The term “Chronic Fatigue Immune Dysfunction Syndrome” (CFIDS) or “Chronic Fatigue Syndrome” (CFS) is comparatively new, though its symptom group was described in medical literature many centuries ago.
As an independent disease, CFS was marked in 1988, by The Centers for Disease Control – CDC, Atlanta, USA. According to modern ideas, CFS is a disease of unknown etiology, basic evidences of which are expressed general weakness, increased fatigability, headaches and muscle spasms, arthralgiae, defective memory, depression, sleep disorders etc. The progression of secondary immunodeficiency, associated with herpes-virus and other intracellular infections, is considered to be in the basis of CFS pathogenesis (Novik et al., 2001). Most clinical symptoms and syndromes, detected at CFS, are caused by cytokine system disorders with the prevalence of production of outinflammatory cytokines.
At that, there is another point of view of CFS origin, which claims special attention. As a result of long clinical pathomorphological researches, the concept of progression of systematic proteinosis as a leading mechanism in the CFS basis was stated (Tsoi et al., 2001). Systematic proteinosis (protein metabolism disorder), developing in prenatal and early postnatal periods, leads to dystrophic changes and exceeding overgrowth of elements of connective tissue, which are marked by fibrosis of organs and tissues as “mesenchymoses” (Sharpe et al., 1977). One of such clinical syndromes, demonstrating the evidence of slowly developing innate systematic proteinosis in children and adults, is poliorganic functional insufficiency, which may be regarded as chronic fatigue syndrome. According to the opinion of authors of this concept, we should pay special attention to such evidences of CFS as general muscle weakness, chronically passing local pain syndrome (cephalgia, myalgia, poliarthralgia etc.), decrease of physical activity. These clinical syndromes are regarded as the evidence of proteinosis with exceeding overgrowth of mesenchymal tissue in muscle tissue, noted as “myofibrillosis”. Indeed, myofibrillosis as an evidence of dystrophic process in skeletal muscles and connective tissue is widespread among children and adults.
However, in literature there are not any data about the status of microvasculature in such patients. Disorders of microvasculature are attended with analogical evidences. The results of the author’s own researches showed that patients with CFS are known to have evident disorders of microvasculature, especially in tissues of stress-dependent zones. Disorders of tissular circulation (VILS syndrome and SIDST) are found in almost all patients with CFS, regardless of their age. At the same time, VGT application for such patients favoured normalization of tissulartrophic function of microvasculature, and that was followed by their recovery. It gives ground to suppose that in CFS pathogenesis the key role belongs to disorders in microvasculature of tissues, which are seen in almost all people, regardless of their age and methods of treatment. That is why, CFS may be regarded as one of clinical evidences of tissular circulation disorders.
Diagnostic criteria of CFS were formulated by G.P. Holms et al. (1988). They regard chronic fatigue and performance impairment by 50% and more in healthy people, lasting for 6 and more months, as the first essential (great) diagnostic criterion. The second great criterion is the absence of somatic disorders or other reasons, which may cause such a status.
Smaller criteria are usually combined in several groups. The first group includes the symptoms which show the presence of chronic infectious process (muscle and joint pains, chronic pharyngitis, subfebrile temperature, increase of the number of lymph nodes). The second group consists of psychic and psychophysiological disorders (memory impairment, insomnia, depression etc.). The third one includes symptoms of vegetative-endocrine dysfunction (quick variations of mass of the body, dysfunction of gastrointestinal tract, loss of appetite, arrhythmia, dysuria etc.). The fourth group includes symptoms of allergy and hypersensitivity to medications, solar radiation, alcohol and some other factors.
According to diagnostic criteria of CDC, 1994, the CFS diagnosis is proved in case if in patient 2 essential (great) criteria and 4 out of 8 additional (smaller) ones are detected if these criteria are seen for 6 months and more.
CFS symptoms are:
1. Clinically established inexplicable permanent or intermittent chronic fatigue of a new type, i.e. which has not been met during lifetime and has not been connected with physical or mental tension, does not stop after rest and leads to significant decrease of earlier reached levels of professional, educational, social and personal activity.
2. The presence of 4 or more of the following symptoms at the same time:
• disorders of short-term memory or attention concentration;
• the presence of inflammatory process in the nasopharynx;
• pains of various localization of non-inflammatory nature;
• multiple joint pain without itch or redness;
• painful cervical and axillary lymph nodes;
• headaches, different by origin from previous ones;
• non-regenerative sleep;
• discomfort after physical or neuropsychic loads, lasting more than 24 hours.
It is interesting to note that the given classification of clinical symptoms of CFS generally corresponds to non-specific evidences of tissular circulation disorder, presented in the work by V.P. Kaznacheeva and A.A. Dzizinskiy (1975). That serves to show that microcirculatory disorders play an important, even key role in CFS appearance.
Most researchers believe that different physical, psychoemotional and biological stressors are the mechanisms which start or accelerate CFS. For example, in terms of chronic stress influence, a number of typical changes of immune system may be seen. At that, cellular components of immunoreactivity (the level of natural killers (NK-cells)), their functional activity and T-lymphocytes ability to respond to mitogens with proliferation are decreased. In contrast, humoral components (production of immunoglobulines of all types by plasma cells) are increased (Novik et al., 2001). This gives the idea to think of cause-and-effect relation between stress, disorders of microvasculature of tissues and CFS.
Nowadays, it is believed that effective monotherapy does not exist (Didkovskiy, 2000). In literature, they study complex therapy of CFS, which includes the usage of psychotropic agents (tricyclic antidepressants); nonsteroid anti-inflammatory, anaesthetic and other medications; vitaminotherapy, phytotherapy, physiotherapy etc. At disorders of immune and neurohormonal indicants, CFS patients undergo special immunooriented therapy with the help of immynotropic agents. The prognosis in most cases is favourable. The patients usually recover in 2-4 years; complete regeneration of physical activity does not happen though. Nearly 20% of patients seem to have progressive increase of CFS symptoms (Novik et al., 2001).
It is necessary to note that among the methods of CFS treatment, mentioned above, there are no ways of direct influence on one of the key links of disease pathogenesis – disorder of microvasculature functioning. Perhaps, this is the reason why the terms of recovery of such patients are so long, and the used therapy is so inefficient.
Writer’s long clinical practice with the use of direct influence on microvasculature of tissues – VGT method – supports the possibility of significant optimization of therapeutic influence on CFS, especially terms of recovery and effectiveness. In consequence of VGT application, CFS patients appeared to improve significantly their health status, pain syndrome decreased and disappeared completely, sleep and psychoemotional status got normal, mental and physical productivity considerably improved. Patients also started to recover after 1-2 weeks, after 3-5 VGT procedures and, as a rule, by the end of the course their complete recovery occurred.
It is necessary to note that in mechanisms of VGT, besides normalization of damaged microcirculatory system of tissues, an important role belongs to total load on cardiovascular system, which is similar to the influence of light or moderate physical load, which causes stimulation and restoration of immunocompetent systems of an organism. It is known that moderate and regular physical loads on CFS patients lead to significant (to 100%) increase of activity of natural killers (Novik et al., 2001). NK-cells – cellular elements with morphology of large granular lymphocytes – are the line of first protection at virus infections and neoplastic processes. They are able to detect and subject neoplastic cells to alteration. There have been a few attempts to use activated NK-cells in treatment of patients with malignant neoplasms.
For CFS patients VGT is used as a monotherapy, sometimes combined with microincisure. Conceptual plan of treatment includes vacuum influence on soft tissues in regions of neck, back, scapulae, back bone, gluteal region and head. The course consists of 9-11 procedures, twice a week.