Perrin Method for ME & Chronic Fatigue Syndrome

What is it?

Chronic Fatigue Syndrome (CFS) and Myalgic Encephalomyelitis (ME) have been difficult conditions to reliably diagnose and treat. The medical profession as a whole is still unsure how best to diagnose it or help CFS/ME sufferers and much depends on the attitude of individual GPs as to how much consideration is given to patients who have the condition. Although the disease has now been given official national recognition both at a national (NICE Guideline 53 2007) and international level (Canadian Consensus Document 2003 Journal of Chronic Fatigue; and the Norwegian Directorate of Health 2011 has even issued a public apology for the way it has treated ME patients) it is still difficult for UK patients to get an accurate diagnosis and access appropriate treatment.

The condition is defined very much by the severity, longevity, complexity and intensity of the total symptom presentation. It has no one single biological marker to differentiate it from other pathologies and therefore has no one single remedy to match the pathology.

Generally it is defined as severe physical and mental fatigue unrelieved by rest, and it is now more widely recognized that for sufferers the condition can be devastating and potentially life destroying.

ME sufferers have often had to carry the additional burden of disbelief from physicians, families and friends when trying to prove that they have a medical condition, although that is gradually changing.

The Perrin technique offers a breakthrough in terms of how we can better understand the condition, and how we can treat it. The technique primarily works on the body’s immune system via the lymphatics to promote better regulation of the immune system and bring the body into a better homeostatic balance.

By considering the interaction of the spine, central nervous system, autonomic nervous system, lymphatic system, the cerebro-spinal fluid and regulatory centres in the brain (like the hypothalamus and amygdala) Perrin’s system can help explain the often disturbing array of symptoms that ME/CFS patients describe.

Who developed it?

The research that osteopath Dr Perrin has conducted over the last twenty years explains how stress can undermine the body’s immune system function to give the entire range of symptom’s that CFS/ME sufferers experience. Dr Perrin, through the Foundation for Research on ME (FORME) - Registered Charity www.forme.org, has developed an international reputation as an innovator in ME treatment.

Whilst recognising the various sources of stress that can affect people in today’s world, e.g. emotional, psychological, environmental, trauma,etc., Dr Perrin puts emphasis on the benefits of a properly targeted and structured physical therapy regime to address dysfunctions in the immune system to allow the body to come back into balance and restore normal functioning.

What conditions is it good for treating?

The combination of the physical explanation for the onset and maintenance of the CFS/ME condition and the physical treatment is the unique feature of Dr Perrin’s work. This makes it both understandable and available to everyone through his network of trained therapists. The diagnostic process gives people a clear understanding of where they are in the process of recovery, and what the progress towards recovery might look like. It is a comprehensive guide to the condition and can easily combine with other therapies like psychological support, diet, supplements and self-paced home treatment and exercises.

The work has given lasting relief to many ME/CFS patients, and hope to many more.

What is the evidence base that supports its effectiveness?

There is widespread agreement that no single biological marker has been identified to explain ME/CFS (ie no single pathogen or virus) e.g. The Canadian Consensus document. Dr Perrin based his Ph.D. study on the organic basis of ME/CFS and his thesis focussed on an in-depth examination of the immune system.

Other texts underpinning the method and rationale are as follows: Komaroff (2000) article “The Biology of Chronic Fatigue Syndrome” in the American Journal of Medicine outlined the basis of the disease in scientifically identified abnormalities in the central nervous system and immune system which together ‘influence and alter the function of the other in a reciprocal cycle’.

Perrin et al in an article published in 1998 in the Journal of Medical Engineering (An evaluation of osteopathic treatment on symptoms associated with Myalgic Encephalomyelitis) which reported ‘a demonstrable improvement in ME symptoms as a result of osteopathic treatment’ targetting improvement of the lymphatic flow.

This was followed in 2007 in an article by Dr Perrin in The Journal of the American Osteopathic Association on “Lymphatic Drainage of the Neuraxis in Chronic Fatigue Syndrome: A Hypothetical Model for the Cranial Rhythmic Impulse” which further developed the rationale for improving the neuro-lymphatic flow based on research into the cranial rhythm to help ME symptoms.

In 2010 Perrin et al published a report in the The British Journal of Radiology that demonstrated no cerebral abnormality in patients with ME compared with normal healthy volunteers as revealed by MRI brain scanning methods which called into question whether such methods can be used diagnostically for ME/CFS; this inference further supports further investigation of lymphatic disturbance as a major contributory factor.

Perrin put forward further evidence of using physical treatment designed ‘to improve the respiratory mechanisms and blood and lymphatic fluid movement within the body and reduce disturbed afferent sympathetic impulses’ in an article in the International Journal of Osteopathy in 2010 (Muscle Fatigue in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) and it’s response to a manual therapeutic approach: A pilot study). Perrin posited that through his method of intervention ‘the overall sympathetic nervous system eventually begins to function normally thus further improving the central lymphatic pump which increases toxic drainage in all body tissues, including skeletal muscle’. The pilot study indicated that post exertion muscle fatigue in ME/CFS patients is not due to muscle dysfunction but is more likely due to lymphatic disturbance.

Further evidence of Perrin’s thesis came from Prof. Basant Puri et al who confirmed the existence of a diagnostic point used by Perrin in his diagnostic process. (Journal of International Medical Research in 2011: “Increased tenderness in the left third intercostals space in adult patients with myalgic encephalomyelitis in a controlled study).

Dr Perrin’s diagnostic approach is currently being compared with standard medical diagnosis in a clinical trial in the north of England, and his method is widely endorsed by ME/CFS groups

What are the risks and benefits of treatment?

The major risk associated with Perrin’s work is a transitory worsening of symptoms as the body’s immune systems becomes better able to deal with toxicity. These changes are seen as evidence of improved lymphatic function.

The benefits are gradual improved functionality and reduction in symptoms.

Are there any side-effects from the treatment?

As above.

How many sessions does it need?

Depending on the severity and chronicity of the condition the treatment will last from between 9 months and two years. The initial sessions are weekly and are gradually decreased to quarterly treatments as the patient takes over the treatment.

How long do sessions need to be?

The initial session is an hour. Follow-ups are 40 minutes.

How many practitioners need to be available?

The therapy is usually delivered on a one-to-one basis, though some limited aspects can be taught as self-healing.

Does it need follow-up support? If so what, how often, by whom...?

Depending on personal circumstances, e.g. levels of personal activity, risk of re-injury, age and levels of active self-care, bodies will either maintain the gains achieved by the therapy or will need occasional maintenance. The Perrin Practitioner will advise on risks of relapse and level of maintenance required for each individual patient.

How does it work as a self-care tool?

The diagnostic work and initial assessment is carried out by a Perrin trained practitioner who will give an indication of the stage of the patient’s recovery and time scale needed for a full recovery.

However, the patient will be expected to undergo a regime of daily self-treatment administered by the patients themselves or a trusted carer. This self-help element is essential for recovery.

The assessment process will give the patient insight into the disease and through that additional supportive therapies will be indicated, such as dietary changes, use of supplements and psychological and emotional work.

What is the best way for teaching the self-care techniques?

All self-help elements are co-ordinated by the Perrin Practitioner and are supported by:

  • Paper based information sheets
  • DVDs
  • CDs
  • And free Web-based learning material

Where can Self-Healing methods be accessed?

TSHP can provide a Perrin approved practitioner locally otherwise practitioners can be found nationally via the Perrin Clinic website (www.theperrinclinic.com).