings indicate that the specific personality traits studied here are not relevant for the FMS and other traits have to be examined.

[ Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: .]

KEYWORDS. Fibromyalgia, coping styles, anger, social support

Marianne Amir, PhD, is Senior Lecturer, and Orley Bor, MA, is a Graduate Student, Department of Behavioral Sciences and Department of Social Work, BenGurion University of the Negev, Beer-Sheva, Israel.

Lily Neumann, PhD, is Professor, Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Yoram Shir, MD, is Senior Lecturer, Department of Anesthesiology and Pain Treatment Unit, Hadassah University Hospital, Jerusalem, Israel.

Alan Rubinow, MD, is Professor and Head of Rheumatic Disease Unit, Hadassah University Hospital, Jerusalem, Israel.

Dan Buskila, MD, is Professor and Head of Rheumatic Disease Unit, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Address correspondence to: Marianne Amir, PhD, Department of Behavioral Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84105 Beer-Sheva, Israel [E-mail: ].

Submitted: April 6, 1999.
Revision accepted: July 22, 1999.

© 2000 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Mon, 21 Aug 2000 19:17:31 -0400 by Fred Springfield

Consoler Toujours - To Comfort Always

Journal of Musculoskeletal Pain, Vol. 8(3) 2000
by I. Jon Russell, MD, PhD

Consoler Toujours -To Comfort Always

On Gotzon Borglum’s statue of Dr. Edward Livingston Trudeau at Saranac Lake, New York, was inscribed the following French phrase:

“Guerir quelquefois, soulager souvent, consoler toujours.”

Idiomatically translated into English, the meaning is: “to cure sometimes, to relieve often, to comfort always” (1). This folk saying, dating back at least to the fifteenth century, emphasizes the commission of all health care workers. Certainly, the goal is dramatic and permanent eradication of illness, but that is not always possible. Certainly, the objective is to relieve suffering, but that too can be elusive. The progress of modern medical science in some areas has been so rapid that expectations in other areas can become unrealistic. Many clinical disorders are still poorly understood, but our inadequacy should not cause us to blame the patients for being ill. Dr. T. F. Main raised the gauntlet when he said: “The sufferer who frustrates a keen therapist by failing to improve is always in danger of meeting primitive human behavior disguised as treatment”(2).

In his time, Dr. Trudeau was a well known physician and patient advocate. He offered humanistic hope for people with tuberculosis at a time when there seemed to be no hope. He developed a method of caring for patients in the early stages of the disease, then, he legitimated that system to the public, and finally, he defended it before his fellow physicians. The extent of his success is a testimony to the legitimacy of his approach. Fibromyalgia syndrome IFMSI, chronic fatigue syndrome, and the myofascial pain syndrome are just three of the many clinical disorders which are still poorly understood. In time, our understanding of these disorders will improve and with understanding, more effective therapeutic modalities will be developed. Until it is possible for health care professionals to cure or even to completely relieve, it is our reasonable responsibility to “always” provide the comfort of genuine human empathy.

If there were a theme for this issue of the Journal it would be “seeking to understand the patient’s view.” The first three original manuscripts examine again the personality, the self-perception of body pain, and the patient’s perspective. It is clearly possible that patients could misinterpret their symptoms or over read the significance of predisposing factors, but their insight may also be instructive beyond current traditional thought. Despite the difficulties of interpretation, of valid comparison groups, of analytic methodology, how do patients with chronic pain view themselves?

For years, it has been intimated that patients with FMS exhibit specific personality traits described by terms such as: compulsive, dependent, hypervigilant, depressive, anxious, somatizer, catastrophizer, list maker, etc. The lead article by Amir and colleagues from Israel (4) used validated questionnaire instruments and reasonable sample sizes to examine personality traits in women with three different painful conditions [rheumatoid arthritis, low back pain, FMS] compared with age-matched healthy normal women. Their analyses indicated that living with chronic pain was far more influential on personality patterns than was the specific diagnosis of FMS.

From a rehabilitation unit in Finland, Viitanen and colleagues (5) compared subjective self-assessments of FMS patients with those of rheumatoid arthritis patients. Pain was a major problem for both groups but was perceived as being more severe in FMS. Both disorders exhibited comparable levels of perceived global ill health, poor quality of life, and inability to work effectively. They also had comparable expectations with regard to the ability of rehabilitation modalities to help them.

The contribution by Prince and colleagues (6) from the University of Cincinnati and Southern Illinois University involved FMS outpatients from three states . The patients were recruited by their support group leaders, and were not specifically examined by a research physician for the purpose of confirming diagnostic criteria, so there is some uncertainty about the diagnosis of FMS and the extent of overlap with other medical conditions. For example, over 10% reported having had cancer and over 50% reported also having arthritis. On the other hand, their experiences and their opinions about a number of clinical phenomena were remarkably similar from one region to the other across the country. For example, about one-third perceived that an accident had contributed to the onset of their symptoms and a similar proportion believed that other family members were similarly affected.

Their perception that their symptoms change with the barometric pressure could easily be critiqued because it is unlikely that they actually know the barometric pressure on an ongoing basis. In this case, the barometric pressure is probably an alias for what the individual perceives as a change in the weather. On the other hand, two studies have shown that FMS symptoms do not consistently change with the weather (7,8), so what is the essence of this observation?

When I was a child, I had a reactive airway condition that was called asthma. Melodramatically perhaps, I thought that it would cause my death at a young age. In fact, my cousin actually did die of asthma in a college dormitory room. My perception during an attack was that I could not get air in. My pulmonary medicine professors later taught me that the problem was getting air out, but the two mechanistic explanations are clearly related. The question is, what should we be learning from these perceptions of the FMS patients?

Other contributions of interest include another attempt by Drewes and colleagues from Denmark (9) to document the induction of pain by deprivation of slow wave sleep. The previous literature on this question is well documented by the authors. Kuan and colleagues from Taiwan (10) further expand our understanding of the myofascial trigger point in an animal model. Chen and colleagues from the same institution in Taiwan (11) report a transient decrease in forearm muscle pressure pain threshold following 20 minutes of continuous piano practice.

Don’t miss the outstanding feast of information in the Literature Review columns, an interesting Research Ideas contribution, the Letters to the Editor, and the Book Reviews sections.

If the contents of this issue please you, or prompt concern, you are welcome to share your opinions in a Letter to the Editor. If you are a reader of the Journal, but not a member of the International MYOPAIN Society, consider joining this growing organization of health care professionals who intend to make a difference. The Journal subscription is just one of many benefits of membership. Applications for membership can be obtained from the Editorial Office or from any of the officers.

I. Jon Russell, MD, PhD


1. Anonymous: Familiar Medical Quotations. MB Strauss, Editor, Little, Brown and Co., Boston, 1968, page 410.
2. Main TF: British Heart Journal, 1957.
3. Ellison DL: Healing Tuberculosis in the Woods, Medicine and Science at the End of the Nineteenth Century. Greenwood Press, Westport, Conn. 1994 [ISBN: 0-313-29005-91.]
4. Amir M, Neumann L, Bor 0, Shir Y, Rubinow A, Buskila D: Coping styles, anger, social support, and suicide risk of women with fibromyalgia syndrome. J Musculoske Pain 8(3):7-19, 2000.
5. Viitanen J, Ronni 5, Ala-Peijari 5, Uoti-Reilama K, Kautiainen H: A comparison of self-estimated symptoms and impact of disease in fibromyalgia and rheumatoid arthritis. J Musculoske Pain 8(3):21-34, 2000.
6. Prince A, Bernard AL, Edsall PA: A descriptive analysis of fibromyalgia from the patients’ perspective. J Musculoske Pain 8(3):35-47, 2000.
7. de Blecourt AC, Knipping AA, de Voogd N, van Rijswijk MH: Weather conditions and complaints in fibromyalgia. J Rheumatol 20(11):1932-4, 1993.
8. Viitanen J, Kautialnen H, Isomaki H: Changes in atmospheric pressure do not influence the pain of patients with primary fibromyalgia. J Musculoske Pain 3(1):77-82, 1995.
9. Drewes JAM, Nielsen KD, Rasmussen C, Arimar T, Svensson P, Rössel P, Arendt-Nielsen L: The effects of controlled delta sleep deprivation on experimental pain in healthy subjects. J Musculoske Pain 8(3):49-67, 2000.
10. Kuan T-S, Lin T-S, Chen J-T, Chen S-M, Hong C-Z: No increased neuromuscular jitter at rabbit skeletal muscle trigger spot spontaneous electrical activity sites. J Muscu loske Pain 8(3):69-82, 2000.
11. Chen S-M, Chen J-T, Kuan T-S, Hong J, Hong C-Z: Decrease in pressure pain thresholds of latent myofascial trigger points in the middle finger extensors immediately after continuous piano practice. J Musculoske Pain 8(3):83-92, 2000.

Journal of Musculoskeletal Pain, Vol. 8(3) 2000
© 2000 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Mon, 21 Aug 2000 00:16:05 -0400 by Ray Colliton

CFS Affects Blood Pressure Response

Sunday August 20 12:35 PM EDT
CFS Affects Blood Pressure Response
By Nancy A. Melville
HealthSCOUT Reporter

SUNDAY, Aug. 20 (HealthSCOUT) -- A new study of chronic fatigue syndrome (CFS) in Gulf War veterans has found there may indeed be a physical basis for the condition.

CFS is baffling with no known cause but a lot of theories, ranging from chemical reactions to psychological disorders. Doctors often misdiagnose it as depression.

The latest study compared 51 Gulf War vets with CFS symptoms with 42 veterans without symptoms and found a distinctive difference in blood pressure reactions. Those with CFS symptoms showed lower blood-pressure responses in two mental stress tests, which indicates a suppression of cardiovascular responses.

"This kind of blunted response indicates that there is something in the system, either in the brain or the blood vessels or somewhere else, that's not functioning properly," says lead study author Arnold Peckerman, a clinical professor at the New Jersey Medical School.

Read the complete article

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Posted to Co-Cure Sun, 20 Aug 2000 02:08:23 -0400 by Kimberly Hare

Evidence-based data on pain relief with antidepressants

Evidence-based data on pain relief with antidepressants.
Ann Med 2000 Jul;32(5):305-16
Fishbain D
University of Miami School of Medicine, Department of Psychiatry, University of Miami Comprehensive Pain and Rehabilitation Center at South Shore Hospital, USA.
PMID: 10949061, UI: 20403337

This structured review addresses the issue of whether antidepressants have an antinociceptive (analgesic) effect for chronic pain independent of their antidepressant effect. In order to answer this question, human acute pain studies, individual placebo-controlled studies for the treatment of specific chronic pain syndromes, and metaanalytic studies were reviewed and placed into table format.

Analysis of this evidence led to the following conclusions: The evidence was consistent in indicating that overall antidepressants may have an antinociceptive effect in chronic pain, and that these drugs were effective for neuropathic pain. There was also some evidence that these drugs could be effective for psychogenic or somatoform disorder-associated pain. This evidence also strongly suggested that serotonergic-noradrenergic antidepressants may have a more consistent antinociceptive effect than the serotonergic antidepressants. Finally, this evidence indicated that antidepressants could be effective for pain associated with some specific pain syndromes, such as chronic low back pain, osteoarthritis or rheumatoid arthritis, fibrositis or fibromyalgia, and ulcer healing.

Possible reasons for the conflicting results of studies in this area are presented, and problems that could limit the validity of the conclusions of this review are discussed.

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Posted to Co-Cure Fri, 18 Aug 2000 05:56:56 -0400 by Kimberly Hare

Acupuncture as a treatment for fibromyalgia

Wien Klin Wochenschr 2000 Jul 7;112(13):580-6
[No title available]
[Article in German]
Sprott H, Jeschonneck M, Grohmann G, Hein G
Rheumaklinik und Institut fur Physikalische Medizin, Universitatsspital Zurich, Schweiz.
PMID: 10944816, UI: 20401113

Apart from widespread pain which is the main symptom of fibromyalgia, a great variety of functional and vegetative changes occur in the presence of this disease. Such changes include alterations in microcirculation, which may cause pain. A preliminary study demonstrated a reduction in regional blood flow above "tender points" in fibromyalgia patients compared with healthy controls.

A consensus statement of the National Institutes of Health (NIH) states that acupuncture is a sufficient adjuvant method to treat patients with fibromyalgia. The aim of the present study was to determine parameters to measure the effectiveness of a specific treatment modality (such as acupuncture) in addition to the patient's subjective assessment of acupuncture treatment.

Twenty patients with fibromyalgia according to the ACR and the Muller/Lautenschlager criteria were included in the study. Acupuncture was performed and adapted to individual needs in accordance with a specific protocol. Five representative "tender points" were examined before and after therapy by laser flowmetry, and the data were compared with temperature measurement and dolorimetry.

Increased blood flow was registered above all "tender points" after acupuncture. Skin temperature had increased in 10/12 tender points by a mean of 0.45 degree C. The number of "tender points" were reduced from 16.1 to 13.8 after therapy. The pain threshold increased in 10/12 "tender points". These data suggest that acupuncture is a useful method to treat patients with fibromyalgia. Besides normalisation of clinical parameters, the improvement in microcirculation above "tender points" may alleviate pain.

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Posted to Co-Cure Thu, 17 Aug 2000 23:41:13 -0700 by Melissa O'Toole

Strength and physiological response to exercise in patients with CFS

Strength and physiological response to exercise in patients with chronic fatigue syndrome.
J Neurol Neurosurg Psychiatry 2000 Sep;69(3):302-307
Fulcher KY, White PD
National Sports Medicine Institute, St Bartholomew's and the Royal London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK.
PMID: 10945803

OBJECTIVE: To measure strength, aerobic exercise capacity and efficiency, and functional incapacity in patients with chronic fatigue syndrome (CFS) who do not have a current psychiatric disorder.

METHODS: Sixty six patients with CFS without a current psychiatric disorder, 30 healthy but sedentary controls, and 15 patients with a current major depressive disorder were recruited into the study. Exercise capacity and efficiency were assessed by monitoring peak and submaximal oxygen uptake, heart rate, blood lactate, duration of exercise, and perceived exertion during a treadmill walking test. Strength was measured using twitch interpolated voluntary isometric quadriceps contractions. Symptomatic measures included physical and mental fatigue, mood, sleep, somatic amplification, and functional incapacity.

RESULTS: Compared with sedentary controls, patients with CFS were physically weaker, had a significantly reduced exercise capacity, and perceived greater effort during exercise, but were equally unfit. Compared with depressed controls, patients with CFS had significantly higher submaximal oxygen uptakes during exercise, were weaker, and perceived greater physical fatigue and incapacity. Multiple regression models suggested that exercise incapacity in CFS was related to quadriceps muscle weakness, increased cardiovascular response to exercise, and body mass index. The best model of the increased exercise capacity found after graded exercise therapy consisted of a reduction in submaximal heart rate response to exercise.

CONCLUSIONS: Patients with CFS were weaker than sedentary and depressed controls and as unfit as sedentary controls. Low exercise capacity in patients with CFS was related to quadriceps muscle weakness, low physical fitness, and a high body mass ratio. Improved physical fitness after treatment was associated with increased exercise capacity. These data imply that physical deconditioning helps to maintain physical disability in CFS and that a treatment designed to reverse deconditioning helps to improve physical function.

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Posted to Co-Cure Thu, 17 Aug 2000 00:39:16 -0700 by Melissa O'Toole

Free radicals in CFS - cause or effect?

Free radicals in chronic fatigue syndrome: cause or effect?
Redox Rep 2000;5(2-3):146-7
Richards RS, Roberts TK, Dunstan RH, McGregor NR, Butt HL
Department of Biological Sciences, University of Newcastle, New South Wales, Australia.
PMID: 10939298, UI: 20393292

We have demonstrated that certain morphological and biochemical changes occur in chronic fatigue syndrome (CFS) and in rheumatoid arthritis (RA). These changes in RA can be explained by the well-established inappropriate increase in free radical generation. The similar changes in CFS suggest a similar explanation and a possible role for free radicals in the aetiology of this condition.

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Posted to Co-Cure Wed, 16 Aug 2000 00:45:02 -0400 by Fred Springfield

A Comparative Analysis of Quality of Life in Rheumatoid Arthritis and Fibromyalgia

A Comparative Analysis of Quality of Life in Rheumatoid Arthritis and Fibromyalgia
Journal of Musculoskeletal Pain, Vol. 7(4) 1999 pp. 5-14
Pinar Borman, M.D.; Reyhan Celiker, M.D.

Objectives: The aim of this study was to explore quality of life [QOL] in rheumatoid arthritis [RA] and fibromyalgia syndrome [FMS] patients.

Methods: Twenty-six RA, 22 FMS patients and 25 control subjects were examined. The Nottingham Health Profile was used to assess quality of life in the subjects.

Results: All dimensions of the NHP in RA and FMS patients were significantly higher than in the control group. The physical activity and pain scores of the RA group were higher than in the FMS group, whereas energy, social isolation, sleep, and emotional reaction scores were higher in FMS patients.

Conclusion: Quality of life as measured by the NHP confirms our expectation that individuals with increasing functional disability have a reduced QOL especially in the physical sections. But FMS patients suffering from widespread pain have a more decreased QOL except for the levels of disability.

[ Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: .]

KEYWORDS. Quality of life, rheumatoid arthritis, fibromyalgia, Nottingham Health Profile

Pinar Borman, MD, is Specialist, University of Hacettepe, School of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkey [E-mail: ].
Reyhan Celiker, MD, is Associate Professor, Hacettepe University School of Medicine, Department of Physical Medicine and Rehabilitation, 06100 Ankara, Turkey [E-mail: ].
Address correspondence to: Pinar Borman, MD, Iran Cad. Turan Emeksiz Sok., Kent Sitesi A-Blok 5/3, GOP 06700 Ankara, Turkey.
Submitted: March 1, 1999.
Revision accepted: May 25, 1999.

© 1999 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Mon, 14 Aug 2000 02:32:46 -0400 by Fred Springfield

Current Research on Myofascial Trigger Points - Pathophysiological Studies

Current Research on Myofascial Trigger Points - Pathophysiological Studies
Journal of Musculoskeletal Pain Vol.7, No. 1/2, 1999, pp. 121-129
Chang-Zern Hong, M.D.
Department of Physical Medicine and Rehabilitation, University of California Irvine, Orange, CA 92868-3201.


Objectives: To summarize recent studies on myofascial trigger point [MTrP] to further clarify the mechanism of MTrP.

Methods: To review recent clinical and basic science studies related to the pathophysiology of MTrPs.

Results: There are multiple loci in an MTrP region. A clinical MTrP characteristically exhibits a sensory component [sensitive locus] and a motor component [active locus]. A sensitive locus is the site from which spot tenderness, referred pain [ReP], and local twitch response [LTR] can he elicited by mechanical stimulation. Sensitive loci [probably sensitized nociceptors] can be widely distributed in the whole muscle, but are concentrated in the endplate zone. An active locus is the site from which spontaneous electrical activity [SEA] can be recorded. Active loci are dysfunctional endplates, since SEA is essentially the same as electrical activity recorded from an abnormal endplate as reported by neurophysiologists. An MTrP is always found in a taut band which is histologically related to contraction knots caused by excessive release of acetylcholine in an abnormal endplate. Both ReP and LTR are mediated through spinal cord mechanisms, demonstrated in both human and animal studies.

Conclusions: The pathogenesis of MTrPs appears to involve serious disturbance of the nerve ending and contractile mechanism at multiple dysfunctional endplates.

Since The Trigger Point Manual, Volume 1, first edition (1) was published, many clinicians have learned appropriate and efficient ways to treat their patients who have chronic pain syndrome due to myofascial trigger points {MTrPsj. In the last 10-15 years, many clinical and basic science research studies of MTrPs have been published. The pathophysiology of an MTrP is now much clearer (2-6). Clarification of the MTrP mechanism is essential for treating MTrPs more appropriately and efficiently.

[ Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: .]

© 1999 by The Haworth Press, Inc. All rights reserved.

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Posted to Co-Cure Sun, 13 Aug 2000 20:27:59 -0400

Tobacco Use and CFS, FMS and TMD

Editor's Correspondence
Archives of Internal Medicine
Vol. 160 No. 15, August 14/28, 2000

Tobacco Use and Chronic Fatigue Syndrome, Fibromyalgia, and Temporomandibular Disorder

The letter is by Stephen J. Jay, MD of Indianapolis, IN. The reply is written by Leslie A. Aaron, PhD, MPH and Dedra Buchwald, MD of Seattle, WA.

Read the Letters

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Posted to Co-Cure Sat, 12 Aug 2000 01:50:14 -0400 by Kimberly Hare

Autonomic nervous system dysfunction in adolescents with POTS and CFS

Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic fatigue syndrome is characterized by attenuated vagal baroreflex and potentiated sympathetic vasomotion.
Pediatr Res 2000 Aug;48(2):218-26
Stewart JM
Department of Pediatrics, The Center for Pediatric Hypotension, New York Medical College, Valhalla 10595, USA.
PMID: 10926298, UI: 20380311

The objective was to determine the nature of autonomic and vasomotor changes in adolescent patients with orthostatic tachycardia associated with the chronic fatigue syndrome (CFS) and the postural orthostatic tachycardia syndrome (POTS).

Continuous electrocardiography and arterial tonometry was used to investigate the heart rate and blood pressure responses before and 3-5 min after head-up tilt in 22 adolescents with POTS and 14 adolescents with CFS, compared with control subjects comprising 10 healthy adolescents and 20 patients with simple faint. Heart rate and blood pressure variability, determined baroreceptor function using transfer function analysis, and measured cardiac vagal and adrenergic autonomic responses were calculated using timed breathing and the quantitative Valsalva maneuver.

Two of 10 healthy controls and 14 of 20 simple faint patients experienced vasovagal syncope during head-up tilt. By design, all CFS and POTS patients experienced orthostatic tachycardia, often associated with hypotension. R-R interval and heart rate variability were decreased in CFS and POTS patients compared with control subjects and remained decreased with head-up tilt. Low-frequency (0.05-0.15 Hz) blood pressure variability reflecting vasomotion was increased in CFS and POTS patients compared with control subjects and increased further with head-up tilt.

This was associated with depressed baroreflex transfer indicating baroreceptor attenuation through defective vagal efferent response. Only the sympathetic response remained. Heart rate variability declined progressively from normal healthy control subjects through syncope to POTS to CFS patients. Timed breathing and Valsalva maneuver were most often normal in CFS and POTS patients, although abnormalities in select individuals were found.

Heart rate and blood pressure regulation in POTS and CFS patients are similar and indicate attenuated efferent vagal baroreflex associated with increased vasomotor tone. Loss of beat-to-beat heart rate control may contribute to a destabilized blood pressure resulting in orthostatic intolerance. The dysautonomia of orthostatic intolerance in POTS and in chronic fatigue are similar.

Full Text of this article

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Note: All abstract summaries, unless otherwise noted, were prepared by Margaret Bailey.

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