Rowe Peter C, Fontaine Kevin R, Lauver Megan, Jasion Samantha E, Marden Colleen L, Moni Malini, Thompson Carol B, Violand Richard L
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
Department of Health Behavior, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, United States of America.
PLoS One. 2016 Jul 18;11(7):e0159386. doi: 10.1371/journal.pone.0159386. eCollection 2016.
Chronic fatigue syndrome (CFS) is a complex, multisystem disorder that can be disabling. CFS symptoms can be provoked by increased physical or cognitive activity, and by orthostatic stress. In preliminary work, we noted that CFS symptoms also could be provoked by application of longitudinal neural and soft tissue strain to the limbs and spine of affected individuals. In this study we measured the responses to a straight leg raise neuromuscular strain maneuver in individuals with CFS and healthy controls. We randomly assigned 60 individuals with CFS and 20 healthy controls to either a 15 minute period of passive supine straight leg raise (true neuromuscular strain) or a sham straight leg raise. The primary outcome measure was the symptom intensity difference between the scores during and 24 hours after the study maneuver compared to baseline. Fatigue, body pain, lightheadedness, concentration difficulties, and headache scores were measured individually on a 0-10 scale, and summed to create a composite symptom score. Compared to individuals with CFS in the sham strain group, those with CFS in the true strain group reported significantly increased body pain (P = 0.04) and concentration difficulties (P = 0.02) as well as increased composite symptom scores (all P = 0.03) during the maneuver. After 24 hours, the symptom intensity differences were significantly greater for the CFS true strain group for the individual symptom of lightheadedness (P = 0.001) and for the composite symptom score (P = 0.005). During and 24 hours after the exposure to the true strain maneuver, those with CFS had significantly higher individual and composite symptom intensity changes compared to the healthy controls. We conclude that a longitudinal strain applied to the nerves and soft tissues of the lower limb is capable of increasing symptom intensity in individuals with CFS for up to 24 hours. These findings support our preliminary observations that increased mechanical sensitivity may be a contributor to the provocation of symptoms in this disorder.
慢性疲劳综合征（CFS）是一种复杂的多系统疾病，可能导致残疾。CFS症状可因身体活动或认知活动增加以及体位性应激而诱发。在初步研究中，我们注意到，对受影响个体的四肢和脊柱施加纵向神经和软组织应变也可诱发CFS症状。在本研究中，我们测量了CFS患者和健康对照者对直腿抬高神经肌肉应变动作的反应。我们将60名CFS患者和20名健康对照者随机分为两组，一组进行15分钟的被动仰卧直腿抬高（真正的神经肌肉应变），另一组进行假直腿抬高。主要结局指标是研究动作期间及之后24小时的得分与基线相比的症状强度差异。疲劳、身体疼痛、头晕、注意力不集中和头痛得分分别在0-10分的量表上进行测量，并汇总得出综合症状得分。与假应变组的CFS患者相比，真应变组的CFS患者在动作期间报告身体疼痛显著增加（P = 0.04）、注意力不集中显著增加（P = 0.02）以及综合症状得分增加（所有P = 0.03）。24小时后，CFS真应变组的头晕个体症状（P = 0.001）和综合症状得分（P = 生0.005）的症状强度差异显著更大。在暴露于真正的应变动作期间及之后24小时，与健康对照者相比，CFS患者的个体和综合症状强度变化显著更高。我们得出结论，对下肢神经和软组织施加纵向应变能够使CFS患者的症状强度增加长达24小时。这些发现支持了我们的初步观察结果，即机械敏感性增加可能是该疾病症状诱发的一个因素。
