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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.

Causes

The cause of CFS is unknown. Researchers are studying the interrelationship of stress, the immune system, toxins, the central nervous system, and activation of latent virus as possible triggers of a neuroendocrine response.

Central Nervous System and Organs Including Endocrine Glands

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Data has shown that the following factors seem to be associated with the development of CFS.

Sex: female
Age: 40 to 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

Diagnosis

The doctor will ask about your symptoms, medical history, and medications and 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, AND
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

CFS patients should avoid overexertion and physical and emotional stress. Moderate exercise that is monitored by a physician or physical therapist may improve symptoms. Light exercise and stretching four hours before bedtime may help with sleep.

Physical Therapies

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. Patients should avoid any foods they may be sensitive to.

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. Relaxation training, stress management, and sleep hygiene counseling may also help.

Cognitive behavioral therapy, activity pacing, and envelope theory, which help patients learn how to moderate activity and spread it evenly throughout the day, without overexerting themselves.

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 suffered by some CFS patients
Nonsteroidal anti-inflammatory drugs (NSAIDS), acetaminophen, aspirin—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 not known.

RESOURCES:

Centers for Disease Control and Prevention

http://www.cdc.gov

Chronic Fatigue and Immune Dysfunction Syndrome Association of America

http://www.cfids.org

CANADIAN RESOURCES:

Chronic Disease Management, Government of British Columbia Ministry of Health

http://www.health.gov.bc.ca/cdm/index.html

Women's Health Matters

http://www.womenshealthmatters.ca/index.cfm

References:

American Academy of Physicians website. Available at: http://www.aap.org .

Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ .

Chronic fatigue syndrome. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/cfs . Accessed on March 13, 2007.

Chronic fatigue syndrome. The Merck Manual Online Medical Library website. Available at: http://www.merck.com/mmpe/sec22/ch334/ch334b.html#sec22-ch334-ch334b-452 . Accessed on March 13, 2007.

Chronic fatigue syndrome: healthcare professionals. Centers for Disease Control and Prevention website. at: Available at: http://www.cdc.gov/cfs/healthcareprofessionals.htm . Accessed on March 13, 2007.

Craig T, Kakumanu S. Chronic fatigue syndrome: evaluation and treatment. Am Fam Physician . 2002;65:1083-90.

Darbishire L, Ridsdale L, Seed PT. Distinguishing patients with chronic fatigue from those with chronic fatigue syndrome: a diagnostic study in UK primary care. Br J Gen Pract . 2003;53:441-5.

The Merck Manual of Medical Information . Simon and Schuster, Inc.; 2000.

National Institute of Allergy and Infectious Diseases website. Available at: http://www.niaid.nih.gov .

National Institutes of Health website. Available at: http://www.nih.gov/ .

Prins JB, Bleijenberg G, Bazelmans E, et al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicertre randomized controlled trial. Lancet . 2001;357:841-7.

Reeves WC, Wagner D, Nisenbaum R, et al. Chronic fatigue syndrome—a clinically empirical approach to its definition and study. BMC Medicine . 2005;3:19. Available at: http://www.biomedcentral.com/1741-7015/3/19 . Accessed on March 13, 2007.

Reid S, Chalder T, Cleare A, et al. Chronic fatigue syndrome. In: Clinical Evidence . London, England: BMJ Publishing Group; 2004:12.

Rimes KA, Chalder T. Treatments for chronic fatigue syndrome. Occup Med . 2005;55:32-39.

Last reviewed March 2008 by Theodor B. Rais, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Chronic Fatigue Syndrome

(Chronic Fatigue and Immune Dysfunction Syndrome)