From edmesh newsletter 72, Summer 2010

The Speaker

Dr. Raymond Perrin is a Registered Osteopath who trained with the British School of Osteopathy. He has been a specialist in the study and treatment of ME since 1989 when he cured a cyclist patient of ME without intending to, and has a Ph.D. in the involvement of cerebrospinal fluid and lymphatic drainage in CFS/ME.

The Perrin Technique for CFS/ME was carefully researched and tested by academic staff in the Universities of Salford and Manchester between 1994 and 2005. Dr. Perrin personally trains and licences all practitioners of his technique at the Perrin Clinic in Manchester.

The Importance of the Lymphatic System

Dr Perrin explained that every part of the body from cells to organs must be nourished and purified to function healthily. The role of the blood and circulatory system is well known in this regard; less understood is the function of the lymphatic system.

The major functions of the body are controlled by the brain. Cerebrospinal fluid surrounds the brain, supplying nutrients to it. The fluid also draws poisons from the brain, which flow through the capillaries into the bloodstream and from there go to be detoxified in the liver.

However, blood capillaries can only deal with small molecules. Large molecules of toxins must go into the lymphatic system, which is a network of tubes which carry lymph, a clear fluid, around the body. This system provides a drainage method that backs up the blood flow. The large particles enter the system at the terminal lymph vessels or terminal lymphatics, through openings like gills in a fish. The particles break down into smaller molecules in the lymph nodes on the way to the two large subclavian veins under the collar bones. The breakdown products flow into the bloodstream and then make for the liver for final detoxification.

How CFS/ME Develops

Patients all seem to have a predisposing history of sympathetic nervous system overload, either physically, chemically, immunologically or emotionally:

• through  overactivity or injury
• because of environmental pollution
• by chronic infections or allergens
• from family or work stress.

An important function of the sympathetic nervous system is to control the pumping mechanism in the walls of the thoracic duct in the chest, which is the central system for draininglymph fluid into the bloodstream. Dr. Perrin explained that the pumping mechanism was discovered in the 1960s by Professor John Kinmonth, a London chest surgeon. However, even today, this is not generally recognised and taught in medical schools.

Diagram of the normal lymph flow through a lymphatic vessel with open valves.

If the sympathetic nervous system is hyperactive, the pump may push the lymph fluid in the wrong direction and lead to a further build-up of toxins in the body.

The lymphatic system extends from the head to the feet, with main lymph nodes in the chest as well as subsidiary lymph nodes in clusters under the chin, at the shoulders, under the arms and in the groin. It includes the lymphatic vessels through which the lymph travels in a one-way system only towards the heart.

In a disease state, toxins can actually be pumped back into the central nervous system, e.g. into the brain or breast tissue. The valves of the lymph vessels may become damaged as the lymph flows in both directions, creating congestion.

This gives rise to varicose lymph vessels or varicose lymphatics, as seen by Professor Kinmonth in surgery, with their typical beaded, colourless appearance on the skin. Dr Perrin says that they can be felt by a specially trained osteopath and that every ME patient has them.

Diagram showing development of varicose lymphatics, with reverse flow of lymph

The Role of the Hypothalamus

The hypothalamus, a small region low in the front of the brain, controls several hormones and the sympathetic nerves, which spread out in twelve pairs from the thoracic section of the spine, extending down the main part of the back.

The hypothalamus is one of the few sites in the brain allowing large molecules from the blood to enter: the blood-brain barrier acts as a filter elsewhere. The function of the hypothalamus is to sample the hormones that pass to it from the blood, and signal to the organs to rebalance if necessary. Unfortunately, large toxic molecules may also enter the brain at this point, or may already be there because of the chemical changes going on in the brain all the time, especially when stress is present.

Fortunately there is a drainage mechanism from the brain into the lymphatic system, discovered in the 1870s by the American founder of osteopathy, Dr. A. T. Still. He wrote that “the lymphatics are closely and universally connected with the spinal cord and all other nerves, and all drink from the waters of the brain.

Dr Perrin explained that there are four drainage points in the brain. The main one is the cribriform plate, part of the ethmoid bone, which separates the nasal cavity from the brain. Two rows of small holes in the plate allow the passage of blood vessels, nerves and cerebrospinal fluid to the nasal passages. The three further drainage points in the skull are situated at the auditory nerve, at the optic nerve and at the part of the trigeminal nerve in the cheek. If, however, the plate or another point is damaged, there will be a build-up of toxins in the lymph and damage to the sympathetic nervous system’s control of the thoracic duct, setting up a vicious circle. Damage can occur through causes such as congenital defect, birth trauma, emotional upset, infection, postural strain or environmental pollution.

Most of the medical profession are ignorant of these drainage points and their function, said Dr Perrin.

The Four Physical Signs of CFS/ME

Having examined over a thousand CFS/ME patients over 21 years, Dr Perrin (and now his trained practitioners) can identify four signs to confirm the diagnosis. These are:

1. Varicose lymphatic vessels and tenderness at ‘Perrin’s Point’ in the left breast area (the point is where the thoracic duct turns to the left to enter the subclavian vein, and where two sets of sensory nerves join).
2. Tenderness at the coeliac or solar plexus, at the front of the upper abdomen, where adjacent sensory and
   sympathetic nerves connect.
3. Structural problems at the mid-point of the spine, which may be flattened or restricted and tender to the touch.
4. Slow, shallow, erratic cranial rhythm to be felt in the upper part of the head, caused by lymphatic pump reversal.

Other signs include yeast patches on the skin; stretch marks (striae) due to collagen damage caused by backflow of lymph; swellings and cysts; acne; and overdilation of pupils from overstimulation of the sympathetic nervous system.

Treatment

Dr Perrin explained briefly that treatment by his technique involves gentle stimulation of the lymphatic system through stroking to drain the offending toxins from the central nervous system. This induces relaxation, soothes irritation and clears congestion from the cranium and also from the spine and surrounding soft tissue. Treatment may take between three months and three years depending on how severe the symptoms and signs are, and involves some self-massage.

In two recent clinical trials, patients with varying degrees of illness severity showed an overall 40% improvement in a year. Dr Perrin said that 90% of his personal patients are helped, and that 30% get to the 100% functioning level.

Publications and Presentations

Dr Perrin has been having articles about his work published in medical journals since 1993, and has also written a book, The Perrin Technique: how to beat Chronic Fatigue Syndrome/ME. His latest article appeared in the British Journal of Radiology in May 2010.

He was asked to make a presentation to the Group on Scientific Research (the Gibson Inquiry) at the House of Commons in 2006. The final report recommended that his methods would be “cost effective”. As a result, Dr Perrin will be presenting a research project that will take five years to prepare to the NHS and NICE.

He presented three papers at the International Association for CFS/ME’s Research and Clinical Conference at Reno, Nevada, in March 2009, and was invited to address the World Congress of Psychosomatic Medicine in 2009 as well as the European Association of Psychiatrists.

Questions

In response to questions, Dr Perrin explained that stresses of all kinds cause chemical changes in the brain and that toxins could remain in the body for years. When they are drained out byhis methods, they will hit the body’s pain receptors, and may cause varying degrees of pain,although usually the more pain, the more gain. Standard lymphatic drainage techniques do not workfor CFS/ME as they simply move the lymph faster the wrong way.

Dr Perrin believes that the drainage pathway is compromised mechanically as part of the root of CFS/ME. The main problem is that the toxins are affecting brain function, and metabolism. There is chronic hyperactivity of the sympathetic nervous system. He conceded that other treatments may be needed to complement his work; some of these come under the heading of “Wellbeing Therapy”.

Commenting on the XMRV virus debate, Dr Perrin quoted Dr Judy Mikovits herself as saying that it is “a consequence of impaired immunity”, and not a cause of CFS/ME. This ties in with his own belief that CFS/ME is more often a pre-viral, not a post-viral condition.

Alcohol can be difficult to tolerate because it is yet another toxin that the liver must struggle with, and because it triggers NMDA receptors, which have heightened sensitivity.

Dr Perrin concluded by warning that the World Health Organisation and the American Psychiatric Association are thinking of reclassifying CFS/ME as a psychiatric disease, and that his work is one of the main things that could stand in the way.

Follow-up

edmesh members may obtain your own free copy of the DVD of Dr Perrin’s talk by emailing jack@edmesh.org.uk. The DVD is also available to borrow from the edmesh library.

The book “The Perrin Technique”, published by Hammersmith Press Ltd in 2007, was kindly presented to the edmesh library by Dr Perrin in 2008.

Dr Perrin’s website is www.theperrinclinic.com and a documentary illustrating how patients have benefited may be viewed at www.forme-cfs.co.uk.

© edmesh 2010.

Please contact the newsletter editor (editor@edmesh.org.uk) if you wish to republish this article.