Chronic Fatigue Syndrome

It is normal for people to get tired or feel depressed and run down occasionally, especially during a hectic or stressful time. However, if a person feels chronically tired and fatigued without any apparent cause or underlying disease condition, they could be suffering from chronic fatigue syndrome, or CFS.

Chronic fatigue syndrome still remains a controversial topic among professionals and the public alike. Even as diagnoses of the condition increase, existence of CFS is sometimes doubted and many consider it to be a psychological ailment. Research has confirmed that it is indeed a physical illness, but it is one that is often misunderstood. At least one million people in the United States have chronic fatigue syndrome, and tens of millions more have a CFS-like conditions, according to the Centers for Disease Control and Prevention (CDC).

Chronic fatigue syndrome is a devastating and complex disorder characterized by overwhelming fatigue that is not improved by bed rest and may be worsened by physical or mental activity. There is no apparent or clinically-evident cause underlying the disease or that is directly responsible for the symptoms. The condition most often affects individuals between the ages of 20 and 40. Women are affected more often than men. Individuals afflicted with CFS usually experience a substantially lower activity level than they did before the onset of CFS.

A complete definition of CFS includes the following criteria. First of all, severe chronic fatigue must be present for six months or longer after a doctor excludes other known medical conditions. Secondly, four or more of the following symptoms must be present:

• Forgetfulness/trouble concentrating

• Sore throat that is frequent or recurring

• Painful or tender lymph nodes in neck or armpit

• Muscle pain or multiple joint pain without swelling or redness

• Headaches (in the case of existing headaches, these must be a new type, pattern, or severity)

• Sleep that provides no refreshment

• Vague feelings of illness or depression, especially after exerting oneself, lasting more than 24 hours after exertion

The following symptoms are not in the above “required four”, but may present as well:

• Mild fever

• Blurry vision

• Chills

• Night sweats

• Diarrhea

• Problems finding or saying a particular word during normal speech (verbal dyslexia)

Causes of CFS are unknown. One possibility is any condition that contributes to the dysfunction of the immune and central nervous systems, including the following:

• Genetic predisposition

• Age

• Gender

• Stress

• Prior illness such as pneumonia, mononucleosis, or bronchitis

• Anemia (iron-poor blood or iron deficiency)

• Environmental allergies

• Sleep disorders

• Low blood pressure

There is no single diagnostic test to identify CFS. So, the diagnosis is, essentially, a diagnosis of exclusion.

Chronic fatigue syndrome may mimic other disorders such as viral infections, kidney disease, cardiac disease, depression, hormone disorders, and neurological illnesses. First and foremost, the doctor usually asks for a detailed history and takes both blood and urine tests. Next, the doctor may perform thyroid, adrenal, and liver function tests. Finally, the doctor may perform antibody tests to determine whether a prior infection may be causing the CFS. All these tests are performed in order to exclude other underlying disease conditions that could cause the symptoms of fatigue.

A psychologist may also be employed to assess symptoms in relation to cognitive skills, concentration, memory, personality, and overall psychological state of the patient. This is helpful because CFS is often seen in people who have depression and anxiety; being thorough as far as the patient’s psychological state is imperative because CFS can sometimes be mistaken for a psychiatric disorder.

A physical examination of an individual may show evidence of fever, swollen and tender lymph nodes, and redness in the throat without drainage or pus. The patient will also be asked to return for office visits, and the physician will check for new symptoms to confirm the presence of CFS and rule out other conditions.

A brain MRI may be ordered to examine possible swelling in the brain or destruction of part of the nerve cells, higher levels of specific white blood cells, CD4 T-cells, and specific white blood cells (lymphocytes). Single-photon emission computed tomography, or CT scan, and/or positron emission tomography scans might reveal presence of decreased blood flow in areas of the brain. In the past, these have been indications of potential CFS.

It is not uncommon for individuals with chronic fatigue syndrome to have difficulty sleeping. In a study conducted by doctors at the University of Washington, 81 percent of individuals who complained of chronic fatigue tested positive for at least one sleep disorder and 41 percent of them were found to have more than one condition associated with sleep deprivation. Similar conclusions were made after home polysomnography (sleeping) tests were used to diagnose obstructive sleep apnea in teenagers with chronic fatigue syndrome.

Because of the overlap, it may be useful for individuals who experience chronic fatigue to undergo a sleep evaluation and study exams monitored by specialists at a sleep study center. Polysomnography tests performed in a lab – the preferred mode – are used to measure sleep cycles, muscle, leg, and eye movement, blood pressure, oxygen saturation, and heartbeat. These factors are recorded during an EEG exam as a patient’s brainwaves are examined during sleep. If a sleeping condition is found to be the root problem of chronic fatigue, treatment may be targeted towards alleviating sleeping problems.

There is currently no proven cure for CFS so treatment is primarily focused on managing the symptoms. In some patients, antidepressant medications, pain medications, anti-inflammatory drugs, and antiviral medications can ease symptoms such as pain, discomfort, fever, anxiety, and depression.

Cognitive behavioral therapy and/or sessions with a licensed therapist or counselor can help the person cope with the limitations brought on by the illness, as well as focusing on changing negative, unrealistic thoughts or feelings into positive and realistic ones. This type of professional may also help with techniques including the following:

• Hypnosis

• Muscle relaxation

• Sleep management

• Deep breathing exercises.

Individuals with CFS should be encouraged to maintain active social lives. He or she should implement a regular regimen of mild physical exercise, avoid sudden bursts of exercise, and pace oneself while doing any physical activity. People with CFS should have a healthy diet and avoid heavy meals, alcohol, caffeine, and large quantities of junk food.

The key to managing CFS is to work with a team of doctors and other health care practitioners such as mental health professionals, rehabilitation specialists, and physical or exercise therapists, to create an individualized treatment program. Finally, the individuals with the best chance for improvement are those who remain as reasonably active as possible, and who seek some degree of control over the course of their illness.

Additional alternative therapies include the following:

• Acupuncture

• Massage

• Stretching

• Yoga

• Tai Chi

• Meditation

A person should try to find a level of activity that he/she is able to handle without getting fatigued. Activity management should involve avoiding doing too much on days when the person feels tired; balancing time between activity, rest, and sleep; breaking big tasks into smaller more manageable ones; and spreading out more challenging tasks throughout the week. With this level of intention and balance, a person with CFS can lead a full and engaging life.