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Chronic Fatigue Syndrome

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Chronic fatigue syndrome (CFS) is a condition that causes fatigue severe enough to interfere with a person's normal life. It is the term used to describe what used to be known as ME (myalgic encephalomyelitis).

In the past, doctors tended to believe that chronic fatigue syndrome was related to depression and that the symptoms were "all in the mind." But most experts now agree that chronic fatigue syndrome is a distinct disease with physical symptoms. Although poorly understood, CFS is real and can be disabling for many people who have it. It can affect any age group including school children and the elderly, but it most commonly affects young adults. Chronic fatigue syndrome is most commonly seen in female ages 30 to 50.

The cause of CFS is unknown but can't be passed from person to person.

Some people appear to develop CFS after a viral or bacterial infection, though it is not the same as the normal fatigue that often follows immediately after a bad infection like ‘flu. Glandular fever is a common trigger.

CFS may also follow distressing life events such as bereavement, divorce, or redundancy.

Some doctors believe CFS may be linked to disorders that affect the body's natural defence system (immune system) and to abnormalities of the hormonal (endocrine) system. There is evidence indicating that CFS involves the nervous system as well. However, the exact significance of these factors in chronic fatigue syndrome, if any, is not clear, as there is no definite scientific evidence.

Some doctors believe that there is a strong psychiatric or psychological element to CFS. They claim that many cases may be depression in another form.

The main symptom of CFS is a new, severe fatigue that lasts for over six months and does not improve after rest. It is disabling all or most of the time. Even normal physical activity exacerbates the feeling of tiredness.

People who have CFS may also have other symptoms such as:

  • forgetfulness, memory loss, confusion, or difficulty concentrating,
  • sore throat,
  • tender lymph nodes in the neck or armpits,
  • muscle pain,
  • joint pain without redness or swelling,
  • headaches,
  • unrefreshing sleep (waking up feeling tired or unrested) or trouble getting to sleep,
  • fatigue that lasts more than 24 hours after exercise or exertion at a level that the person was previously able to manage without fatigue.

Other symptoms may include:

  • feeling hot or feverish even though temperature may be normal
  • sensitivity to light or sound
  • orthostatic hypotension, which causes light-headedness or dizziness as a result of a drop in blood pressure when standing or sitting up from a reclining position.
When a doctor examines people with CFS, they have no physical abnormalities. Diagnosis of CFS is made by taking a medical history, and by ruling out other possible conditions. Blood tests may help to rule out other illnesses, and in people with CFS the results will be negative. There is no test that diagnoses CFS positively.

Often, simply making the diagnosis of CFS and explaining what this means will help the person affected enormously. It is important to be aware that the cause of CFS remains a mystery and that there is no simple cure. Recovery may take months, or even years, but most patients do recover.

With chronic fatigue syndrome, treating both physical and psychological factors is important. To help with the physical aspects, the following may be beneficial:

  • Gentle exercise - getting regular gentle exercise helps relieve and control symptoms. Most people with CFS can only tolerate light exercise, so follow a "graded exercise programme", which means starting with an activity that can be done comfortably, and increasing the level of activity every few days. Getting too much exercise or increasing the level of exercise too quickly can make symptoms worse.
  • Painkillers - Pain relievers such as ibuprofen, aspirin or paracetamol may help relieve muscle and joint pain, headaches, and other physical symptoms. Some prescribed painkillers can become addictive and should only be used in the most severe cases on a short-term basis. Long-term use of any medication should be under the supervision of a doctor.
  • Daily routine - Adjusting the daily schedule to improve sleep habits may help.

To help with the psychological aspects, the following may help:

  • Cognitive behavioural therapy (CBT) – this is the most successful treatment for CFS. CBT helps people identify how their thoughts affect their behaviour. It can help people to develop ways to cope more successfully with fatigue and other symptoms of CFS. Referral to a psychiatrist for this treatment does not mean that the doctor believes it is "all in the mind".
  • Antidepressants – these may be beneficial for some people with CFS where depression is a significant symptom.

Complementary treatments

Complementary medicine such as relaxation therapy, acupuncture, special diets or mineral supplements may alleviate symptoms. However, although some people may find them useful, there is no scientific evidence that these are effective.

People with CFS need a regular review every couple of months by either a specialist or their general practitioner. If any new symptoms appear, treatment will need to be reassessed. For people with CFS who do not respond to these treatments may be referred to a team including a physician, psychiatrist, psychologist, occupational therapist, physiotherapist and liaison nurse.

With or without treatment, most people who have CFS find that their symptoms get better over time and that they are able to resume normal daily activity within 1 to 2 years. Some people will continue to have symptoms for many years.

The ME Association

National ME Centre

Chronic Fatigue and Immune Dysfunction Syndrome Association of America, Inc.

Centers for Disease Control and Prevention
National Center for Infectious Diseases

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