Chronic Fatigue Syndrome

//Chronic Fatigue Syndrome
Chronic Fatigue Syndrome 2016-11-17T09:50:34+00:00

What Is Chronic Fatigue Syndrome?

Chronic fatigue syndrome (CFS) affects more than one million individuals in the United States, according to the Centers for Disease Control and Prevention. CFS is a serious, complex disorder that is characterized by extreme fatigue that does not improve with bed rest, and may worsen with mental or physical activity.

Characteristic symptoms of chronic fatigue syndrome include weakness, muscle pain, diminished memory, decreased ability to concentrate, and insomnia. Further, patients with chronic fatigue syndrome may report additional symptoms including mental health disorders (i.e. depression), chills, irritable bowel syndrome, night sweats, visual disturbances, dizziness, difficulty maintaining balance, difficulty maintaining an upright position, fainting, brain fog, and allergies or intolerances to foods, medications, odors, noises, or chemicals. The symptoms of chronic fatigue syndrome can be debilitating and often result in a substantial reduction in personal, occupational, educational, and social status.

Diagnosing chronic fatigue syndrome can be difficult for physicians as there are no specific tests to diagnosis CFS; therefore, other causes of fatigue must be ruled out. Physicians typically perform a detailed medical history (including a review of medications) and a physical examination (including a mental status exam). This is usually followed by laboratory tests, including blood and urine tests, to look for alternative causes of fatigue. If these initial laboratory tests indicate an alternative cause of fatigue, further laboratory tests will be ordered.

If the results do not indicate an alternative cause of fatigue, the patient may be diagnosed with chronic fatigue syndrome if they meet the three criteria outlined by the by the CDC, including:

  1. Severe, chronic fatigue lasting for a period of six or more consecutive months. The fatigue must not be the result of ongoing exertion or other medical conditions.
  2. The fatigue must interfere with normal activities.
  3. The patient must have four or more of the eight following symptoms concurrently that were not present before the fatigue:
  • Post-exertion malaise that persists for longer than 24 hours
  • Non-restorative sleep
  • Substantial impairment in short-term memory or mental concentration
  • Muscle pain
  • Joint pain without redness or swelling
  • Headaches (new type, severity, or pattern)
  • Lymph node tenderness in the armpit or neck
  • Frequent or recurrent sore throat

What Causes Chronic Fatigue Syndrome?

Even though there has been considerable research investigating the cause of CFS, researchers have been unable to identify what causes this disorder.

Researchers have identified some possible causes of chronic fatigue syndrome, including:

  • Infectious agents: Borna disease virus, parvovirus B19, glandular fever, enterovirus, human herpes viruses 4, 6, and 7, infectious mononucleosis, Nipah virus encephalitis, and Q fever have all been implicated
  • Immune system dysfunction
  • Nutritional deficiencies
  • Abnormally low blood pressure
  • Stress that activates the HPA axis (where the hypothalamus, pituitary, and adrenal glands interact)

While researchers have yet to identify the cause of CFS, there are some characteristics that have been found to increase an individual’s risk of developing chronic fatigue syndrome, including:

  • Sex: Women are affected four times more often than men
  • Age: Individuals in their 40s and 50s are most commonly affected
  • Genetics: CFS is sometimes seen in family members; this does not indicate that it is contagious, rather that there may be a familial or genetic link to the disorder
  • Ethnicity: Chronic fatigue syndrome occurs in all ethnic and racial groups worldwide
  • Income level: Chronic fatigue syndrome affects individuals of all income levels

Treatments For Chronic Fatigue Syndrome

Treatment for chronic fatigue syndrome can be complicated as the symptoms of the disorder can vary over time. Additionally, no drugs have been developed to treat CFS specifically. Symptoms of CFS vary dramatically among patients and treatment needs to be individualized for each patient.

Successful management of the disorder usually involves a team approach, including primary care physicians, mental health professionals, as well as rehabilitation and exercise specialists. The team of professionals works to develop an individualized program that meets the needs of the patient. The main goal of chronic fatigue syndrome treatment is to help the patient get relief from the symptoms that they are experiencing.

Some patients with CFS may be treated with certain medications. Occasionally patients with chronic fatigue syndrome may also have depression, and are therefore prescribed antidepressants. Treating a patient’s depression can make it much easier for them to cope with CFS. Further, low doses of certain antidepressants can help to improve sleep and reduce pain. If home treatment measures do not improve sleep, sleep aids may be prescribed to help patients experience better sleep.

From a physical activity standpoint, graded exercise with a physical therapist may be recommended. Exercise programs will often begin with range of motion and stretching exercises for a few minutes a day. Strength and endurance will improve gradually over time; at this point, exercise intensity can be increased.

Psychological counseling, including cognitive behavioral therapy, may help some individuals to learn how to work around the limitations that chronic fatigue syndrome places on them. Cognitive behavioral therapy has been shown to reduce symptoms and improve functioning in some patients with chronic fatigue syndrome.

Alternative treatment options that may help to reduce the symptoms associated with CFS include acupuncture (sometimes combined with interferential current), massage, and yoga/tai chi.

Self care measures for individuals with chronic fatigue syndrome include:

  • Stress reduction: Allow time each day for relaxation in order to limit overexertion and emotional stress.
  • Improve sleep: Develop a sleep routine. Go to bed and get up at the same time every day. Limit napping throughout the day and limit or avoid alcohol, caffeine, and nicotine.
  • Pace yourself: Keep activity levels consistent from day to day and don’t overdo it when you’re feeling good.

Conclusion

Chronic fatigue syndrome is a chronic, often debilitating, condition that is characterized by extreme fatigue that is not relieved by rest. The condition can be accompanied by many other symptoms including muscle pain, diminished memory, decreased ability to concentrate, and insomnia. The symptoms associated with CFS often limit an individual’s ability to carry on with normal activities of daily living.

Diagnosis of chronic fatigue syndrome can be difficult and involves excluding various other causes of chronic fatigue. Treatment of CFS is often multi-faceted and involves multiple practitioners. Treatment may include pharmacological options, mental health counseling, alternative treatments, and self-care measures. Individuals suffering from symptoms of chronic fatigue syndrome are encouraged to speak to their pain doctor about their symptoms. Proper diagnosis can help physicians to develop a suitable treatment plan that will help to manage symptoms that may be negatively impacting an individual’s quality of life.

References

  1. gov. CDC – Chronic Fatigue Syndrome (CFS). 2015. Available at: http://www.cdc.gov/cfs/. Accessed August 3, 2015.
  2. gov. CDC – Risk Groups – Chronic Fatigue Syndrome (CFS). 2015. Available at: http://www.cdc.gov/cfs/causes/risk-groups.html. Accessed August 4, 2015.
  3. Brurberg K, Fonhus M, Larun L, Flottorp S, Malterud K. Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review. BMJ Open. 2014;4(2):e003973-e003973. doi:10.1136/bmjopen-2013-003973.
  4. org. Chronic fatigue syndrome – Mayo Clinic. 2015. Available at: http://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/basics/definition/con-20022009. Accessed August 4, 2015.
  5. Griffith JP, Zarrouf FA. A systematic review of chronic fatigue syndrome: don’t assume it’s depression. Prim Care Companion J Clin Psychiatry. 2008;10(2):120-128.
  6. Flo E, Chalder T. Prevalence and predictors of recovery from chronic fatigue syndrome in a routine clinical practice. Behavior Research and Therapy. 2014;63:1-8. doi:10.1016/j.brat.2014.08.013.
  7. Huang F, Chen X, Zhou L, Huang P, Guo L. Clinical study on electroacupuncture plus interferential current therapy for chronic fatigue syndrome. Journal of Acupuncture and Tuina Science. 2014;12(3):156-159.
  8. Chambers D, Bagnall AM, Hempel S, Forbes C. Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. J R Soc Med. 2006 Oct;99(10):S06-S30.

 

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