Chronic Fatigue Syndrome
Chronic Fatigue Syndrome (CFS), also known as Myalgia Encephalomyelitis (ME), or ME/CFS, is a complex, long-term illness characterized by extreme fatigue that doesn’t improve with rest and can’t be explained by an underlying medical condition. The fatigue is often made worse by physical or mental activity, and the condition affects multiple body systems, leading to a variety of symptoms.
Symptoms of Chronic Fatigue Syndrome
The primary symptom of CFS is persistent fatigue that lasts for at least 6 months. This fatigue significantly limits one’s ability to perform normal daily activities. However, CFS is more than just feeling tired; it’s a multi-system condition that can cause a wide range of other symptoms, including:
Post-Exertional Malaise (PEM): A worsening of symptoms after physical or mental activity that can last for days or even weeks.
Unrefreshing Sleep: Despite sleeping for long periods, individuals with CFS often wake up feeling just as tired as when they went to bed.
Cognitive Difficulties ("Brain Fog"): Problems with concentration, memory, and mental clarity.
Muscle and Joint Pain: Often without any swelling or redness.
Headaches: That can be severe or different from those the person had before the illness.
Sore Throat or Swollen Lymph Nodes: Common but without signs of infection.
Orthostatic Intolerance: Feeling dizzy, lightheaded, or faint when standing up.
Other possible symptoms include sensitivity to light, sound, and temperature, digestive issues, and depression or anxiety.
Diagnosis of Chronic Fatigue Syndrome
There is no specific test for diagnosing CFS, and it is often a diagnosis of exclusion, meaning other potential causes of chronic fatigue must be ruled out first. Diagnosis typically involves the following steps:
Clinical History:
A doctor will review a patient’s medical history and symptoms to identify fatigue lasting 6 months or longer that cannot be explained by other medical conditions.
The fatigue must be severe enough to reduce the person’s ability to perform daily activities.
Physical Examination and Laboratory Tests:
Basic blood tests (such as complete blood count, thyroid function tests) are often performed to rule out other conditions like anaemia, thyroid disorders, or infections that can cause fatigue.
Criteria-Based Diagnosis:
According to the Institute of Medicine (IOM) (now part of the National Academy of Medicine), for a diagnosis of CFS, the patient must meet the following criteria:
Severe chronic fatigue lasting at least 6 months.
Post-exertional malaise (PEM): Worsening of symptoms after physical or mental effort.
Unrefreshing sleep: Poor-quality sleep despite adequate rest.
At least one of the following: cognitive impairment (“brain fog”) or orthostatic intolerance (symptoms worsen when standing upright).
Exclusion of Other Conditions:
Conditions like sleep disorders, depression, anaemia, hypothyroidism, and autoimmune diseases can cause similar symptoms and must be excluded before a diagnosis of CFS can be made.
Differentiation from Depression:
Although some symptoms overlap with those of depression, people with CFS often have distinct differences, such as feeling mentally alert but physically drained, while depression typically involves a lack of interest in activities.
Management and Treatment of Chronic Fatigue Syndrome
There is no cure for CFS, and treatment focuses on symptom management and improving the patient’s quality of life.
Lifestyle Modifications:
Pacing: Learning to manage energy levels by pacing activities throughout the day and avoiding “boom and bust” cycles of activity.
Dietary Adjustments: Maintaining a balanced diet and staying hydrated.
Cognitive Behavioural Therapy (CBT):
Some patients find benefit from CBT, which focuses on improving the way patients cope with the impact of the illness.
Graded Exercise Therapy (GET): This should be tailored by an ME specialist. GET is now approached with more caution and is individualised to ensure patients do not worsen.
Some individuals may benefit from a carefully tailored exercise program, although this approach has been controversial and not suitable for everyone due to the potential worsening of symptoms (PEM).
Medications:
Pain relief for muscle and joint pain (e.g., ibuprofen or acetaminophen).
Sleep aids: To address unrefreshing sleep.
Antidepressants: In cases where depression or anxiety coexists with CFS.
Managing Other Symptoms:
Treating associated symptoms like headaches, digestive problems, or dizziness with targeted therapies can help improve quality of life.
Significance of Diagnosis and Treatment
CFS can be a life-altering condition. Early diagnosis and management are crucial to minimizing its impact on daily activities and overall health. Because there is no single treatment for CFS, a multidisciplinary approach that includes both medical and psychological support can help patients cope with the illness over time.
Valid References for Further Information
NHS - Chronic Fatigue Syndrome
NHS - CFS/ME Overview
Centres for Disease Control and Prevention (CDC) - ME/CFS
CDC - Chronic Fatigue Syndrome
Mayo Clinic - Chronic Fatigue Syndrome
Mayo Clinic - CFS
National Institute for Health and Care Excellence (NICE) - Guideline for ME/CFS
NICE - CFS/ME