Summary
The purpose of this study is to examine the relationship between anesthetic-induced malignant hyperthermia (MH) and severe, generalized, and persistent muscle pain. We have performed the caffeine-halothane contracture test (CHCT) (3% halothane-induced contractures, caffeine-specific concentrations [CSCs], and 2 mM caffeine-induced contractures) on 34 healthy volunteer controls, 114 patients who have had known or suspected malignant hyperthermic (MH) reactions, and 143 patients who have had severe and persistent muscle pain that has prevented full-time work. Serum creatine kinase (CK) levels, 3% halothane contractures, and 2 mM caffeine contractures were substantially greater and CSCs were significantly smaller in the MH and muscle pain (MP) patients than in the control patients. There were no significant differences in these parameters between the MH and the MP patients except that CK levels were greater in the MP than in the MH patients. There seem to be at least three possible scenarios for the etiology of MP. The first is that MP patients are simply MH genotypes who have not yet had an MH reaction. They possess the MH gene, and their symptoms are triggered by environmental factors such as excessive exercise, extreme heat or cold, infection, or chemicals in the workplace. The second is that MP individuals are actually chronic fatigue immune dysfunction syndrome (CFIDS) patients. It may be that muscle changes occur in CFIDS patients that mimic MH, at least so far as the CHCT is concerned. The third possibility is that the MP patients have some third, as yet unidentified, condition that is different from both MH and CFIDS. We have shown that a cohort of chronic muscle pain patients possess an organic muscle defect as evidenced by abnormal CHCTs even though the microscopic appearance of their muscles was normal and in spite of a lack of objective physical abnormalities. This defect is probably similar to MH, but whether it is identical to MH has not been shown by this study.
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References
Poels PJE, Joosten EMG, Sengers RCA, Stadhouders AM, Veerkamp JH, Benders AAGM (1991) In vitro contraction test for malignant hyperthermia in patients with unexplained recurrent rhabdomyolysis. J Neurol Sci 105: 67–72
Gronert GA, Thompson RL, Onofrio BM (1980) Human malignant hyperthermia: awake episodes and correction by dantrolene. Anesth Analg 59: 377–378
Wingard D, Gatz EE (1977) Some observations on stress susceptible patients. In: Aldrete JA, Britt BA (eds) Second international symposium on malignant hyperthermia. Grune and Stratton, New York, pp 363–367
Wingard D (1977) Malignant hyperthermia—acute stress syndrome of man? In: Henschel EO (ed) Malignant hyperthermia current concepts. Appleton-CenturyCrofts, New York
Wingard DW (1980) A stressful situation. Anesth Anal 59: 1041–1042
Wingard DW (1974) Malignant hyperthermia: a human stress syndrome? Lancet i: 408
Krivosec-Horber AP, Reyford H (1991) Relationship between exercise-induced myolysis and malignant hyperthermia. Br J Anaesth 67: 221–228
Heytons L, Martin JJ, Van de Kelft E, Bossnert LL (1992) In vitro contracture tests in patients with various neuromuscular diseases. Br J Anaesth 68: 72–75
Proceedings of a workshop on chronic fatigue syndrome, Toronto, Ontario, 28/29 September 1989. Organized by the Laboratory Centre for Disease Control, Health Protection Branch, Dept. of National Health and Welfare, Canada
Goldenberg D, Simms RW, Geiger A, Komaroff AL (1990) High frequency of fibromyalgia in patients with chronic fatigue seen in primary care practice. Arthritis Rheum 33: 381–387
Goldenberg D, Komaroff AL (1989) The chronic fatigue syndrome: definition, current studies and lessons for fibromyalgia research. J Rheumatol (suppl) 19: 23–27
Abbey SE, Garfinkel PE (1991) Neurasthenia and chronic fatigue syndrom. Am J Psychiatty 148: 1638–1646
Ichise M, Salit JE, Abbey SE, Chung D-G, Gray B, Kirsh JC, Freedman M (1992) Assessment of regional cerebral perfusion by technetium-99 m HM-PAO SPECT in chronic fatigue syndrome. Nucl Med Commun 13 (10): 767–772
Ahles TA, Yunus MB, Masi AT (1987) Is chronic pain a variant of depressive illness? The case of primary fibromyalgia syndrome. Pain 29: 105–111
Buchwald D, Goldenberg DL, Sullivan JL, et al (1987) The chronic active Epstein-Barr virus infection syndrome and primary fibromyalgia. Arthritis Rheum 30: 1132–1136
David A, Wesseley S, Pelosi A (1988) Post viral fatigue: time for a new approach. Br Med J 296: 696–698
Wesseley S (1990) Old wine in new bottles: neurasthenia and ME. Psychol Med 20: 35–53
Arnold DL, Radde GK, Bore PJ, Styles P (1984) Excessive intracellular acidosis of skeletal muscle on exercise in a patient with a post-viral exhaustion/fatigue syndrome, Lancet 1: 293
Behan PO, Bchan WMH, Bell EJ (1985) The post-viral fatigue syndrome—an analysis of the findings in 50 cases. J Infection 10: 211–222
Mildon A (1991) Chronic fatigue syndrome. Can Dis Wkly Rep (suppl) 17S1E: 18
Archard LC, Bowles NC, Behan PO, Bell EJ, Doyle D (1988) Postviral fatigue syndrome: persistence of enterovirus RNA in muscle and elevated creatine kinase. J R Soc Med 81: 326–329
Russell IJ (1989) Neurohormonal aspects of fibromyalgia syndrome. Rheum Dis Clin North Am 15: 141
Montague TJ, Marrie TJ, Klassen GA, Bewick DJ, Horacek BM (1989) Cardiac function at rest and with exercise in the chronic fatigue syndrome. Chest 95: 779–784
Gow JW, Behan WMH, Clements GB, Woodall C, Riding M, Behan PO (1991) Enteroviral RNA sequences detected by polymerase chain reaction in muscle of patients with postviral fatigue syndrome. Br Med J 302: 692
Ritz J (1989) The role of natural killer cells in immune surveillance (editorial). N Engl J Med 320: 1748–1749
Archard LC, Cunningham L (1992) Molecular virology of muscle disease: persistent virus infection of muscle in patients with postviral fatigue syndrome. In: Hyde BM, Goldstein J, Levine P (eds) The clinical and scientific basis of myalgic encephalitis/chronic fatigue syndrome. Nightingale Research Foundation, Ottawa, Canada, P 343
Klimas NG, Salvato FR, Morgan R, Fletcher MA (1990)) Immunologic abnormalities in chronic fatigue syndrome. J Clin Microbiol 18: 1403–1410
Landay AL, Jessop C, Lennette ET, Levy JA (1991) Chronic fatigue syndrome: clinical condition associated with immune activation. Lancet 338: 707
Hickie I, Lloyd A, Wakefield D, Parker G (1990) The psychiatric status of patients with chronic fatigue syndrome. Br J Psychiatry 156: 534–540
Holmes GP, Kaplan JE, Grantz NM, et al (1988) Chronic fatigue syndrome: a working case definition. Ann Intern Med 108: 387–389
Cody RP, Smith JK (1991) Applied statistics and the SAS programming language. North-Holland, New York
Britt BA (1991) Malignant hyperthermia—a review. In: Schonbaum E, Lomax P (eds) Thermoregulation: pathology, pharmacology and therapy. Pergamon Press, New York, pp 179–292
Larach MG (1989) Standardization of the caffeine halothane muscle contracture test. Anesth Analg 69: 511–515
Gronert GA, Chun K, Martucci R, Jones BR (1990) Concentration of halothane in Kreb’s medium. Anesth Analg 71: 305–314
Larach MG, Localio AR, Allen GC, Denborough MA, Ellis FR, Gronert GA, Kaplan RF, Muldoon SM, Nelson TE, Ording H, Rosenberg H, Waud B (1994) A clinical grading scale to predict malignant hyperthermia susceptibility. Anesthesiology 80: 771–779
Britt BA, Endrenyi L, Peters PL, et al (1976) Screening of malignant hyperthermic susceptible families by CPK measurement and other clinical investigations. Can Anaesth Soc J 23: 263–284
Ellis FR, Clarke IMC, Modgill M, Currie S, Harriman DGF (1975) Evaluation of creatine phosphokinase in screening patients for malignant hyperpyrexia. Br Med J 3: 511–513
Paasuke RT, Brownell KW (1986) Serum creatine kinase level as a screening test for susceptibility to malignant hyperthermia. JAMA 255: 769–771
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© 1996 Springer-Verlag Tokyo
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Britt, B.A., Mildon, C.A., Frodis, W., Scott, E. (1996). Association Between Malignant Hyperthermia and Severe, Chronic Muscle Pain. In: Morio, M., Kikuchi, H., Yuge, O. (eds) Malignant Hyperthermia. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68346-9_20
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DOI: https://doi.org/10.1007/978-4-431-68346-9_20
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