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ObjectiveTo assess five physical signs to see whether they can assist in the screening of patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and potentially lead to quicker treatment.MethodsThis was a diagnostic accuracy study with inter-rater agreement assessment. Participants recruited from two National Health Service hospitals, local CFS/ME support groups and the community were examined by three practitioners on the same day in a randomised order. Two allied health professionals (AHPs) performed independent examinations of physical signs including: postural/mechanical disturbances of the thoracic spine, breast varicosities, tender Perrin’s point, tender coeliac plexus and dampened cranial flow. A physician conducted a standard clinical neurological and rheumatological assessment while looking for patterns of illness behaviour. Each examination lasted approximately 20 min.ResultsNinety-four participants were assessed, 52 patients with CFS/ME and 42 non-CFS/ME controls, aged 18–60. Cohen’s kappa revealed that agreement between the AHPs was substantial for presence of the tender coeliac plexus (κ=0.65, pConclusionsUsing the physical signs appears to improve the accuracy of identifying people with CFS/ME and shows agreement with current diagnostic techniques. However, the present study concludes that only two of these may be needed. Examining for physical signs is both quick and simple for the AHP and may be used as an efficient screening tool for CFS/ME. This is a small single-centre study, and therefore, further validation in other centres and larger populations is needed.

Research over the past twenty years by the author into the bio-mechanical aspects of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis has led to a hypothesis that a common aetiological pathway involves an insult to the lymphatic drainage of toxins from the central nervous system. Hypothalamic involvement in the pathogenesis of CFS/ME is discussed. The ensuing neurotoxicity due to infection, pollution and emotional or physical trauma may lead to excess of neurotransmitters such as acetylcholine due to autonomic over-activity. Indeed an increase of choline has been found in the occipital cortex of CFS/ME sufferers. (Excess breakdown in acetylcholine could lead to high levels of choline in the brain). Damage to the phospholipid bonds from neurotoxins is shown to be repaired by the additional supplementation of EPA. By combining the EPA with The Perrin Technique (a manual treatment combining lymphatic drainage, spinal and cranial osteopathy) it is argued that the neurotoxins are drained away from the central nervous system thus leading to a lasting improvement in the health of CFS/ME patients.