Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is an illness characterized by prolonged, debilitating fatigue that does not improve with rest and worsens with physical or mental activity. It is also characterized by multiple nonspecific symptoms such as headaches, recurrent sore throats, muscle and joint pains, and memory and concentration difficulties.


CFS can be hard to diagnose, and its cause or causes are unknown. Even its name can be confusing: CFS is also known as myalgic encephalomyelitis (ME or ME/CFS or CFS/ME), as well as chronic fatigue and immune dysfunction syndrome (CFIDS).
Profound fatigue, the hallmark of the disorder, can come on suddenly or gradually and persists or recurs throughout the period of illness. Unlike the short-term disability of an illness such as the flu, by definition CFS symptoms must have lasted for at least six months. They often linger for years.
CFS affects women at about four times the rate that it affects men, and the illness is diagnosed more often in people in their 40s and 50s. It can affect any sex, race or socioeconomic class. Research shows that it is at least as common in Hispanics and African Americans as it is in Caucasians. And although CFS is less common in children than in adults, children can develop the illness, particularly during the teen years. It can be as disabling as multiple sclerosis and chronic obstructive pulmonary disease.
The prevalence of CFS is difficult to measure because the illness can be difficult to diagnose, but, in general, it is estimated that at least 1 million people in the United States have CFS, according to the CDC. CFS is sometimes seen in members of the same family, suggesting there may be a genetic link; more research is needed to prove this link.
CFS does not appear to be a new illness, although it only recently was assigned a name. Relatively small outbreaks of similar disorders have been described in medical literature since the 1930s. Furthermore, case reports of comparable illnesses date back several centuries.
Interest in CFS was renewed in the mid-1980s after several studies found slightly higher levels of antibodies to the Epstein-Barr virus (EBV) in people with CFS-like symptoms than in healthy individuals. Most of these people had experienced an episode of infectious mononucleosis (sometimes called mono or the "kissing disease") a few years before they began to experience the chronic, incapacitating symptoms of CFS. As a result, for a time, the CFS-like illness became popularly termed "chronic EBV."
Further investigation revealed that elevated EBV antibodies were not indicative of CFS, since healthy people have EBV antibodies and some people with CFS don't have elevated levels of EBV antibodies.
The international group organized by the CDC named the illness chronic fatigue syndrome because the name reflects the most common symptom: long-term, persistent fatigue. It is important to note, however, that the word "fatigue" may be extremely misleading. Fatigue is but one symptom among many that make up this illness, and it doesn't reflect the significance of other disabling symptoms. The word also adds to generalized misunderstanding and trivialization of the illness. Use of the name
ME/CFS is becoming more common.
There are no indications that CFS is contagious or that it can be transmitted through intimate or casual contact. Research continues to determine the safety of blood donation by people with CFS. The AABB, an organization representing blood banking centers in the United States and around the world, has recommended the indefinite deferral of potential blood donors with a past or current history of CFS. This recommendation has been adopted by the American Red Cross and America's Blood Centers, the two largest blood collectors in the United States.
CFS may begin suddenly or come on gradually. The sudden onset frequently follows a respiratory, gastrointestinal or other acute infection, including mononucleosis. Other cases develop after emotional or physical traumas such as serious accidents, bereavement or surgery.
Although CFS can persist for many years, long-term studies indicate that CFS generally is not a progressive illness. Symptoms are usually most severe in the first year or two. Thereafter, the symptoms typically stabilize, then persist chronically, wax and wane, or improve. For some people with CFS, however, symptoms can get worse over time.

It appears that while the majority of people with CFS partially recover, only a few fully recover, while others experience a cycle of recovery and relapse. There's no way to predict which category you might fall into. There is some evidence that the sooner a person is diagnosed with CFS and symptoms are managed and treated, the better the chances of improvement, which illustrates the importance of early diagnosis and treatment.

Diagnosis
Chronic fatigue syndrome (CFS) is diagnosed by excluding known medical and psychiatric illnesses that also exhibit fatigue and similar symptoms. It is important to diagnose these conditions because treatments may be available. Diseases that also have fatigue include:

• hypothyroidism
  
• sleep apnea
  
• narcolepsy
  
• alcohol or substance abuse
  
• severe obesity
  
• lupus
  
• multiple sclerosis
  
• cancer
  
• depression
  
• anorexia nervosa
  
• bulimia nervosa
  
• schizophrenia
  
• bipolar disorder
  
• dementia
  

Thus, the diagnosis of CFS is one of exclusion—excluding other possible causes of the symptoms. Some diseases eliminate a diagnosis of CFS, such as multiple sclerosis, lupus or a severe psychiatric disorder such as schizophrenia. It would not provide any benefits in these cases to have a second diagnosis.
The current diagnostic criteria for CFS specify unexplained, persistent fatigue that's not due to ongoing exertion, isn't substantially relieved by rest, started recently and leads to significant reduction in previous activity levels. They also require the presence of at least four of the following symptoms:

• sleep problems
  
• impairment in short-term memory or concentration
  
• post-exertional malaise occurring within 12 to 24 hours of exertion and lasting 24 hours or more
  
• joint pain without joint swelling or redness
  
• muscle discomfort or pain
  
• headaches of a new type or severity
• recurrent sore throat
  
• tender lymph nodes in the neck and underarms
  

Multiple subjective symptoms are also reported, and although these are not included in the current diagnostic criteria, they are reported with relative frequency. These include:

• irritable bowel syndrome and other gastrointestinal complaints
• allergy-like symptoms
• skin rashes
• visual disturbances
• dizziness
• numbness and tingling in arms and legs
• sensitivities to various chemicals
• dry eyes
• chills
• night sweats
• alcohol and medication intolerances

Some CFS patients also report mild to moderate symptoms of anxiety or depression. However, many people with CFS don't have depression or any other psychiatric illness. Depression may be a secondary effect of CFS, not necessarily a primary condition, as people attempt to cope with the changes in lifestyle that living with a chronic illness dictates.
Whether anxiety or depression occurs before or during the illness is not the significant factor; getting help for these distressing conditions is what is essential.

Allergies also tend to be more common in CFS patients than in the general population. Many CFS patients have a history of allergies years before the onset of the syndrome. Sometimes patients report a worsening of allergic symptoms or the onset of new allergies after becoming ill with CFS. Because allergies are so common in people with CFS, it is important to identify symptoms caused by allergies so they can be treated independently.

Your health care professional should take a thorough medical history and conduct extensive physical and mental status examinations, including laboratory tests.

Treatment
A variety of interventions have been shown to help with chronic fatigue syndrome (CFS). Treatment is based on individual symptoms. If you're diagnosed with CFS, you'll probably manage the condition with the following:

• Symptom-based treatment (e.g., pain medications, sleep medications).
  
• Education about the disease.
  
• Regular follow-up visits to rule out alternative diagnoses and assess response to therapy.
  
• Lifestyle changes. While lifestyle changes cannot cure the symptoms of CFS, they can make life more manageable and enjoyable. Increased rest, the use of stress reduction and management techniques, energy conservation techniques, dietary restrictions, nutritional supplementation and exercise based on personal abilities may be recommended by your health care professional.
  
• Staying in condition. It is important to not become deconditioned because this may complicate your CFS. Certain types of physical activity such as yoga, stretching and qigong can provide symptom relief, in addition to helping maintain your physical condition. Working with a physical therapist may also be useful. Know your limits so you don't make your symptoms worse.
  
• Cognitive behavior therapy. This therapy helps people with CFS identify negative beliefs and behaviors that may be getting in the way of their recovery. It has been shown to help reduce symptoms of CFS. With the help of a mental health provider, cognitive behavior therapy helps you replace negative thoughts with positive, healthy ones.
  
• Medication. Certain over-the-counter or prescription medications may help you manage your symptoms. Specifically:
  
  • For aches and pains, over-the-counter medicines and prescription treatments including nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Motrin), naproxen (Aleve), acetaminophen (Tylenol) and the prescription drug piroxicam (Feldene) may help. Deep massage, stretching, an activity program that has been designed with the help of a physical therapist or chiropractic treatment may also help minimize these symptoms.
  • For sleep problems that accompany CFS, your health care professional may first suggest you change your sleep habits and stick to a regular bedtime, skip daytime naps and avoid substances like alcohol and caffeine. If this doesn't help, he or she may prescribe a short-term dose of sleep medication.
    
  • For depression, antidepressants are often used. It often takes several weeks to see benefits with antidepressants or to identify side effects, so be patient and work with your health care professional to find the medication that is best for you.
    
  • For allergy symptoms, such as a runny nose or itchy eyes, your health care professional may recommend a non-drowsy antihistamine.

You may also benefit from keeping an energy/activity diary. Keep a log for several weeks, noting the times when you feel the most fatigued and what activities you performed during the day. This can help you identify patterns in your illness and factors that contribute to your fatigue or other symptoms, such as headaches. There are several apps available now that you can use on your computer or smartphone to help you track and onitor your CFS.
Also schedule rest periods and adjust your schedule to fit your energy patterns. Making time to relax and meditate during certain times of the day may be helpful, as will avoiding situations you know to be physically or psychologically stressful.
Work with your health care professional to develop a highly individualized activity plan based on your personal capabilities. Some CFS sufferers experience profound fatigue even after very minimal exercise, so start off slowly and build up gradually. Many people find exercise such as stretching, walking, swimming, biking, water aerobics and relaxation exercises to be helpful in easing their symptoms. A physical therapist may help you put together an exercise program you can do at home.
Diet may also be an effective way to take control of your illness. Research suggests that CFS patients benefit from a basic healthy diet low in animal fat and high in fiber with plenty of fresh fruits and vegetables. Talk with a nutritionist about your diet and ways that foods can help increase your energy levels and relieve symptoms. If you lack the stamina to prepare well-balanced meals, let your health care provider know. Services may be available to assist with obtaining meals. A visit with a dietitian may be needed if you've lost or gained weight or been unable to eat a balanced diet.

You should also avoid certain triggers that aggravate CFS symptoms, such as a chemical, pesticide, household cleaning product or other potential environmental toxins. To identify your triggers, remove all suspected toxins from your environment, then reintroduce them one by one to pinpoint what may be aggravating your symptoms.

Prevention
Despite a decade of research into the origins of chronic fatigue syndrome (CFS), researchers still don't know what causes this debilitating disease. Neither are there known steps you can take to prevent CFS. However, research into the cause, control and prevention of CFS is being conducted.