Chronic fatigue syndrome, abbreviated as CFS, is a poorly understood condition that results in severe fatigue and other symptoms.
The cause of chronic fatigue syndrome is not known, although many theories have been offered. It is a chronic condition with an unpredictable course. It can only be diagnosed if other medical conditions that cause fatigue have been excluded. Treatment is limited by a lack of understanding of the disease process itself.
The U.S. Centers for Disease Control and Prevention (CDC) has established criteria for a diagnosis of chronic fatigue syndrome. First of all, the individual must have a recent history of fatigue. The fatigue must be severe and last, whether constant or not, for at least six months. This fatigue is not relieved by rest and forces people to reduce their level of activity.
Many people describe a sudden onset of fatigue triggered by a physical stress, such as an illness or injury. At the same time, the person must have at least four of the following eight symptoms for CFS to be diagnosed: feeling bad or having discomfort after any type of exertionimpaired memory or concentrationjoint pain affecting multiple jointsmuscle painnew headaches, meaning the headaches did not occur before the person started to have severe fatiguesore throattender lymph nodes in the armpit or neckunrefreshing sleep
The cause of chronic fatigue syndrome is unknown. It is most likely that a combination of factors, rather than one single factor, brings about CFS in an individual. The list of possible factors includes the following: Low blood pressure caused by the autonomic nervous system may cause CFS. It is more prevalent in people with CFS than in the general population.Immune disorders, such as allergies or an autoimmune disorder, may cause CFS. An autoimmune disorder is a condition in which the person creates antibodies against his or her own tissue.Infection alone does not cause CFS. However, an infection may be one of multiple causes that bring about CFS in an individual.Nutritional deficiencies may play a role in causing CFS. However, there is no definitive proof.Stress stimulates centers in the brain, known as the hypothalmic-pituitary-adrenal axis. These centers produce cortisol and other hormones. Overstimulation from stress may influence the immune system to bring on CFS.
There are no known effective measures to prevent chronic fatigue syndrome.
The most important part of the diagnosis of CFS is to rule out other causes for fatigue. There are many medical illnesses that can cause fatigue. These include infections, hormone imbalances, immune system diseases, and many different kinds of cancer.
To rule out other conditions, a medical history and physical exam are performed. Multiple blood tests and a urine test are then done. Further tests, such as X-ray tests, may be ordered. There is no one test that can make a diagnosis of CFS. The diagnosis of CFS is generally made when no other cause can be found for a person's fatigue and other symptoms.
The long-term effects of CFS relate to the person's severe fatigue. Affected people may be unable to work or go to school. They may lack the energy to form or keep relationships with other people. This can result in depression and a feeling of hopelessness. Friends and healthcare professionals sometimes have a negative attitude toward a person with CFS.
Chronic fatigue syndrome is not contagious and poses no risks to others.
Treatment must be tailored to fit each person with chronic fatigue syndrome, depending on symptoms and response to different therapies. There are two types of therapy: behavior therapy and drug therapy.
Behavior therapy may include: attending support group meetingsavoiding caffeine and alcoholcognitive behavioral therapy, to help the person change perceptions and beliefs about his or her health statuseating a balanced dietmoderate exercise, being careful to avoid overexertionreceiving regular, individual counselingrelaxation methods, such as meditation, biofeedback, and hypnosis
Drug therapy may include: antidepressants, such as fluoxetine (i.e., Prozac, Sarafem), sertraline (i.e., Zoloft), paroxetine (i.e., Paxil, Pexeva), venlafaxine (i.e., Effexor), and bupropion (i.e., Wellbutrin)antihistamines, such as astemizole (i.e., Hismanal) and loratadine (i.e., Alavert, Claritin)blood pressure medications, such as fludrocortisone (i.e. Florinef) and atenolol (i.e., Tenormin)decongestants for nasal or sinus congestionmuscle relaxing medications to relieve muscle spasmsnonsteroidal anti-inflammatory drugs, also called NSAIDs, such as naproxen (i.e., Naprosyn, Aleve, Anaprox, Naprelan), ibuprofen (i.e., Advil, Motrin), and piroxicam (i.e., Feldene) tricyclic medications to relieve pain and promote sleep, including doxepin, amitriptyline, desipramine (i.e., Norpramin), and nortriptyline (i.e., Pamelor, Aventyl HCl)
Because chronic fatigue syndrome is difficult to treat and the course of the disease is unpredictable, many people with CFS use alternative therapies to relieve or reduce symptoms. Some of these therapies have included: acupuncturechiropractic treatmentcraniosacral therapy, which addresses the flow of cerebrospinal fluid within the bodyhydrotherapy, which is also called water therapymassage therapytai chi, which combines exercise and balancetherapeutic touchyoga
NSAIDs can cause stomach upset and allergic reactions. Antidepressants may cause problems sleeping, headaches, or stomach upset.
The course of CFS is very difficult to predict. Fortunately, most people eventually get better with or without treatment, though a cure is often not possible. People may return to normal activities whenever they feel able.
Affected people are in the best position to monitor the condition. Any new or worsening symptoms should be reported to the healthcare professional.
Conn's Current Therapy, 2000, Rakel et al.
