Vasoconstriction, Norepinephrine, and CFS/FMS

Red Blood Cells and Chronic Fatigue Syndrome

New Zealand researcher Dr. L.O. Simpson has theorized that Chronic Fatigue Syndrome results from "insufficient oxygen availability due to impaired capillary blood flow." Simpson attributes the impaired capillary blood flow to smaller-than-usual capillaries and to the presence of abnormal red blood cells. ("Red Blood Cells and Chronic Fatigue Syndrome")


When the core body temperature is cooled below approximately 37 degrees Celsius (98.6 F), special mechanisms are set into play to conserve the heat that is already in the body, and still other mechanisms are set into play to increase the rate of heat production.

One of the first effects is intense vasoconstriction of the skin vessels over the entire body. The posterior hypothalamus strongly activates the sympathetic nervous signals to the skin blood vessels, and intense vasoconstriction occurs throughout the body. This vasoconstriction obviously prevents the conduction of heat from the internal portions of the body to the skin. Consequently, with maximal vasoconstriction the only heat that can leave the body is that which can be conducted directly through the insulater layers of the skin. This effect conserves the quantity of heat in the body. ("Human Physiology and Mechanisms of Disease", Guyton, pg.554)

Sympathetic impulses are transmitted to the adrenal medullae at the same time that they are transmitted to all the blood vessels. These impulses cause the medullae to secrete both epinephrine and norepinephrine into the circulating blood. These two hormones are carried in the blood stream to all parts of the body, where they act directly on the blood vessels, usually to cause vasoconstriction. (ibid, pg.166)

Norepinephrine has vasoconstrictor effects in almost all vascular beds of the body, and epinephrine has similar effects in most, but not all, beds. (ibid, pg.167)

According to the findings of one study, Norepinephrine-evoked pain in fibromyalgia., the adrenal hormone norepinephrine may be responsible for the body pain associated with FMS. The studies conclusion: Fibromyalgia patients have norepinephrine-evoked pain. This finding supports the hypothesis that fibromyalgia may be a sympathetically maintained pain syndrome

Another study, Abnormal microcirculation and temperature in skin above tender points in patients with fibromyalgia, showed that vasoconstriction occurs in the skin above tender points in FM patients, supporting the hypothesis that FM is related to local hypoxia in the skin above tender points.

This makes sense; The norepinephrine which causes vasoconstriction is likely responsible for the pain that is associated with the tender points in FMS.


Some studies have found that with exercise, the person with CFS/FMS actually experiences a drop in body temperature. The opposite response one would expect to happen.

"In coming years it was discovered that little was guaranteed to exacerbate chronic fatigue syndrome more rapidly or more profoundly than exercise, particularly rigorous exercise. During aerobic exercise, CFS victims were found to experience a sudden drop in body temperature and a decrease in oxygen flow to the brain - the opposite of what occurs in normal people. The oxygen deficit in the brain persisted for several days after even brief activity" - Ismael Mena, "Study of Cerebral Perfusion by NeuroSPECT in Patients with Chronic Fatigue Syndrome,"

In a healthy person, exercise increases blood flow and oxygen delivery to the cells. The cells generate ATP, much of which is expended to generate heat in the body. With the increase in body temperature comes a further increase in metabolism, energy production, and more heat. The metabolic rate increases by 15 percent for each degree celsius increase in body temperature.

In the case of a person with CFS/FMS, exercise causes an increase in blood flow to the extremities. However, due to blockages that impair energy production in the mitochondria, less ATP is generated. The ATP that is generated is used to fuel the activity of the exercise, relatively little is available for the generation of heat. A lot of the ATP generated is via the anaerobic process of glycolysis. Accumulations of a byproduct of glycolysis, pyruvic acid, causes the tissue to become more acidic, indirectly blocking energy production in the mitochondria.

because the blood is being pumped out to the extremities and the tissue is not generating much heat, the net effect is that the blood is being cooled down, thus lowering the body temperature. This would explain the findings in the study of the effects of exercise and CFS.

It can probably be deduced that massage may also have a similar affect, to lower the core body temperature. One goal of massage is to increase blood circulation in the tissue. This is contrary to one goal of vasoconstriction in the tissue, which is to conserve heat in the body. Increasing blood flow in the tissue by massage will warm up the tissue. But at what cost? Lowering the core body temperature? And, how will the body respond? The adrenals may likely secrete more norepinephrine to constrict blood flow to conserve heat. With the increased norepinephrine may also come an increase in pain.

In a Nutshell

Due to blockages in mitochondrial energy production of ATP, the body is unable to maintain the desired operating temperature of 98.6 degrees F. To conserve heat, blood flow to the extremities is decreased via vasoconstriction, signaled by the hormone norepinephrine. Elevated levels of blood norepinephrine contribute to body pain. Exercise has an effect of further lowering body temperature in people with CFS/FMS. More norepinephrine is secreted in an attempt to conserve heat, and consequently more pain results.

Tips and Tricks

Exercise is good. But take care not overdo it. Dress warm to minimize heat loss. If the outside air temperature is cold, or even cool, in addition to warm clothing wear a warm hat and gloves. Most of the heat lost from the body escapes through the head.

Walking is probably one of the better exercises that you can do. If you are not able to do this, then do stretching exercises, slowly increasing the amount of exercise that you can tolerate.

If you have a FIR sauna, then finish your exercise session with a little time in the sauna and drink a couple glasses of water. This will help to move some of the acidic metabolic waste out of your body.

If getting a massage, find a therapist that will first warm your body prior to giving the massage. There are some massage therapists now using FIR saunas. Warm up before the massage and then after the massage use the FIR heat again. Drink a large glass of water, before and after to help the body expel metabolic waste products.

If this article made sense, you may also wish to read other articles in the "Soapbox" section. Click on the return button located below.

All the best,

The following was contributed by Barb from another CFS/FMS forum. She has reminded me of another symptom of the illness that could contribute to the restricted blood flow to the extremities.

Jim, this makes sense. I was taught (pharmacy school...Guyton's was one of our texts) that there's not enough blood to go full-supply to all parts of the body at once. The body can be divided into 3 zones: vital organs, digestive organs, and muscles. Normally, blood can flow in full supply to two of these zones at a time.

Because blood is directed to the gut after eating, there is not enough for the skeletal muscles, and they could cramp if you're active (thus the advice: don't swim after you eat.) That's also why you might feel cold after eating--not enough blood flow to the skin. I get REAL cold after I eat, and have to both rest and pull all the covers over me.

I suspect this is due not only to low ATP, but also to the low thyroid function and hypovolemia (low blood volume) that are a part of CFS. Sometimes, I feel cold from the INSIDE. Brrr.

Oh, yeah... if our neurotransmitter norepinephrine (NE) is overactive, that and it's hormone cousin, epinephrine (adrenalin), it will cause blood to be shunted from the digestive tract to muscles, including the heart muscle (preparing for "fight or flight"). I can see it restricting blood flow to the skin, too, but am not sure about this. Since it shunts blood by narrowing or opening blood vessels, this is consistent with Simpson's discoveries--the part about capillary constriction.