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A Few Fatigue Syndromes

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Chronic Fatigue Syndrome Is Now, "Systemic Exertion Intolerance Disease (SEID)

"The criteria for SEID[4] are supposed to be simpler than the Centers for Disease Control and Prevention (CDC) [1994 criteria set for Chronic Fatigue Syndrome[1]] and include substantial decline in functional activities for at least 6 months, postexertional fatigue, and nonrestorative sleep. The criteria require all three, and then at least one of the following: cognitive impairment [I believe they mean of a subjective nature] or orthostatic intolerance. The patient also can have some of the other symptoms that were included in the definition of chronic fatigue syndrome, such as gastrointestinal issues, pain, stimuli hypersensitivity, lymphadenopathy, and sore throat."

Auwaerter PG. "Managing Systemic Exertion Intolerance Disease (SEID) – A New Name for Chronic Fatigue Syndrome."Medscape Infectious Diseases.

[1] Centers for Disease Control and Prevention. Chronic fatigue syndrome. April 24, 2014. Accessed February 26, 2015.

[4] Institute of Medicine. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. February 10, 2015. Accessed February 26, 2015.


S.H.I.N.E. — A Holistic Approach That Begins To Addresses Fatigability and Energy Optimization

Dr. Jacob Teitelbaum's "S.H.I.N.E." [no working link 7/24/15] concept or approach identifies five key areas related to the body that, when addressed in combination, provide a blueprint for promoting optimal energy." He claims "Tending to these can help you maintain healthy energy levels when you are well, and can help support recovery when dealing with CFS and fibromyalgia."

  SLEEP: Get adequate sleep, preferably eight to nine hours a night. Sleep replenishes the body's energy and heals its muscles. Inadequate sleep will leave you exhausted and in pain.

  HORMONES: Get tested for hormone deficiency and treated if needed. Hormone deficiencies can contribute to fibromyalgia and chronic fatigue syndrome.


  IMMUNITY: Get treatment when symptoms of infections occur. The lack of restorative sleep in CFS/FM leads to dysfunctional immune systems. Underlying viral, bacterial, bowel, sinus and yeast infections are common and can be a contributing cause or result of CFS/FM.

  NUTRITON: To maintain normal health and optimal energy levels you need to be sure your body is getting a proper balance of nutrition, particularly as nutritional deficiencies can result from CFS/FM. Vitamin B-12, magnesium, Acetyl L-Carnitine, glutathione, as well as your basic A, B, C and D vitamins are especially vulnerable to depletion from this.

  EXERCISE: Exercise as able. After 10 weeks on the 4 steps above, you will be able to slowly increase your exercise-without being wiped out the next day!

Patient-Reported Outcomes Measurement Information System (PROMIS) in Fibromyalgia
Merriwether ENRakel BAZimmerman MB, et al.  "Reliability and Construct Validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) Instruments in Women with Fibromyalgia."  Pain Med. 2016 Aug 24. pii: pnw187.



The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to standardize measurement of clinically relevant patient-reported outcomes. This study evaluated the reliability and construct validity of select PROMIS static short-form (SF) instruments in women with fibromyalgia.


Analysis of baseline data from the Fibromyalgia Activity Study with TENS (FAST), a randomized controlled trial of the efficacy of transcutaneous electrical nerve stimulation.


Dual site, university-based outpatient clinics.


Women aged 20 to 67 years diagnosed with fibromyalgia.


Participants completed the Revised Fibromyalgia Impact Questionnaire (FIQR) and 10 PROMIS static SF instruments. Internal consistency was calculated using Cronbach alpha. Convergent validity was examined against the FIQR using Pearson correlation and multiple regression analysis.


PROMIS static SF instruments had fair to high internal consistency (Cronbach α = 0.58 to 0.94, P < 0.05). PROMIS 'physical function' domain score was highly correlated with FIQR 'function' score (r = -0.73). The PROMIS 'total' score was highly correlated with the FIQR total score (r = -0.72). Correlations with FIQR total score of each of the three PROMIS domain scores were r = -0.65 for 'physical function,' r = -0.63 for 'global,' and r = -0.57 for 'symptom' domain. PROMIS 'physical function,' 'global,' and 'symptom' scores explained 58% of the FIQR total score variance.


Select PROMIS static SF instruments demonstrate convergent validity with the FIQR, a legacy measure of fibromyalgia disease severity. These results highlight the potential utility of select PROMIS static SFs for assessment and tracking of patient-reported outcomes in fibromyalgia.

© 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.


A far less common fatigue syndrome is the other end of the spectrum in that it is well characterized–Osteogenesis imperfecta (OI), a genetic disorder that causies bones to break easily; thus, it has come to be known as “brittle bone disease.” A person is born with this disorder and is affected throughout his or her life time.

In addition to fractures people with OI often have muscle weakness, hearing loss, fatigue, joint laxity, curved bones, scoliosis, blue sclerae, dentinogenesis imperfecta (brittle teeth), and short stature. Restrictive pulmonary disease occurs in more severely affected people.

The great majority of people with OI, even those who are the only affected person in a family, have dominantly inherited forms of the disorder.  The genetics or possible inheritance of this disorder. is a separate topic, however,

  • OI is caused by an error called a mutation on a gene that affects the body’s production of the collagen found in bones, and other tissues. It is not caused by too little calcium or poor nutrition.
  • OI is variable with 8 different types described in medical literature.
  • The types range in severity from a lethal form to a milder form with few visible symptoms.
  • The specific medical problems a person will encounter will depend on the degree of severity.
  • A person with mild OI may experience a few fractures while those with the severe forms may have hundreds in a lifetime.
  • The number of Americans affected with OI is thought to be 25,000-50,000. 
  • The range is so wide because mild OI often goes undiagnosed.