Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS) or ME/CFS are some of several names given to a poorly understood, highly debilitating disorder of uncertain cause/causes, which is thought to affect approximately 250,000 people in the UK. It is also known as Post-Viral Fatigue Syndrome (PVFS) or Chronic Fatigue Immune Dysfunction Syndrome (CFIDS) and there seems to be a link with Gulf War Syndrome. For information on the Perrin Technique click here.

ME / CFS is marked by long term physical and mental exhaustion, often severe, and by other specific symptoms, arising usually in previously healthy and active people. All types of people at all ages are affected. ME / CFS occurs more often, but not exclusively, in women, for unknown reasons but thought to be linked to hormonal fluctuations and increased lymphatic tissue in the breast. ME / CFS is most easily diagnosed when previously active adults become ill, and is most commonly found in young to middle aged adults, although it can also affect children, adolescents and the elderly. The most common symtopms are severe and debilitating fatigue, painful muscles and joints, disordered sleep, gastric disturbances, and poor memory and concentration. The onset is often linked to a viral infection but other triggers may include trauma. immunisation or an operation. There remains no objective assay or pathological finding which is widely accepted to be diagnostic of CFS. Diagnosis is usually made by exclusion, made on the basis of patient history and symptomatic criteria. There are some tests exist which can help diagnosis.

Many people with ME / CFS report a sudden, drastic start to their illness. Sufferers may remember a specific day or even hour when they noticed the onset. Often ME / CFS starts with, or is triggered by, another infection or illness. Many people remember a case of a flu-like or other respiratory infection from which they seem never to fully recover and which develops into ME / CFS . Some patients report that it began after immunisation or even a blood transfusion. Some cases have a very slow onset, sometimes developing over years.

Symptoms of Myalgic Encephalomyelitis ME / CFS

In 2003 the Canadian Clinical Working Definition of ME / CFS divided the symptoms of ME / CFS into eight categories:

* Fatigue: Unexplained, persistent, or recurrent physical and mental fatigue/exhaustion that substantially reduces activity levels and is not relieved (or not completely relieved) by rest.

* Post-exertional malaise: An inappropriate loss of physical and mental stamina, rapid muscular and cognitive fatigability, symptom exacerbation after exertion, plus a pathologically slow recovery period usually 24 hours or longer.

* Pain: Pain is often widespread and migratory in nature, including a significant degree of muscle pain and/or joint pain (without joint swelling or redness, and may be transitory). Other symptoms include headaches (particularly of a new type, severity, or duration), lymph node pain, sore throats, and abdominal pain (often as a symptom of irritable bowel syndrome). Patients also report; bone, eye and testicular pain, nerve pain and painful skin sensitivity. Chest pain has been attributed variously to microvascular disease or cardiomyopathy by researchers, and many patients also report painful tachycardia. A systematic review assessing the studies of chronic pain in ME / CFS found that although the exact prevalence is unknown, it is strongly disabling in patients, but unrelated to depression.

* Sleep dysfunction: "Unrefreshing" sleep/rest, poor sleep quantity, insomnia or rhythm disturbances. A study found that most CFS patients have clinically significant sleep abnormalities that are potentially treatable. Several studies suggest that while ME / CFS patients may experience altered sleep architecture (such as reduced sleep efficiency, a reduction of deep sleep, prolonged sleep initiation, and alpha-wave intrusion during deep sleep) and mildly disordered breathing, overall sleep dysfunction does not seem to be a critical or causative factor in CFS. Sleep patterns may be further interrupted by vivid "feverish" dreams, and unlike in healthy persons, exercise can worsen the sleep dysfunction.

* Neurological/cognitive manifestations: Common occurrences include confusion, forgetfulness, mental fatigue/brain fog, impairment of concentration and short-term memory consolidation, disorientation, difficulty with information processing, categorizing and word retrieval, and perceptual and sensory disturbances (e.g. spatial instability and disorientation and inability to focus vision), ataxia (unsteady and clumsy motion of the limbs or torso), muscle weakness and "twitches". There may also be cognitive or sensory overload (e.g. photophobia and hypersensitivity to noise and/or emotional overload, which may lead to "crash" periods and/or anxiety).

* Autonomic manifestations: Common occurrences include orthostatic intolerance, neurally mediated hypotension (NMH), postural orthostatic tachycardia syndrome (POTS), delayed postural hypotension, lightheadedness, extreme pallor, nausea and irritable bowel syndrome, urinary frequency and bladder dysfunction, palpitations with or without cardiac arrhythmias, and exertional dyspnea (perceived difficulty breathing or pain on breathing).

* Neuroendocrine manifestations: Common occurrences include poor temperature control or loss of thermostatic stability, subnormal body temperature and marked daily fluctuation, sweating episodes, recurrent feelings of feverishness and cold extremities, intolerance of extremes of heat and cold, digestive disturbances and/or marked weight change - anorexia or abnormal appetite, loss of adaptability and worsening of symptoms with stress.

* Immune manifestations: Common occurrences include tender lymph nodes, recurrent sore throat, recurrent flu-like symptoms, general malaise, new sensitivities to food and/or medications and/or chemicals (which may complicate treatment). At least one study has confirmed that most ME / CFS patients reduce or cease alcohol intake, mostly due to personal experience of worsening symptom (although the cause of this is unknown and may not be strictly "immunological" as implied by the symptom list).

For all ME / CFS sufferers the main symptom is likely to be incapacitating fatigue that is:

* of new or definite onset (not since birth) unexplained by other medical condition.

* lasts for at least six months (from onset, not necessarily from when the patient becomes aware that the fatigue is an ongoing symptom).

* not improved by rest.

When diagnosing ME / CFS the fatigue must be accompanied by a minimum of 4 of the following eight symptoms:

1. Impairment of short-term memory and concentration

2. Sore throat

3. Tender lymph nodes

4. Muscle pain

5. Multi-joint pain

6. Headaches of a new type, pattern, or severity

7. Unrefreshing sleep or insomnia

8. Post-exertional malaise or fatigue lasting more than 24 hours after exertion.

Prognosis for Myalgic Encephalomyelitis ME / CFS

Most sufferers with ME / CFS will see their illness fit one of the categories below:

* Those who manage to return to completely normal health, even though this may take a considerable period of time. The percentage falling into this category is fairly small.

* The majority, who tend to follow a fluctuating pattern with both good and bad periods of health. Relapses or exacerbations are often precipitated by infections, operations, temperature extremes or stressful events.

* A significant minority, who remain severely affected and may require a great deal of practical and social support.

* A few, who show continued deterioration, which is unusual in ME/CFS. When this occurs, a detailed medical assessment is advisable to rule out other possible diagnoses.

Treatment for Myalgic Encephalomyelitis ME / CFS

Dr Raymond Perrin has been researching ME / CFS for the last 18 years. As an osteopath he first noticed some postural similarities in ME / CFS sufferers which when corrected could lead to a dramatic improvement in the patients ME symptoms. He has postulated that toxins build up in the cerebro-spinal fluid, the fluid that surrounds the brain and spinal cord due to poor drainage caused by these postural restrictions. His research shows that by improving the circulation of the cerebro spinal fluid using gentle cranial osteopathic techniques and by aiding lymphatic drainage using effulage many ME / CFS sufferers will see a significant improvement in their symptoms. Dr Perrin goes as far as claiming a cure rate of 30% in his patients whilst 90% report significant benefits.

The Perrin Technique also involves prescribing the ME sufferer some gentle exercises to help restore movement in the thoracic spine, self massage to improve the circulation of cerebro spinal fluid and lymphatic drainage. Combined with some supplements for improving the physiology of the nervous system and detoxification by the liver.

Max Secchi (Registsered Osteopath) is a trained and registered Perrin practitioner. The Perrin Technique has been shown to be helpful to chronic fatigue syndrome (CFS) and Myalgic Encephalomyelitis (ME) sufferers. Max uses the methods researched by Dr Raymond Perrin who has shown that chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) can be caused by poor circulation of the cerebrospinal fluid and lymphatics resulting in a toxic build up. Treatment involves osteopathic techniques to stimulate the circulation of cerebrospinal fluid and lymphatic drainage, restoration of upper back function and to facilitate detoxification by the liver.