#55 Teitelbaum's treatment approach, CDC definition
CFS-NEWS Electronic Newsletter
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Chronic Fatigue Syndrome Electronic Newsletter
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No. 55 February 29, 1996 Washington DC
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TEITELBAUM'S NEW TREATMENT APPROACH / CFS DEFINITION
CONTENTS
>>>1. Study of Teitelbaum's new treatment approach
>>>2. Komaroff et al. examine the CDC case definition
>>>3. Neuropsych comparisons of CFS, Multiple Chemical
Sensitivities
>>>4. Medical publications update
>>>5. Publication of proceedings of 1994 clinical conference at
Florida
>>>6. Network news: change of Web URL
Note: the CFS-NEWS web page has changed its URL address to
http://www.alternatives.com/cfs-news/index.htm . See article below.
Thanks to the CFIDS Association of America, and Steve Clancy of the
University of California at Irvine, Science Library, for assistance
with this edition.]
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>>>1. Study of Teitelbaum's new treatment approach
Jacob Teitelbaum and Barbara Bird report on their multi-prong
approach to treating severe chronic fatigue states, including CFS and
Fibromyalgia, in article published in the Journal of Musculoskeletal
Pain. Their study shows that treating many sub-problems
simultaneously is much more effective than treating them one by one,
and that the prospects of long-term remission are greater if such a
program is applied.
In their paper, Teitelbaum and Bird report that 64 patients that were
treated in accordance with this principle showed an "almost complete
resolution of fatigue" in 37 cases (57 percent), and "significant but
incomplete improvement" in 25 cases (39 percent). The sub-problems
that received special attention for treatment include: subclinical
hypothyroidism, decreased adrenal function, fibromyalgia, chronic
infections (including bacterial/urinary-tract, bowel parasites, and
fungal), depression, and micronutrient deficiencies. Patients in
this study had been ill for a median of 3 years prior to the
treatment. Some of the patients who reported positive response had
been ill 10 to 15 years prior to treatment, according data presented
in the paper. Median length of treatment was seven weeks (ranging
from less than a week, to 15 months). Improvement appeared to endure
in most cases. Most subjects remained in follow-up for over one
year.
Teitelbaum explained his basic concept to CFS-NEWS as follows: "The
human body is a complex mechanism, perhaps like an automobile. If
your car is in a serious wreck, then merely fixing one component may
not necessarily get it started again. You must have all major
subcomponents working sufficiently well, and at the same time, in
order for the car to be able to start. A similar process seems to be
happening in severe chronic fatigue states."
The Teitelbaum/Bird paper further discusses how these sub-problems
may relate to endocrine and immunologic dysfunctions as explored in
other published research. It also discusses the interpretation of
laboratory tests and issues regarding treatments.
The journal citation for this paper is:
Teitelbaum J, Bird B. Effective Treatment of Severe Chronic
Fatigue: A Report of a Series of 64 Patients. Journal of
Musculoskeletal Pain 1995:3(4);91-110
Copies of this paper are available from the Haworth Document Delivery
service. Telephone to 1-800-722-5857 in the USA (some overseas
locations will need to dial 1-607-722-5857). The reprint of this
20-page article costs about $14 for individuals. Some individuals
may find it cheaper to order that entire edition instead of the one
article.
This study was conducted during 1991-93. Teitelbaum's recent book
about treatments (written about in CFS-NEWS number 50) is more
up-to-date and comprehensive than this paper. "From Fatigued to
Fantastic: A Manual for Moving Beyond Chronic Fatigue and
Fibromyalgia" by Jacob Teitelbaum, MD, (ISBN 0-9647599-7-7) can be
purchased for $22.95 (includes shipping) from Deva Press, 139 Old
Solomons Island Road, Annapolis, MD 21401, USA, or phone
1-800-333-5287. For volume discounts, phone 1-410-224-2222.
[Thanks to Ellen Goudsmit for alerting CFS-NEWS about this article,
and thanks to Dr. Teitelbaum and Barbara Bird for assistance with
this report.]
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>>>2. Komaroff et al. examine the CDC case definition
Anthony Komaroff of the Harvard School of Medicine, and colleagues,
have examined the CDC case definition in the light of a large study
of CFS patients, and made recommendations for revising the
definition. The researchers looked for minor criteria that would
distinguish CFS not only from the normal healthy population, but also
from other diseases that typically involve chronic fatigue. After
comparing 281 CFS patients to 25 patients with relapsing-remitting
multiple sclerosis, 19 patients with major depression, and 311
healthy controls, the researchers recommended the following
revisions: drop muscle weakness, arthralgias and sleep disturbance,
add diminished appetite and nausea, and re-instate fever/chills
(which had been dropped in 1994).
This study was published as:
Komaroff A, Faglioli L, Geiger A, Doolittle T, Lee J, Kornish J,
Gleit M, Guerriero R. An Examination of the Working Case
Definition of Chronic Fatigue Syndrome. Am J Med 1996:100;56-64
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>>>3. Neuropsych comparisons of CFS, Multiple Chemical
Sensitivities
A New Jersey research team has made a neuropsychiatric comparison of
CFS and multiple chemical sensitivities (MCS) subjects to healthy
controls, and have found higher rates of current psychiatric
disorders in both patient groups, particularly for MCS patients who
had no definite date of onset. MCS subjects generally also did
poorly on a complex visual memory test.
The study included 23 MCS patients with definite date of onset, 13
MCS patients without a definite date of onset, 18 CFS patients, and
18 normal controls. They were examined using: a special
questionnaire about lifestyle and chemical sensitivities, the
Structured Clinical Interview for the DSM-III Revised to measure Axis
I diagnoses, the MMPI-2, the somatization section of the Diagnostic
Interview Survey-III-A, a neuropsychological battery including tests
developed for epidemiological studies of the effects of
neurotoxicants. The journal citation for this paper is:
Fiedler N, Kipen H, DeLuca J, Kelly-McNeil K, Natelson B. A
Controlled Comparison of Multiple Chemical Sensitivities and
Chronic Fatigue Syndrome. Psychosomatic Medicine 1996:58;38-49
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>>>4. Medical publications update
[The following was contributed by Mr. Steve Clancy of the Science
Library of the University of California at Irvine.]
This CFS UPDATE is a review of the current, published medical
literature on Chronic Fatigue Syndrome and is presented as a public
service. The presence or absence of any information in this review
should not be taken as advocating one method of treatment over
another, and should not be construed as providing medical advice or
diagnosis.
The references may be taken from various sources and should be used
for educational purposes only. Databases accessed may include the
MEDLINE online database produced by the National Library of Medicine,
as well as other online and print sources. This listing is NOT a
complete review, but represents a selection.
Many of these articles and journals will be available from libraries
in hospitals and universities. Please do not contact Steve Clancy,
or the UCI Science Library for copies of articles from this list.
Steve Clancy, M.L.S.
Science Library
University of California, Irvine, U.S.A.
(NOTE: Articles with title in brackets [ ] are not in English.)
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1. Dunne FJ; Dunne CA. Fibromyalgia syndrome and psychiatric
disorder. British Journal of Hospital Medicine, 1995 Sep 6-19,
54(5):194-7. UI: 96098236
2. Swanink CM; Vercoulen JH; Bazelmans E; Fennis JF; Bleijenberg G;
van der Meer JW; Galama JM. Viral antibodies in chronic fatigue
syndrome [letter]. Clinical Infectious Diseases, 1995 Sep,
21(3):708-9. UI: 96077419
3. Wessely S. The epidemiology of chronic fatigue syndrome.
Epidemiologic Reviews, 1995, 17(1):139-51. UI: 96051462
4. Hutchison AS. Exercise responses in the chronic fatigue syndrome.
Objective assessment of study is difficult without knowledge of data
[letter]. Bmj, 1995 Nov 11, 311(7015):1304. UI: 96069115
5. Pollmacher T; Mullington J; Korth C; Hinze-Selch D. Influence of
host defense activation on sleep in humans. Advances in
Neuroimmunology, 1995, 5(2):155-69. UI: 96043882
6. Berelowitz GJ; Burgess AP; Thanabalasingham T; Murray-Lyon IM;
Wright DJ. Post-hepatitis syndrome revisited. J Viral Hepat, 1995,
2(3):133-8. Type D 6 AB to see abstract. UI: 96091320
7. Hamre HJ. [Chronic fatigue syndrome (letter)]. Tidsskrift for den
Norske Laegeforening, 1995 Nov 10, 115(27):3419. UI: 96097518
8. Van Houdenhove B; Onghena P; Neerinckx E; Hellin J. Does high
'action-proneness' make people more vulnerable to chronic
fatigue syndrome? A controlled psychometric study. Journal of
Psychosomatic Research, 1995 Jul, 39(5):633-40. UI: 96058813
9. Patnaik M; Komaroff AL; Conley E; Ojo-Amaize EA; Peter JB.
Prevalence of IgM antibodies to human herpesvirus 6 early antigen
(p41/38) in patients with chronic fatigue syndrome. Journal of
Infectious Diseases, 1995 Nov, 172(5):1364-7. UI: 96036399
10. Goldberg M; Lichten J. High androgen levels in chronic fatigue
patients [letter]. Journal of Clinical Endocrinology and Metabolism,
1995 Nov, 80(11):3390-1. UI: 96064816
11. Shepherd C. Illness behaviour in the chronic fatigue syndrome and
multiple sclerosis. Disentangling common characteristics is not so
easy [letter]. Bmj, 1995 Oct 21, 311(7012):1093.
12. Campion PD; Dowrick CF; Edwards RH. Illness behaviour in the
chronic fatigue syndrome and multiple sclerosis. Choice of multiple
sclerosis as comparison condition was inappropriate
[letter]. Bmj, 1995 Oct 21, 311(7012):1092-3. UI: 96041864
13. Shepherd C. Patients with a self diagnosis of myalgic
encephalomyelitis [letter]. Bmj, 1995 Oct 14, 311(7011):1021. UI:
96022017
14. Plioplys S; Plioplys AV. Chronic fatigue syndrome (myalgic
encephalopathy). Southern Medical Journal, 1995 Oct, 88(10):993-1000.
UI: 96011775
15. Boda WL; Natelson BH; Sisto SA; Tapp WN. Gait abnormalities in
chronic fatigue syndrome. Journal of the Neurological Sciences, 1995
Aug, 131(2):156-61. UI: 96061271
16. Nairn C; Galbraith DN; Clements GB. Comparison of coxsackie B
neutralisation and enteroviral PCR in chronic fatigue patients.
Journal of Medical Virology, 1995 Aug, 46(4):310-3. UI: 96061534
17. Lutgendorf SK; Antoni MH; Ironson G; Fletcher MA; Penedo F; Baum
A; Schneiderman N; Klimas N. Physical symptoms of chronic fatigue
syndrome are exacerbated by the stress of Hurricane Andrew.
Psychosomatic Medicine, 1995 Jul-Aug, 57(4):310-23. UI: 96076053
18. Cater RE 2nd. Chronic intestinal candidiasis as a possible
etiological factor in the chronic fatigue syndrome. Medical
Hypotheses, 1995 Jun, 44(6):507-15. UI: 96038377
19. Comings DE. Role of genetic factors in depression based on
studies of Tourette syndrome and ADHD probands and their relatives.
American Journal of Medical Genetics, 1995 Apr 24, 60(2):111-21. UI:
96090228
20. Farrar DJ; Locke SE; Kantrowitz FG. Chronic fatigue syndrome. 1:
Etiology and pathogenesis. Behavioral Medicine, 1995 Spring,
21(1):5-16. UI: 96016479
21. Kantrowitz FG; Farrar DJ; Locke SE. Chronic fatigue syndrome. 2:
Treatment and future research. Behavioral Medicine, 1995 Spring,
21(1):17-24. UI: 96016480
22. Libbus K; Baker JL; Osgood JM; Phillips TC; Valentine DM.
Persistent fatigue in well women. Women and Health, 1995,
23(1):57-72. UI: 96054572
23. Bombardier CH; Buchwald D. Outcome and prognosis of patients with
chronic fatigue vs chronic fatigue syndrome. Archives of Internal
Medicine, 1995 Oct 23, 155(19):2105-10. UI: 96011570
24. Hamre HJ. [Chronic fatigue syndrome--a review of the literature].
Tidsskrift for den Norske Laegeforening, 1995 Oct 10, 115(24):3042-5.
Language: Norwegian. UI: 96038699
25. Haukenes G; Aarli JA. [Postviral fatigue syndrome].
Tidsskrift for den Norske Laegeforening, 1995 Oct 10,
115(24):3017-22. Language: Norwegian. UI: 96038691
26. Malt UF. [Exhausted by life--or mysteriously ill?].
Tidsskrift for den Norske Laegeforening, 1995 Oct 10, 115(24):3016.
Language: Norwegian. UI: 96038690
27. Berman DS; Wenglin BD. Complaints attributed to chronic Lyme
disease: depression or fibromyalgia? [letter]. American Journal of
Medicine, 1995 Oct, 99(4):440. UI: 96006095
28. Fisk JW. Chronic fatigue syndrome [letter]. New Zealand Medical
Journal, 1995 Sep 22, 108(1008):393. UI: 96033856
29. Hickie IB; Lloyd AR; Wakefield D. Chronic fatigue syndrome:
current perspectives on evaluation and management. Medical Journal of
Australia, 1995 Sep 18, 163(6):314-8. UI: 96018942
30. Dunstan RH; Donohoe M; Taylor W; Roberts TK; Murdoch RN; Watkins
JA; McGregor NR. A preliminary investigation of chlorinated
hydrocarbons and chronic fatigue syndrome. Medical Journal of
Australia, 1995 Sep 18, 163(6):294-7. UI: 96018938
31. Loblay RH. Chronic fatigue syndrome: what's in a name?
[editorial]. Medical Journal of Australia, 1995 Sep 18, 163(6):285-6.
UI: 96018934
32. Cope H; Pernet A; Kendall B; David A. Cognitive functioning and
magnetic resonance imaging in chronic fatigue. British Journal of
Psychiatry, 1995 Jul, 167(1):86-94. UI: 96055762
33. Nixon PG. Chronic fatigue syndrome in Army general practice
[letter]. Journal of the Royal Army Medical Corps, 1995 Jun,
141(2):112-3. UI: 96009134.
34. Sisto SA; Tapp W; Drastal S; Bergen M; DeMasi I; Cordero D;
Natelson B. Vagal tone is reduced during paced breathing in patients
with the chronic fatigue syndrome. Clinical Autonomic Research, 1995
Jun, 5(3):139-43. UI: 96040750
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>>>5. Publication of proceedings of 1994 clinical conference at
Florida
The proceedings of the 1994 AACFS clinical conference have been
published in the Journal of Chronic Fatigue Syndrome, Vol. 1 numbers
3/4. This conference had taken place in Ft. Lauderdale, Florida in
October, 1994. (Reports on this conference appeared in CFS-NEWS
numbers 40 and 41.) To obtain a copy of the clinical proceedings,
contact Haworth Press at telephone 1-800-722-5857 in the USA (some
overseas locations will need to dial 1-607-722-5857), fax
1-800-895-0582 (or 1-607-722-63620), or by postal mail at Haworth
Press, Inc., 10 Alice Street, Binghamton, NY 13904-1580. Inquiries
can be sent by e-mail to get...@haworth.com. The price is $23.40
for individuals in the USA (Canada $32.55 in USA dollars, elsewhere
$32.76), higher for institutions and libraries. The research
proceedings will be published in a different journal later this year.
Subscriptions to the quarterly Journal of Chronic Fatigue are $32.40
per year for individuals. Inquire about multi-year rates, and rates
for institutions and libraries.
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>>>6. Network news: change of Web URL
Effective immediately, the CFS/ME information web pages set up by
Roger Burns, including the sub-page for the CFS-NEWS Electronic
Newsletter, have been moved to a new site. Some of the sub-page
filenames have been changed also, since the new web site is
DOS-based. The new URL for the main CFS/ME page is
http://www.alternatives.com/cfs-news/index.htm
The previous sponsor, metro.turnpike.net, is ending its free web
service, and the old URL is now defunct. Please alter any links you
may have to reflect this change.
Note that the filenames at the new URL all end with ".htm" with no L
on the end. Some systems may not be able to default to the index
file so it may be necessary to explicitly show the full filename
"index.htm" if you wish to reach the main page.
Below is a conversion table showing the new URL and filenames for all
of the old sub-pages.
Description: Main page
Old filename: index.html
New URL: http://www.alternatives.com/cfs-news/index.htm
Description: CFS FAQ
Old filename: faq.html
New URL: http://www.alternatives.com/cfs-news/faq.htm
Description: Quick Index
Old filename: quick.html
New URL: http://www.alternatives.com/cfs-news/quick.htm
Description: CFS-NEWS Newsletter
Old filename: cfs-news.html
New URL: http://www.alternatives.com/cfs-news/cfs-news.htm
Description: CFS Network Help
Old filename: net-help.html
New URL: http://www.alternatives.com/cfs-news/net-help.htm
Description: Index of CFS FAQs
Old filename: cfs-index.html
New URL: http://www.alternatives.com/cfs-news/cfs-indx.htm
Description: Mailing lists
Old filename: lists.html
New URL: http://www.alternatives.com/cfs-news/lists.htm
Description: CFS group
Old filename: cfs-l.html
New URL: http://www.alternatives.com/cfs-news/cfs-l.htl
Description: CFS group rules
Old filename: cfs-l.rules.html
New URL: http://www.alternatives.com/cfs-news/cfsrules.htm
Description: Advocacy group
Old filename: cfids-l.rules.html
New URL: http://www.alternatives.com/cfs-news/cfids-l..htm
Description: Advocacy info page
Old filename: cfids.html
New URL: http://www.alternatives.com/cfs-news/cfids.htm
Description: CFS doctors info
Old filename: doctors.html
New URL: http://www.alternatives.com/cfs-news/doctors.htm
Description: CFS doctors FAQ
Old filename: doctors.faq.html
New URL: http://www.alternatives.com/cfs-news/dr-faq.htm
Description: Doctors group
Old filename: doctors.reg.html
New URL: http://www.alternatives.com/cfs-news/dr-reg.htm
Description: Fibromyalgia info
Old filename: fibro.html
New URL: http://www.alternatives.com/cfs-news/fibro.htm
Description: FM patients info
Old filename: fm-pt.html
New URL: http://www.alternatives.com/cfs-news/fm-pt.htm
Description: FM doctors info
Old filename: fm-md.html
New URL: http://www.alternatives.com/cfs-news/fm-md.htm
Description: FM pain document
Old filename: fm-pain.html
New URL: http://www.alternatives.com/cfs-news/fm-pain.htm
Description: Lyme info
Old filename: lyme.html
New URL: http://www.alternatives.com/cfs-news/lyme.html
Description: IRC channel info
Old filename: irc.html
New URL: http://www.alternatives.com/cfs-news/irc.html
Description: IRC basics
Old filename: irc.basics.html
New URL: http://www.alternatives.com/cfs-news/ircbasic.htm
Description: Further IRC info
Old filename: irc.info.html
New URL: http://www.alternatives.com/cfs-news/irc-info.htm
Description: IRC channel times
Old filename: irc.time.html
New URL: http://www.alternatives.com/cfs-news/irc-time.htm
Description: IRC People Page
Old filename: irc.people.html
New URL: http://www.alternatives.com/cfs-news/irc-bio.htm
Description: People Page form
Old filename: irc.people.form
New URL: http://www.alternatives.com/cfs-news/irc-form.txt
===================================================================
CFS-NEWS (ISSN 1066-8152) is an international newsletter published
and edited by Roger Burns in Washington D.C. It is distributed:
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Newsgroup bit.listserv.cfs.newsletter. Back issues are on file on
the Project ENABLE BBS in West Virginia USA at telephone 1-304-759-
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or by Fido NetMail to 1:109/432, or at telephone 1-202-966-8738, or
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or post a message to the CFS echo or to the Internet CFS-L group or
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