Chronic Fatigue Syndrome

About chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is a condition marked by profound, long-lasting fatigue and multiple other symptoms such as joint pain and muscle pain. A syndrome is not a disease but rather a cluster of symptoms. CFS often starts abruptly but can develop gradually. The cause is unknown. CFS is believed not to be contagious or fatal, though it can be very debilitating.

People with chronic fatigue syndrome experience disruption in one or more aspects of their life, such as work, self-care and family life. The name is misleading because it does not indicate the severity of the disabling symptoms, according to the National Women’s Health Resources Center and CFS support groups.

The syndrome has been controversial, with disagreements over diagnostic criteria, treatment and even the existence of CFS. Patients have sometimes been described disparagingly as having “yuppie flu,” faking a condition or being mentally ill. However, recent research released by the U.S. Centers for Disease Control and Prevention (CDC) supports CFS as having a biological basis. Some research has suggested genetics plays a role.

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) emphasizes that chronic fatigue syndrome is not the same thing as chronic fatigue, which is also a symptom of fibromyalgia, rheumatoid arthritis, lupus and other conditions.

CFS can strike anyone but is most common in young and middle-age women. More than 1 million Americans have CFS, and tens of millions have similar conditions, the U.S. Centers for Disease Control and Prevention (CDC) estimates. It is much more common in women than better-known conditions such as HIV infection or lung cancer, according to the Chronic Fatigue and Immune Dysfunction Syndrome Association of America.

Chronic fatigue syndrome was named in the 1980s, but the condition or similar disorders have been known by other names for centuries. It used to be known as chronic Epstein-Barr because it was once blamed on the Epstein-Barr virus. Current alternate terms for CFS include chronic fatigue and immune dysfunction syndrome (CFIDS) and postviral fatigue syndrome.

Risk factors and causes of CFS

Scientists do not know what causes chronic fatigue syndrome (CFS). It was once thought to be caused by infection with Epstein-Barr virus (EBV) or another virus and used to be referred to as chronic EBV. However, it is now believed that CFS cannot result from infection with any one known human pathogen, though infectious agents may play a role in some cases of CFS, according to the National Center for Infectious Diseases.

Some CFS patients have signs of autoimmune diseases, such as autoantibodies (immune system proteins that mistakenly attack the body’s healthy tissues). However, tissue damage characteristic of autoimmune disorders has not been described in people with CFS.

Several studies indicate that the central nervous system has a role in CFS. For example, CNS dysfunction may impair the immune system or inhibit the release of pain-relieving hormones such as cortisol. More research would be needed to establish a link.

In addition to researching possible roles of viruses and the immune and nervous systems, scientists are studying other possible factors, including genetic predisposition, stress, metabolic disturbances, hormones and environment. Recent research has suggested that genetics might impair CFS patients' ability to cope with physical and psychological stress.

According to the National Women’s Health Resource Center, one-third of cases follow a symptomatic respiratory, stomach or other acute infection, and other cases develop after physical or emotional trauma such as surgery, a car accident or the death of a loved one. Some research has linked a sedentary lifestyle to increased risk of CFS.

In spite of different speculations, the exact cause of CFS remains unknown.

The primary known risk factors for chronic fatigue syndrome are sex and age. Three to four times as many women as men have CFS, and the condition seems to be most common in women in their 40s, according to the National Women’s Health Resource Center. The condition can occur at any age and has also been described in young adults and adolescents.

Signs and symptoms of CFS

The primary indicator of chronic fatigue syndrome (CFS) is severe fatigue that has lasted for months. Individuals often feel exhausted even after mild or moderate physical activity. Other common signs and symptoms include:

*Difficulties with memory or concentration
*Muscle or joint pain
*Insomnia or other problems with sleep
*Headaches
*Sore throat
-*Tender, painful lymph nodes
*Stress, anxiety, depression or panic

Other symptoms that individuals may experience include:

-Abdominal pain or bloating
-Chest pain, irregular heartbeat or shortness of breath
-Diarrhea
-Dizziness
-Dry eyes and mouth
-Ear pain
-Intolerance for alcohol
-Jaw pain such as TMJ disorder
-Morning stiffness
-Nausea
-Night sweats
-Tingling
-Unexplained weight loss

Because these signs and symptoms can also point to many other conditions, it is important to see a physician for diagnosis.

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Treatment and prevention of CFS

There is no known cure for chronic fatigue syndrome (CFS). Treatment focuses on relieving symptoms and helping the patient adapt. The treatment plan developed with the physician can vary greatly, depending on the individual’s needs, symptoms and general health. The treatment plan may include:

*Exercise/physical therapy. It is especially important for CFS patients to get their healthcare provider's approval before starting or changing an exercise program. Regular participation in mild to moderate physical activity prevents deconditioning, promotes sleep, improves the ability to cope and reduces the risk of other health problems, such as heart disease. Movement therapies such as yoga and tai chi might curb anxiety and enhance a feeling of well-being, according to the U.S. Centers for Disease Control and Prevention (CDC). However, it is important for patients to pace themselves, rest as needed and avoid overexertion and fatigue. Steady, gradual exercise is typically recommended. Patients may be referred to physical therapy for help in creating an exercise program that works for them.

*Education. Educating the patient about the disease process, possible outcomes, various therapies, expectations and treatment plans has been seen to be beneficial. Talking to other patients with the same condition or enrolling in a group program has also been helpful, as the diagnosis process and treatment process is frustrating for patients.

*Medications. Patients are advised to ask their physician about the benefits and side effects of medications. Drugs that have been used in the treatment of CFS include:

-Aspirin, naproxen or other NSAIDs (nonsteroidal anti-inflammatory drugs) to reduce pain and inflammation

-Analgesics such as acetaminophen to relieve pain

-Antidepressants, such as tricyclics and serotonin reuptake inhibitors, to improve sleep and relieve malaise

-Anxiolytic agents to reduce anxiety

-Stimulants to reduce daytime lethargy

Physicians may also choose to prescribe other medications, such as an anticonvulsant (seizure drug) that was approved in 2007 to treat fibromyalgia. In addition, researchers are studying new drugs to treat CFS.

*Cognitive behavioral therapy. This treatment has been shown to help CFS patients cope and to allow increased activities without increased symptoms, according to the CDC.

*Stress management and relaxation therapy. Classes, support groups and other methods can help CFS patients reduce stress and insomnia, which can worsen their condition. Techniques such as biofeedback may help. Massage therapy may offer relief.

*Sleep therapy. Sleep centers may be able to treat the sleep disorders that are common with CFS.

*Energy conservation. Techniques such as task simplification, time management and use of adaptive equipment can help individuals cope with CFS. Occupational therapy can offer instruction in such methods.

*Diet. A general healthy eating plan (e.g., rich in vegetables, whole grains and lean protein, low in animal fats and sugar) can promote endurance in people with chronic fatigue syndrome. The CDC cautions against the many unproven dietary supplements and herbal products that have been touted as beneficial for CFS. Some of these products, including comfrey and high-dose ginseng, have been shown to be harmful, the agency reports.

*Acupuncture. Several small-scale studies have found acupuncture useful in easing symptoms of CFS. Acupressure may also provide relief for some.

There is no known way to prevent chronic fatigue syndrome, but people can help avoid exacerbations by practice good habits (exercise, diet, sleep) as described above.

In addition, avoiding excess standing and heat may help. Many people with CFS experience lightheadedness or increased fatigue if they stand for long periods or spend time in warm places, according to the CDC. Such individuals are advised to avoid triggers such as long showers, saunas and tasks that require prolonged standing.