I was contacted recently by someone, who had read one of my recent blogs regarding psychosomatic illness and its potential contribution in “long Covid” and other forms of Chronic Fatigue Syndrome (CFS).
Mark was kind enough to send me a couple of articles from other clinicians and researchers working in the field of chronic fatigue and now Long Covid.
The first was an interview with Professor Paul Garner, who is an expert on infectious disease and the evaluation of clinical research.
Professor Paul Garner thought he would never recover from Long Covid. Then came what he himself calls a “turn on the light” moment.
It describes his story of getting acute Covid, but not being hospitalised and then developing various Long Covid symptoms, which he thought would never disappear.
He then became aware of Recovery Norway, an organization that shares stories about people who, using cognitive and mental techniques, have recovered from medically unexplained diseases such as ME (CFS).
The idea is that acute infections can cause the nervous system to hang on to a kind of emergency preparedness, which can lead to fatigue. According to this way of thinking, it is also possible to influence the nervous system and physiological processes by, among other things, changing thought patterns, which has aroused great debate.
So, you have this autonomic nervous system that is on alert, it is looking for things that can be linked to a need to shut down. What you have to do then is get out of your own head. You need to remove the thought from the notion that you have some kind of internal biological disease, that the muscles or mitochondria are destroyed. You need to look forward to recovery
If you wish to read the full article by Jon Kare Time, translated from Norwegian please go to
The second was a fatigue patient guide written by Professor Michael Hyland, Dr Tony Davies and The Plymouth Patient Group, “Body Reprogramming for central sensitivity syndromes”.
For those of you who don’t know Central sensitivity syndromes include some of the chronic pain syndrome such as fibromyalgia/ chronic fatigue syndrome and other medically unexplained symptoms (MUS).
Professor Highland suffered from chronic fatigue syndrome and this is the protocol he developed to help those suffering from CFS. Essentially the hypothesis is that central sensitivity syndromes are caused by faulty program stop program. The stop program generates symptoms that stop you doing things.
It gives an excellent perspective for the patient in simple terminology. The stop program is triggered by lifestyle. The model predicts that the cure is also through lifestyle. By changing your lifestyle, you can prevent yourself getting worse and may be able to cure yourself completely. Change in symptoms is slow as improvement takes time.
Treatment is focused on various techniques in order to aid deep relaxation, creating positive emotions, optimal movement, linking relaxation and physical activity, there is some mention of nutrition but it’s not that prescriptive. There is a small section on nutritional supplements and prescription medication which some patients might find helpful. There is a good section on the generation of symptoms and the ideas behind them such as the threat of damage and that the body can often remain on high alert and tries to protect itself by maintaining symptoms of pain even after healing has completed.
He uses the analogy of the problem being either a hardware problem or a software problem which I think is easy for patients to understand. He touches upon sleep which is critical to our healing process and many people with central sensitivity simply do not sleep properly.
If you wish to read the full article, please go to
http://www.bodyreprogramming.org/Guide.aspx
It’s great to see that other clinicians, like me, also believe that for many patients with post viral syndrome and now probably Long Covid, do not have defined pathology (an actual ongoing disease process responsible for their symptoms). As with many complex clinical problems especially those defined as unexplained medical symptoms, the issue tends to be an interplay of functional factors. For what it’s worth I think a big driver of this is the autonomic nervous system, and the fact that viruses and other illnesses will often leave the individual in a state of a switched on stress nervous system response.
With functional disturbance the key is to measure it, I tend to do this via heart rate variability, explain to the patient the mechanism behind the symptoms and the treatment strategies (which will often need to be multidisciplinary) that will often be useful to reduce and hopefully eventually settle the symptoms completely.
There will be people who do have defined pathology, which is why a proper history and clinical examination and appropriate investigations may be necessary for many patients, if just to rule out obvious pathology so that the functional factors can be concentrated on or appropriate specialist referral organised.