Welcome to the 39th Emerge Australia Research Digest, where you will find summaries of some of the latest research and information about ME/CFS, with links to the complete articles.

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Systematic review of randomized controlled trials for chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME)

Author: Kim, D.Y., Lee, J.S., Park, S.Y., Kim, S.J., Son, C.G.
Link: https://jci.org/articles/view/132185/sd/1

This systematic review of randomised controlled trials (RCTs) for ME/CFS includes 55 trials which were deemed to have met the study’s criteria: 25 RCTs of 22 different pharmacological treatments, 28 RCTs of 18 non-pharmacological treatments and 2 RCTs of combined treatments. The majority (more than 75%) of the trials used the Fukuda diagnostic criteria for participant selection and all trials except one used subjective rating scales as the primary outcome measure. One study, a drug trial, used the number of steps taken per day as the primary outcome measure.

Among the pharmacological treatments included in the review were 8 psychiatric drugs, 3 corticosteroids, 4 immunomodulators, 3 mitochondrial modulators (both supplements and drugs), as well as a homeopathic treatment. Apart from the corticosteroids (which had two trials each), each pharmacological agent had just one trial which met the criteria for inclusion in this review. Of the 25 RCTs of pharmacological agents included in the review, just three showed positive results: 2 immunomodulators and 1 mitochondrial modulator.

The authors noted that, among the diverse treatments evaluated by the review, “psychiatric approaches were predominant in both the pharmacological interventions and non-pharmacological interventions; however they failed to show the repeatability of positive outcomes”.

No intervention demonstrated sufficient effectiveness or reproducibility, and the authors conclude that more systematic study into the pathophysiology of ME/CFS, as well as the development of better treatments, are needed.


Reduced heart rate variability predicts fatigue severity in individuals with chronic fatigue syndrome/myalgic encephalomyelitis.

Author: Escorihuela, R.M., Capdevila, L., Castro, J.R., Zaragozà, M.C., Maurel, S., Alegre, J., Castro-Marrero, J.
Link: https://www.ncbi.nlm.nih.gov/pubmed/31906988

Heart rate variability (HRV) is the variation in the time interval between successive heart beats, and is considered a useful measure of autonomic nervous system function. In this study, researchers looked at HRV as an objective, non-invasive biomarker for ME/CFS, as well as its relationship to self-reported symptoms. A total of 45 ME/CFS female patients and 25 healthy controls participated in the trial.

The researchers found that ME/CFS participants had significantly lower (worse) HRV, and scored significantly higher on all symptom scales than healthy controls. They also found a significant negative correlation between reported symptoms and most HRV indices, in both the ME/CFS and healthy control groups. Two HRV indices also showed a significant negative relationship with fatigue severity in ME/CFS participants, but not healthy controls.

The researchers conclude that these results suggest that autonomic nervous system dysfunction presenting as increased sympathetic hyperactivity may contribute to fatigue severity in ME/CFS patients, and that more longitudinal studies are needed.


The role of low-grade inflammation in ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) - associations with symptoms

Author: Jonsjö, M.A., Olsson, G.L., Wicksell, R.K., Alving, K., Holmström, L., Andreasson, A.
Link: https://www.sciencedirect.com/science/article/pii/S0306453019313198

Previous research has found that low grade inflammation is associated with severity of ME/CFS symptoms although the relationship between them is still unclear. In this study, researchers examined the relationship of 13 inflammatory markers to symptom severity among 53 adults with ME/CFS, as well as the role of biological sex as a moderator of this relationship.

Their results found that higher levels of β-NGF were significantly correlated with higher post-exertional fatigue and more musculoskeletal pain; higher levels of TNF-α were significantly associated with recurrent flu-like symptoms; and higher levels of β-NGF and CCL11 were significantly associated with greater cognitive impairment.

There were three markers for which biological sex moderated its relationship to symptoms: higher levels of CXCL10 were associated with lower levels of post-exertional fatigue in women, but higher levels in men (although the relationship was only significant for women); and higher levels of both IL-7 and TGF-β were associated with higher levels of musculoskeletal pain, but only for men.

The researchers recommend longitudinal studies to further explore the relationship between inflammatory markers and symptoms.


The hollow man: A mysterious illness with few symptoms and no cure is sucking the very life out of Tony Wallace.

In this powerful and moving article, former WA police senior sergeant Tony Wallace bravely shares his experience of living with ME/CFS, and the impact it has had on his wife, career and social life.

Please note: this article has a visual scrolling feature which some people may find difficult to tolerate.

Link: https://www.abc.net.au/news/2020-01-13/chronic-fatigue-syndrome-illness-left-tony-wallace-a-hollow-man/11839536