Background Patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) sometimes present with stiffness of the cervical muscles. To investigate the pathophysiology of ME/CFS, this observational study compared patients with versus without recovery from ME/CFS through local modulation of the cervical muscles. Methods Over a period of 11 years, a total of 1226 inpatients with ME/CFS who did not respond to outpatient care were enrolled in this study. All patients received daily cervical muscle physical therapy during hospitalization. Self-rated records documenting the presence or absence of ME/CFS, as well as the representative eight symptoms that frequently accompany it at admission and discharge, were compared. Pupil diameter was also measured to examine autonomic nervous system function involvement. Results The recovery rate of ME/CFS after local therapy was 55.5%, and did not differ significantly by sex, age strata, and hospitalization period. The recovery rates of the eight symptoms were variable (36.6–86.9%); however, those of ME/CFS in the symptom subpopulations were similar (52.3–55.8%). The recovery rates of all symptoms showed strong associations with that of ME/CFS (p < 0.001). The pupil diameter was more constricted in the ME/CFS-recovered patients than in the ME/CFS-unrecovered patients in the total population and the subpopulations stratified by sex, age, and hospitalization period. Conclusions There was a strong association between the recovery of ME/CFS and other related whole-body symptoms. The recovery of ME/CFS may be partly linked to amelioration of the autonomic nervous system in the cervical muscles. Trial registration UMIN000036634. Registered 1 May 2019 - Retrospectively registered.
Background A considerable number of patients with whiplash-associated disorders (WAD) report variable and indefinite symptoms involving the whole body, despite there being no evidence of direct injuries to organs other than the neck. However, little is known about their management or underlying mechanism. This study examined the effect of intensive physical therapy at the cervical muscles in patients with WAD reporting whole-body indefinite symptoms. Methods A total of 194 hospitalized patients with WAD who were resistant to outpatient care by reporting whole-body indefinite symptoms between May 2006 and May 2017 were enrolled in this observational study. All patients underwent daily physical therapies by low-frequency electric stimulation therapy and far-infrared irradiation to the cervical muscles during hospitalization. Self-rated records in the medical interview sheets on 22 representative whole-body symptoms at admission and discharge were compared. Results The number of symptoms was markedly decreased by the physical therapies during hospitalization. Almost all symptoms showed recovery rates of more than 80% at discharge as compared to those at admission. Although the percentage of patients reporting at least four of the 22 representative indefinite symptoms was 99.0% at admission, it decreased to 7.7% at discharge. Sixteen percent of patients recovered completely without any residual symptoms. The mean number of symptoms significantly decreased from 13.1 at admission to 2.0 at discharge. Notably, symptoms other than those in the neck or shoulder recovered to a greater extent than those in the neck or shoulder. Conclusions This study, for the first time, examined the management of whole-body indefinite symptoms in patients with WAD. The intensive physical therapy markedly improved the symptoms, suggesting the involvement of cervical muscles in the pathogenesis. Trial registration UMIN000035435 (Retrospectively registered on Jan 3, 2019). Electronic supplementary material The online version of this article (10.1186/s12891-019-2621-1) contains supplementary material, which is available to authorized users.
Background: Patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) sometimes coincide with stiffness of cervical muscles. This study examined the effect of local modulation of the cervical muscles on ME/CFS and the underlying mechanism.Methods: In total, 1,226 inpatients with ME/CFS who were resistant to outpatient care were enrolled in this study for 11 years. All patients underwent daily physical therapies to the cervical muscles during hospitalization. Self-rated records documenting the presence and absence of ME/CFS and the representative eight disorders that frequently accompany it at admission and discharge were compared. The pupil diameter was also measured to examine involvement of autonomic nervous system function.Results: The recovery rate of ME/CFS after local therapy was 55.5%, and did not differ significantly by sex, age strata, and hospitalization period. The recovery rates of the eight disorders were variable (36.6-86.9%); however, those of ME/CFS in the disorder subpopulations were similar (52.3-55.8%). The recovery rates of all disorders showed strong associations with that of ME/CFS (p<0.001). The pupil diameter was decreased at discharge, and the change was significantly higher in the ME/CFS-recovered patients than ME/CFS-unrecovered patients in the total population and the subpopulations stratified by sex, age, and hospitalization period.Conclusions: Local therapy to the cervical muscles led to recovery in more than half of patients with ME/CFS, at least partly through amelioration of the autonomic nervous system. There may be a causal relationship between recoveries of ME/CFS and these related whole-body disorders.Trial registration ID: UMIN000036634. Registered 1 May 2019 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/index.cgi
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