The Perrin Technique for the osteopathic diagnosis and treatment of Chronic Fatigue Syndrome/ME & Fibromyalgia

30Dr Raymond Perrin DO (UK), PhD. Registered Osteopath

Neuroscientist and Specialist in Chronic Fatigue Syndrome/ME.

Hon. Senior lecturer – Allied Health Professions Research Unit, The University of Central Lancashire, Preston, UK.

Vice Patron – University College of Osteopathy, London.

International Faculty member of The Osteopathie Schule Deutschland(OSD) Visiting Professor: Osteopathic Department:  St Petersburg University Medical School, St Petersburg, Russia and The International Academy of Osteopathic Medicine, Sicily.

Winner of the Institute of Osteopathy’s Research and Practice Award 2015.

The planned 2 day workshop is accredited in the UK with CPD from the General Osteopathic Council and has received accreditation for 13 hrs CME in the USA with the AOA.

It  fulfils the seven core CME competencies required by the American Osteopath Association :

1. Osteopathic Philosophy/Osteopathic Manipulative Medicine – The Perrin Technique is entirely based on the application and the teaching of knowledge of accepted standards in osteopathic manipulative treatment appropriate to the treatment of CFS/ME , CFIDS and fibromyalgia. Future planned refresher workshops and newsletters will ensure that the practitioners remain updated with the latest developments in the field of CFS/ME.
2. Medical Knowledge – The workshop will amply demonstrate and apply knowledge of accepted standards of clinical medicine with the other current treatments being examined and discussed.
3. Patient Care – There will be hands on practical teaching of the physical examination and treatment of CFS/ME and fibromyalgia. By the end of the workshop, delegates will have been taught and be required to demonstrate the ability to effectively treat patients and provide medical care that incorporates the osteopathic philosophy, patient empathy,awareness of behavioral issues, the incorporation of preventive medicine and health promotion.
4. Interpersonal and Communication Skills – This is so important in the field of CFS/ME and fibromyalgia. The workshop will show how by explanation of what we now know to be occurring with this disease interpersonal and communication skills enable a physician to establish and maintain a much better professional relationships with patients, families, and other members of health care teams.
5. Professionalism – The workshop will go through the case studies of a variety of the hundreds of CFS/ME  and fibromyalgia patients treated by Dr Perrin and will emphasize the practitioner be cognizant of physical and mental health in order to effectively care for patients.
6. Practice-Based Learning and Improvement – The entire 2 day workshop will be dedicated to demonstrate the ability to critically evaluate methods of clinical practice, integrate evidence based medicine into patient care. The previous and present research trials undertaken by Dr Perrin with leading scientists from some of the top universities in the UK will be discussed.
7. Systems-Based Practice – this is covered in day 2 of the workshop which will be practically based showing the delegates how to provide effective and qualitative patient care practice cost effective medicine to improve the quality of life in patients with CFS/ME and Fibromyalgia.

At present over 1000 sufferers across the UK receive The Perrin Technique from around 60 licensed practitioners. The demand for this treatment is growing in Europe as seen by the increasing number of emails He receives from patients from all over the continent.

According to the National Alliance for Myalgic Encephalomyelitis  in the US ,recent research has the number closing in on a million Americans, with similar statistics in other countries in proportion to their population.   ME/CFS affects more Americans than AIDS, lung cancer and breast cancer combined, more people than have multiple sclerosis or cystic fibrosis, and latest estimates place economic impact of ME/CFS in the U.S. at $22 – $28.6 billion annually.  More importantly, nearly 90% of patients have not been properly diagnosed. Recovery rate is poor, estimated between 5% and 10% of patients attaining total remission.  Patients can be as functionally impaired as those suffering from diabetes, heart failure and kidney disease, and are often as severely disabled as those with heart failure, late-stage AIDS, MS, patients undergoing chemotherapy, and COPD (chronic obstructive pulmonary disease).

The Perrin Technique ^TM

TRAINING SEMINAR  

Course Lecturer:  Dr Raymond N Perrin D.O., PhD 

Registered Osteopath, Neuroscientist and Specialist in Chronic Fatigue Syndrome/ME

THE PERRIN TECHNIQUE WORKSHOP

DAY 1  THEORY

9.00 am                           Registration/Coffee

9.30 am                           Applied Anatomy and physiology of the sympathetic nervous and neuro-lymphatic systems.

11.00 am                         Tea/Coffee break

11.15 am                         The pathogenesis of CFS/ME

1.00 pm                            Lunch

2.00 pm                           The Physical signs of CFS/ME.

2.30 pm                           Diagnosis (with a full consultation with a CFS/ME patient)

4.00 pm                           Tea/Coffee break

4.15 pm                           Practical training: Examination and diagnosis.

6.00 pm                           Close

DAY 2  Treatment

9.00 am                            Coffee

9.30 am                             Current Management and Treatment of CFS/ME

11.00 am                         Tea/Coffee break

11.15 am                         Practical training: Treatment

1.00 pm                           Lunch

2.00 pm                          Practical training: Treatment cont. Plus exercises and management advice.

4.00 pm                          Tea/Coffee break

4.30 pm                          Workshop summary: Questions and Answers Session

6.00 pm                          CLOSE

The Theory

The Perrin Technique^tm  for the diagnosis and treatment of CFS/ME was developed by myself in 1989. This technique is based on the following hypothesis. The central nervous system is the only region in the body that has no true lymphatic system.  The cerebrospinal fluid  acts as a lymphatic system draining toxins along cranial and spinal peri-vascular spaces. The toxins then drain into lymphatic vessels in the tissue primarily around the nasal sinuses. (Knopf and Cserr 1995, Cserr & Knopf, 1992) There is further drainage of the cerebrospinal fluid down the spine and outwards to pockets of lymphatic vessels running alongside the spine . The lymphatic vessels take the toxins away via the thoracic duct into the blood and the liver where they are broken down.

A new study published in the Journal of Science Translational Medicine (Iliff et al., 2012) using new scanning techniques  has proven the existance of this neuro-lymphatic drainage  down what they refer to as para-vascular spaces  with the primary function to rid the brain of unwanted extracellular fluids. Iliff and colleagues, conducting their research at the University of Rochester Medical Centre, New York, were intrigued by the fact that there appeared to be no obvious lymphatic vessels in the brain and that, without such a system, substances including amyloid-beta – a peptide that accumulates in the brains of people with Alzheimer’s – would accumulate, with possible detrimental effects.  Such findings certainly support his  theory that the failure of the body’s drainage system to function optimally can result in the accumulation of toxic substances.

In CFS/ME it is these drainage pathways, both in the head and the spine, that are not working sufficiently, leading to a build-up of toxins within the central nervous system. The aetiology may be traumatic, congenital and may even be hereditary. If the structural integrity of the spine and brain are both affected leading to reduced drainage, the increased toxicity (often following a viral or bacterial infection) plus stress factors (physical, chemical, emotional, immunological  and/or environmental) will lead to hypothalamic dysfunction and thus affect sympathetic control of the central lymphatic vessels (Kinmonth, 1982).

Clinical Trials

In the workshop, you will learn how to examine patients for physical signs that aid in the diagnosis of CFS/ME and Fibromyalgia. These signs have been confirmed in a recent, NHS study at Wrightington Hospital published in the BMJ Open (Hives L et al. Nov, 2017), which will be discussed in detail.

The effectiveness of this manual approach was tested using two separate clinical trials. The studies were designed to develop a greater understanding of the disorder, for which there is much scientific uncertainty regarding the cause, diagnosis and treatment.

Overall this research has provided strong evidence that an important component of CFS/ME involves a disturbance of lymphatic drainage of the brain and muscles. This novel osteopathic treatment has been statistically validated in both clinical trials, emphasising the need to focus future research on the biomechanical aspects of this disorder.(Perrin,1994; Perrin et al, 1998; Perrin, 2005; Perrin, 2007) The technique has featured in many articles in the media such as New Scientist (Hooper, 2006).  Over the past 18 yearstogether with Neurobiologist Dr Vic Pentreath, Health psychologist Dr Pat Hartley, bioengineers Prof. Jack Edwards and Prof Jim Richards at the University of Salford in conjunction with neuro-radiologist Professor Alan Jackson and his team at the University of Manchester, we have expanded overall knowledge of  CFS/ME. 

Independent Support

The treatment plan has already been validated by an independent published survey conducted by a local patient support group in the North West (Vernon, 2004). One hundred and fifty members of the Stockport M.E. support group answered questionnaires related to the services provided by NHS professionals and complementary practitioners. One of the outcomes of this independent survey was a list of therapies that the group’s members found useful in managing their illness.

Table 1Results of Stockport ME patients support group survey on treatment therapies effective in their case: listed in order of preference (Vernon, 2004)

Some of the 150 patients listed more than one treatment that they had found helpful.  This explains why the total of all patient numbers in this table add up to 161.

The data suggests that although aromatherapy, massage, the Alexander and the Bowens techniques are also forms of therapy with the emphasis on the physical, they score the lowest ratings in the table compared to the manual treatment advocated in this thesis which scored the highest.  So the observed benefits are not achieved by the mere laying of hands by a sympathetic practitioner. The complete treatment approach required includes spinal, cranial and specialised lymphatic drainage techniques.

An independent parliamentary enquiry took place in 2006, under the chairmanship of Dr Ian Gibson MP, to examine the latest research and treatment of CFS/ME. The Gibson Enquiry committee, which included two eminent physicians Lord Turnberg and Dr Richard Taylor MP, concluded that the NHS clinics treatment of CBT, GET and pacing is useful in mild cases but may prove harmful for severe cases. At the initial meeting it was unanimously agreed that early diagnosis leading to an earlier treatment and management strategy was a major factor in improving the prognosis. Dr Taylor was interested in the physical diagnosis developed by Dr Perrin stating that it looked simple to implement and most importantly sounded inexpensive and should be further investigated. The report further concluded that useful and empirical methods of treatment such as The Perrin Technique should not be dismissed simply because it is unorthodox. (Gibson et al, 2006) and called for further research into this area.

The ME Association of the UK has been behind probably the largest-ever British survey of opinion among people with ME/CFS and their carers about which treatments and therapies work for them and which don’t. The survey also shows what people with the illness want from their health and social care providers. They are contained in a 32-page report called ‘Managing my ME’, which was published by The ME Association on 27 May 2010. The survey, carried out online and through a paper questionnaire by the ME Association in the summer of 2008, attracted huge interest when the questionnaire was held open online for over four months. A total of 3,494 people answered the questions online. Another 723 completed the paper questionnaire after it was circulated with our quarterly ME Essential magazine.

The survey results were submittedto an inquiry into the state ofNHS services for people with ME/CFS in England carried out by the All-Party Parliamentary Group on ME. Key findings from the MEA survey were inserted into the final APPG report.

In the survey, a table of 25 therapies tried by patients were listed by the percentage of people who improved.

Graded Exercise Therapy (GET) was listed as 24^th  with only 22.1% improved with significantly 56.5% worse. CBT faired slightly better listed at 22^ndwith only 25.9% improved. The Top 3 were:

1.Pacing: 71.2% improved

2.Meditation and relaxation: 53.7% improved

3.The Perrin Technique: 51.3% improved

In 2009 Ray Perrin presented his work to the World’s leading experts in CFS/ME at the conference of the International Association of CFS/ME in Reno, Nevada and in March 2014 Dr Perrin presented some further research findings at the conference of the International Association of CFS/ME in San Francisco. In 2016 he was a lecturer at the IACFS/ME conference in Fort Lauderdale, Florida where he was invited to present his findings to the Neuro-immune research centre at the College of Osteopathic Medicine at NOVA South Eastern university he has also been  invited to lecture to The World Congress of Psychosomatic Medicine in Torino, Italy and the first three World congresses of Neurobiology and Psychopharmacology in Thesoliniki, Greece. He was able to put forward the case to some of the leading psychiatrists in the World that CFS/ME is a physical disease and not a mental disorder.  He has been honoured to be on the scientific committee for The Congress on Neurobiology and Psychopharmacology. These conferences are organised by the European association of psychiatrists so it is significant that the psychiatric camp are acknowledging that CFS/ME needs a different approach.

In 2015 he won the inaugural Research and Practice award from the Institute of Osteopathy.

In 2016 A large independent blinded controlled trial into the physical diagnosis finished within the National Health service together with two leading hospitals in the UK  and the University of Central Lancashire, Preston. He  will be detailing this groundbreaking research project in his proposed lecture and workshop. It is very soon to be published in one of the leading medical journals.

As well as the in the UK, Dr Perrin has so far run workshops in The Czech Republic, Germany, The Netherlands, Ireland, Norway, Sweden, Finland, Poland, Greece, Channel Isles, Sicily, South Africa, The USA and Russia. Now it is Mainland Italy’s turn.

Testimonials from other osteopaths who have attended Dr Perrin’s Workshop.

“Attending Raymond’s workshops has helped me immeasurably with my patients, firstly in giving me the confidence to correctly diagnose whether they do or don’t have ME/CFS. Secondly if they don’t have ME/CFS it has also helped me to understand much better how to improve the function of the lymphatics and autonomics, which in general osteopathic practice often need attention and treatment to help many patients who are working under par or struggling with stress. 

I would highly recommend studying this work, which is well researched, has been consistently shown to be clinically effective and has provided reassurance, hope and brought much needed expertise to many, many patients in their often long and challenging journey back to health.” Isla Brown,  Glasgow, Scotland

“Excellent course material. Very stimulating lectures and brilliantly taught. The content was interesting and mostly Dr Perrin had energy and passion in teaching and everything was well structured and organized. I very much enjoyed the course and would definitely recommend it to future practitioners.” Rakhee Soni The Chalfont Clinic, Buckinghamshire , UK                                                                                                                                                                                                                                                       

“I attended my first Perrin Technique training seminar over 10 years ago. It opened the way for me to use osteopathy to treat a whole set of patients that otherwise wouldn’t have been possible. The training seminar led by Dr Ray Perrin an expert in ME/CFS and the world leader in it’s treatment through osteopathy, taught me how osteopathy treats one’s patient at a deep physiological level. Continued attendance of his excellent annual conferences has only gone on to widen the scope of my osteopathy and practice.”  Ian Trotter, BSc. Registered Osteopath, Chester, UK. 

Seit 2 Jahren wende ich erfolgreich die Perrin-Technik in meiner allgemeinärztlichen Praxis für ärztliche Osteopathie an. Bevor ich die Perrin-Technik in Manchester erlernen durfte habe ich bereits seit vielen Jahren Patienten mit dem Leitsymptom Erschöpfung in meiner Praxis behandelt. Mein Konzept der Behandlung aller dekompensierten autonomen Systeme, war bisher auch erfolgreich. Bisher standen die Dysfunktionen der Immuno-, Psycho-, Endokrino- und Neuropathie im Vordergrund. Nach der Ausbildung von Ray Perrin mit seinem wunderbarem Curriculum habe ich nun die Perrin-Technik in mein Praxiskonzept integriert. Ich kann rein retrospektiv beobachten, dass die Heilung der CFS-ME Patienten seither schneller verläuft und dass die Fälle, bei denen bisher wenig Heilung erzielt werden konnte, nun deutlich besser verlaufen. Dr. med. Klaus Dörhage, Facharzt für Allgemeinmedizin, Ärztl. Osteopath (D.O. DAAO), Hamburger Landstr. 26a, 24113 Molfsee

Dr Raymond N. Perrin  DO, PhD Contact details:

Tel 0044 161 773 0123  Mob 0044 7899 752404  email drperrin@theperrinclinic.com

References:

Browse NL. Response of lymphatics to sympathetic nerve stimulation. J. Physiol. (London) 1968,19: 25.

Cserr HF, Knopf  PM. Cervical Lymphatics, the blood-brain barrier and immunoreactivity of the brain: a new view. Immunology Today. 1992, 13: 507-512.

Gibson I, et al.. Inquiry into the status of CFS/M.E. and research into the causes and treatment. Group on Scientific Research into M.E.2006.

Hooper R. Waking up to chronic fatigue. New Scientist,  20^thMay 2006, 10-1.

Kinmonth JB. The Lymphatics, 2^ndEdition; Edward Arnold, London. 1982: p80

Knopf PM, Cserr HF. Physiology and Immunology of lymphatic drainage of interstitial and cerebrospinal fluid from the brain. Neuropathology and applied Neurobiology. 1995,  21: 175-180.

Perrin RN. Lymphatic Drainage of the Neuraxis in Chronic Fatigue Syndrome: A Hypothetical Model for the Cranial Rhythmic Impulse. Journal of the American Osteopathic Association, 2007. 107(06), 218-224.

Perrin RN. The Perrin Technique^tmHow to beat Chronic Fatigue Syndrome /ME. Hammersmith Press, 2007, London.

Perrin RN. The involvement of cerebrospinal fluid and lymphatic drainage in Chronic fatigue syndrome/ME , PhD Thesis, University of Salford, 2005. Salford, Gr. Manchester.

Perrin RN, Edwards J and Hartley P An evaluation of the effectiveness of osteopathic treatment on symptoms associated with Myalgic Encephalomyelitis. A preliminary report.  Journal of Medical Engineering and Technology, 1998.  22(1), 1-13.

Perrin RN. Chronic Fatigue Syndrome, a review from the biomechanical perspective. British Osteopathic Journal, 1993,11.

Vernon D.. Stockport ME  Group Members Survey. Hermes Newsletter, 2004,  March; 3.

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