Chronic fatigue syndrome (CFS) is a complicated disorder characterized by profound fatigue that doesn’t improve with bed rest and may worsen with physical or mental activity. Of all chronic illnesses, chronic fatigue syndrome is one of the most mysterious. Unlike infections, it has no clear cause. Unlike conditions such as diabetes or anemia, there’s essentially nothing to measure. And unlike conditions such as heart disease, there are relatively few treatment options.
Chronic Fatigue Syndrome may occur after infections such as a cold, bronchitis, mononucleosis, hepatitis or intestinal illness. It can start during or shortly after a period of high stress or come on gradually without any clear starting point and any obvious cause. It is an influenza-like condition that can drain your energy and sometimes last for years. People previously healthy and full of energy may experience extreme fatigue, weakness and headaches as well as painful joints, muscles and lymph nodes.
Chronic Fatigue Syndrome is diagnosed more commonly in women than in men. However, it’s unclear whether chronic fatigue syndrome affects women more frequently or women simply report it more often than men do. An estimated 500,000 people in the United States have a chronic fatigue syndrome like condition. Although Chronic Fatigue Syndrome is most common in people 25 to 45 years old, it can affect people of all ages.
Signs and Symptoms of Chronic Fatigue Syndrome
CFS exhibits signs and symptoms similar to those of most common viral infections. Unlike influenza (flu) symptoms, which usually subside in a few days or weeks, the signs and symptoms of CFS can last for months or years. They may come and go frequently with no identifiable pattern.
In addition to persistent fatigue not caused by other known medical conditions, Chronic Fatigue Syndrome has eight possible primary symptoms. These include:
- Loss of memory or concentration
- Sore throat
- Painful and mildly enlarged lymph nodes in your neck or armpits (axilla)
- Unexplained muscle soreness
- Pain that moves from one joint to another without swelling or redness
- Headache of a new type, pattern or severity
- Sleep disturbance
- Extreme exhaustion after normal exercise or exertion
According to the International Chronic Fatigue Syndrome Study Group — a group of scientists, researchers and doctors brought together by the Centers for Disease Control and Prevention (CDC) to determine a standard method for defining and diagnosing CFS, a person meets the diagnostic criteria of CFS when unexplained persistent fatigue occurs for 6 months or more with at least four of the eight primary symptoms also present.
In addition, people with CFS have reported other various signs and symptoms that aren’t part of the official definition of CFS determined by the International Chronic Fatigue Study Group. These include:
- Abdominal pain
- Alcohol intolerance
- Bloating
- Chest pain
- Chronic cough
- Diarrhea or constipation
- Dizziness
- Dry eyes and mouth
- Earache
- Irregular heartbeat
- Jaw pain
- Morning stiffness
- Nausea
- Night sweats
- Shortness of breath
- Tingling sensations
- Weight loss
- Psychological problems such as depression, irritability, anxiety disorders and panic attacks
People with CFS usually experience the most severe symptoms within the first 1 to 2 months of illness. After that, a small number of those affected recover completely while a small percentage of others become incapacitated by their symptoms. However, for most people a gradual improvement occurs, although those affected by CFS often don’t regain their normal level of energy.
Causes of Chronic Fatigue Syndrome
Doctors don’t know the cause of CF Syndrome. Several possible causes have been proposed, including:
- Iron deficiency anemia
- Low blood sugar (hypoglycemia)
- Allergies to environmental elements
- Body wide infections such as mononucleosis
- Dysfunction in the immune system
- Changes in the levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands
- Mild, chronic low blood pressure (hypertension)
Some studies show that the cause of CFS may be an inflammation of the pathways of the nervous system as a response to an autoimmune process, but with nothing measurable in the blood like in other autoimmune diseases such as rheumatoid arthritis or lupus. CFS may also occur when a viral illness is complicated by a dysfunctional immune system. In one study, researchers found that some people with Chronic Fatigue Syndrome had a low blood pressure disorder that triggered the fainting reflex.
In most cases, however, no serious underlying infection or disease is proved to specifically cause CFS. Lack of medical knowledge and understanding of CFS has made determining and describing the characteristics of CFS difficult.
Prevention of Chronic Fatigue Syndrome
Because the cause of CFS remains unknown, there’s no way to prevent the illness from occurring. Be aware of CFS and seek the help of your doctor to manage its symptoms.
Treatment of Chronic Fatigue Syndrome
There’s no specific treatment for CFS. In general, doctors aim to relieve your symptoms by using a combination of the following steps:
- Lifestyle changes.
Your doctor may encourage you to slow down and to avoid excessive physical and psychological stress. This may save your energy for essential activities at home or work and help you cut back on less important activities. - Gradual but steady exercise.
Often with the help of a physical therapist, you may be advised to begin a graded exercise program in which physical activity gradually increases. This can help prevent or decrease the muscle weakness caused by prolonged inactivity. In addition, your energy level can often improve significantly. - Treatment of psychiatric problems.
Doctors can treat problems often related to Chronic Fatigue Syndrome, such as depression, with medication, behavior therapy — learning to change your behavior to reduce the symptoms of a certain disease or condition — or a combination of the two. If you’re depressed, medications such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may help. Tricyclic antidepressants include amitriptyline (Elavil, Endep), desipramine (Norpramin, Pertofrane) and nortriptyline (Aventyl, Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and citalopram (Celexa). Studies have found that people with CFS benefit from low-dose antidepressants just as well as those with fibromyalgia, an illness similar to CFS. These medications may help control your pain and improve your sleep. - Treatment of existing pain.
Acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin) may be helpful for headaches, muscle pain and joint pain associated with . Like fibromyalgia, however, the pain associated with CFS may not respond well to these medications. - Treatment of allergylike symptoms.
Antihistamines such as fexofenadine (Allegra) and loratadine (Claritin) and decongestants such as Sudafed and Dimetapp that contain pseudoephedrine may relieve allergylike symptoms such as runny nose. - Treatment of low blood pressure (hypotension).
The drug fludrocortisone (Florinef), a form of cortisone that retains fluid in the body and raises blood pressure, has been studied as a treatment for Chronic Fatigue Syndrome. However, the use of this drug hasn’t been proved to be effective.
Some medications can cause adverse reactions or side effects that are worse than the original symptoms of CFS. Talk to your doctor before starting any treatment for CFS.
Not everyone with CFS benefits from any or all of the common treatment options. Research shows that both graded (gradually increasing) exercise and behavior therapy can work for some, but not all, people.
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