IACFS/ME 09 Conference: Lifestyle Management

Not before time!

IACFS/ME 09 Conference: Lifestyle Management: "Mind:Body? Or is it Body:Mind? In the beginning, behavioral therapists suggested that people with chronic fatigue syndrome differ little from healthy people in a physiological sense but that they’re quite different psychologically; they’re either too absorbed in their symptoms or they’re depressed or anxious - i.e., if you could just get them to stop focusing so much on their problems, they’d get well.

Dr. Jason appears to believe that those early CBT practitioners were putting the cart before the horse. Rather than the mind driving the body, it may be that the body is driving the mind. All those symptoms (that anxiety, that depression. . .) are what occur when patients transgress their physiological capabilities. His research is putting stress reduction therapies into a physiological context rather than a psychological one. Instead of suggesting that ME/CFS patients are mental basket cases he’s proposing that they’re rather courageous individuals (yes, he did say ‘courageous’) bucking up against an impaired physiology that greatly limits their choices.

He proposed that, instead of cycles of maladaptive behavior driving their limitations, there are actual physiological limits to what ME/CFS patients can achieve. Once they get outside of that activity ‘safety zone’ they encounter increased levels of oxidative stress, and neuroendocrine and immune problems that cause their symptoms to flare up again.

His thinking is clearly borne out by increasing evidence that if you push ME/CFS patients too far in any way – physically or psychologically – in the street or in the laboratory – their systems are going to behave abnormally....

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Looked at in this light, instead of correcting patient's maladaptive thought patterns, cognitive behavioral therapies and other types of stress reduction approaches are doing nothing more than reducing stressful inputs and relieving the strain on an overworked system and allowing it to heal at least somewhat.

Don't Use It - Don't Lose It - The envelope theory is perfect for Dr. Jason’s studies. It relies on the idea that there’s only so much juice in a chronic fatigue syndrome patient's batteries. If you use that juice up it’s gone and needs to be built up again, but if you don’t use it up it can actually build up over time. In his study Dr. Jason had chronic fatigue syndrome patients use envelope theory techniques and recorded their symptom levels. His graphs vividly showed that as ME/CFS patients use up their energy their symptoms rise dramatically. On the other hand, when they were using the energy envelope techniques not only did their symptoms drop – dramatically – but over time their overall level of activity increased. Here was vivid evidence that lifestyle management techniques can pay off in improved health."

New hope for fibromyalgia sufferers

New hope for fibromyalgia sufferersAs many as 10 million Americans suffer from fibromyalgia, a chronic condition most noted by pain and fatigue. Despite a host of symptoms, experts say it is often misdiagnosed and misunderstood -- even by doctors. But now, new research is leading to new hope.

Experts say one problem is not all doctors are familiar with the condition. The symptoms are often vague and seem unrelated, and conventional tests typically come back normal.
"It doesn't have any markers to standard blood tests or x-rays. There's nothing in the blood that says, 'I have fibromyalgia.' There's nothing you're going to see on an x-ray," said fibromyalgia researcher Dr. Patrick Wood.
"It's a diagnosis of exclusion. Once you rule out more organic causes, diagnosis of fibromyalgia comes in," said rheumatologist Dr. Dan La.
Fibromyalgia was first identified more than 10 years ago. Yet there are still doctors who question whether the condition exists. Some suggest the symptoms are psychosomatic.
"There are still doctors who feel that," said Dr. La. "From my standpoint, I've seen these patients, some science behind it as well."
The exact cause isn't known, but some experts think stress or genetics may play a role. And while it's considered a muscle and joint condition, the majority of research - like that conducted by Dr. Wood - focuses on the brain.
"Changes in brain chemistry and levels of chemicals, such as dopamine or serotonin, are believed to be implicated," said Dr. Wood.
Recently, the FDA approved Lyrica as the first drug to treat fibromyalgia. Dr La says it's working for half of the patients he's prescribed it for.
Patients hope the FDA's move to approve Lyrica has legitimized the syndrome in the eyes of skeptics.