Chronic Fatigue Syndrome: Definition

Chronic fatigue syndrome (CFS) is characterized by chronic, debilitating fatigue that lasts at least six months. The fatigue is not relieved by bed rest and is often made worse by physical or mental activity. It is accompanied by symptoms that are severe enough to impair or interfere with daily activities. People who have CFS perform at a significantly lower level compared to their activity prior to the onset of the illness.

The cause of CFS is unknown. To discover possible triggers, researchers are studying the relationship between stress, the immune system, toxins, the central nervous system, and activation of latent virus.

Central Nervous System and Organs Including Endocrine Glands

© 2011 Nucleus Medical Media, Inc.

Risk Factors

Data has shown that the following factors seem to be associated with the development of CFS.

• Sex: female
• Age: 40-59 years old (But, people of all ages can develop CFS.)

Symptoms

Symptoms vary from person to person. They include:

• Unexplained, new onset, persistent fatigue that is not relieved with bed rest and often worsens with physical or mental activity
• Muscle aches over six months
• Joint pain without swelling or redness over six months
• Headaches over six months
• Trouble with short-term memory or concentration
• Forgetfulness or confusion
• Irritability, anxiety, panic attacks, mood swings, or depression
• Sore throat over six months
• Tender lymph nodes over six months
• Trouble sleeping or not feeling refreshed after sleep over six months
• Prolonged fatigue lasting 24 hours or more after exercise
• Visual disturbances (eyes sensitive to light, blurring, pain)
• Reduced activities (social, job-related, educational, and personal)
• Dizziness, balance problems, or fainting
• Brain fog
• Chills and night sweats
• Allergies or sensitivities to foods, chemicals, odors, medications, or noise
• Irritable bowel syndrome

Diagnosis

The doctor will ask about your symptoms, medical history, and medications. The doctor will perform a physical exam. There are no specific diagnostic tests for CFS, but the doctor will perform several tests to rule out other conditions that can have similar symptoms.

The doctor will look for the following signs to determine if you have CFS:

• Severe, chronic fatigue for at least six months that is not due to another illness or medical cause, along with:
• At least four of the following symptoms according to the International Chronic Fatigue Syndrome Study Group Criteria:
  • Impairment of short-term memory or concentration
  • Sore throat
  • Tender lymph nodes
  • Muscle pain
  • Joint pain without swelling or redness
  • Headaches of a new type, severity, or pattern
  • Unrefreshing sleep
  • Prolonged fatigue lasting 24 hours or more after exercise

Treatment

The main goal of CFS treatment is to achieve symptom relief.

Treatments for CFS include:

Physical Activity

If you have CFS, avoid overexertion and physical and emotional stress. Balancing your activities throughout the day may help you to not overexert yourself. Moderate exercise that is monitored by a doctor or physical therapist may improve symptoms. Slowly increasing the duration and intensity of exercise may be helpful to lessen fatigue ^BE. Light exercise and stretching four hours before bedtime may help with sleep.

In addition, your doctor may have you work with a physical therapist. Some therapies that might be helpful for you include:

• Massage
• Stretching
• Tai chi
• Yoga

Diet and Nutrition

A well-balanced diet can help prevent nutritional deficiencies and weight fluctuations. Nutritional supplements cannot make up for an inadequate diet. Avoid foods to which you may be sensitive.

Counseling

CFS can be mentally and physically debilitating. Depression is common among people with CFS. In fact, as many as half develop depression as a consequence of CFS. Psychotherapy and supportive counseling often help CFS patients cope with the disorder. Learning relaxation training and stress management techniques, as well as changing your sleep routine, may also help.

By working with a therapist who specializes in cognitive behavioral therapy (CBT), you may have improvements in your level of fatigue and physical activity ^BE.

Medications

Medications used to treat specific symptoms of CFS include:

• Antidepressants—to help improve sleep and relieve depression
• Anti-anxiety drugs—to treat panic disorders
• Acetaminophen (Tylenol); aspirin (Bayer); and nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (eg, Advil, Motrin)—to treat pain and fever
• Stimulants—mild ones may be helpful, but strong stimulants may cause the “push-crash cycle” and lead to relapse
• Sedatives—to help with insomnia

Experimental Treatments

The following experimental treatments are sometimes used for CFS but have not been proven to be effective. Talk to your doctor before trying any experimental treatments.

• Experimental drugs
• Dietary and vitamin supplements (eg, magnesium)
• Herbal remedies (eg, evening primrose oil)
• Acupuncture
• Aquatic therapy
• Chiropractic therapy
• Self- hypnosis

Prevention

There are no guidelines for preventing CFS because the cause is unknown.

BE = This therapy has the best evidence available showing that it is effective.