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Chronic Fatigue Synrome

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Overview

Chronic fatigue syndrome, or CFS, is a devastating and complex disorder. People with CFS have overwhelming fatigue and a host of other symptoms that are not improved by bed rest and that can get worse after physical activity or mental exertion. They often function at a substantially lower level of activity than they were capable of before they became ill.

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Overview

Besides severe fatigue, other symptoms include muscle pain, impaired memory or mental concentration, insomnia, and post-exertion malaise lasting more than 24 hours. In some cases, CFS can persist for years.

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Overview

Researchers have not yet identified what causes CFS, and there are no tests to diagnose CFS. Moreover, because many illnesses have fatigue as a symptom, doctors need to take care to rule out other conditions, which may be treatable.

CDC

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Symptoms

Chronic fatigue syndrome can be misdiagnosed or overlooked because its symptoms are similar to so many other illnesses. Fatigue, for instance, can be a symptom for hundreds of illnesses. Looking closer at the nature of the symptoms though, can help a doctor distinguish CFS from other illnesses.

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Symptoms

Primary SymptomsAs the name chronic fatigue syndrome suggests, fatigue is one part of this illness. With CFS, however, the fatigue is accompanied by other symptoms. In addition, the fatigue is not the kind you might feel after a particularly busy day or week, after a sleepless night, or after a single stressful event. It's a severe, incapacitating fatigue that isn't improved by bed rest and that is often worsened by physical activity or mental exertion. It's an all-encompassing fatigue that can

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Symptoms

People with CFS function at a significantly lower level of activity than they were capable of before they became ill. The illness results in a substantial reduction in work-related, personal, social, and educational activities.

The fatigue of CFS is accompanied by characteristic illness symptoms lasting at least 6 months. These symptoms include:

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Symptoms

increased malaise (extreme exhaustion and sickness) following physical activity or mental exertion

problems with sleep

difficulties with memory and concentration

persistent muscle pain

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Symptoms

joint pain (without redness or swelling)

headache

tender lymph nodes in the neck or armpit

sore throat

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Symptoms

Other SymptomsThe symptoms listed above are the symptoms used to diagnose CFS. However, many CFS patients and patients in general may experience other symptoms, including:

brain fog (feeling like you're in a mental fog)

difficulty maintaining an upright position, dizziness, balance problems or fainting

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Symptoms

allergies or sensitivities to foods, odors, chemicals, medications, or noise

irritable bowel

chills and night sweats

visual disturbances (sensitivity to light, blurring, eye pain)

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Symptoms

depression or mood problems (irritability, mood swings, anxiety, panic attacks)

It's important to tell your health care professional if you're experiencing any of these symptoms. You might have CFS, or you might have another treatable disorder. Only a health care professional can diagnose CFS.

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Symptoms

What's the Clinical Course of CFS?The severity of CFS varies from patient to patient. Some people can maintain fairly active lives. For most patients, however, CFS significantly limits their work, school, and family activities for periods of time.

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Symptoms

While symptoms vary from person to person in number, type, and severity, all CFS patients are limited in what they can do to some degree. CDC studies show that CFS can be as disabling as multiple sclerosis, lupus, rheumatoid arthritis, heart disease, end-stage renal disease, chronic obstructive pulmonary disease (COPD), and similar chronic conditions.

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Symptoms

CFS often affects patients in cycles: Patients will have periods of illness followed by periods of relative well-being. For some patients, symptoms may diminish or even go into complete remission; however, they often recur at a later point in time. This pattern of remission and relapse makes CFS especially hard for patients to manage. Patients who are in remission may be tempted to overdo activities when they're feeling better, but this overexertion may actually contribute to a relapse.

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Symptoms

The percentage of CFS patients who recover is unknown, but there is some evidence to indicate that patients benefit when accompanying conditions are identified and treated and when symptoms are managed. High-quality health care is important.

CDC

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Diagnosis

For doctors, diagnosing chronic fatigue

syndrome (CFS) can be complicated by a number of factors:

-- There's no lab test or biomarker for

CFS.

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Diagnosis

-- Fatigue and other symptoms of CFS are

common to many illnesses.

-- For some CFS patients, it may not be

obvious to doctors that they are ill.

-- The illness has a pattern of remission

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Diagnosis

and relapse.

-- Symptoms vary from person to person in

type, number, and severity.

These factors have contributed to a low

diagnosis rate. Of the one to four million Americans who have CFS,

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Diagnosis

less than 20% have been diagnosed.

Exams and Screening Tests for CFS

Because there is no blood test, brain

scan, or other lab test to diagnose CFS, the doctor should first rule

out other possible causes.

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Diagnosis

If a patient has had 6 or more

consecutive months of severe fatigue that is reported to be

unrelieved by sufficient bed rest and that is accompanied by

nonspecific symptoms, including flu-like symptoms, generalized pain,

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Diagnosis

and memory problems, the doctor should consider the possibility that

the patient may have CFS. Further exams and tests are needed before a

diagnosis can be made:

A detailed medical history will be

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Diagnosis

needed and should include a review of medications that could be

causing the fatigue and symptoms

A thorough physical and mental status

examination will also be needed

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Diagnosis

A battery of laboratory screening tests

will be needed to help identify or rule out other possible causes of

the symptoms that could be treated

The doctor may also order additional

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Diagnosis

tests to follow up on results of the initial screening tests

A CFS diagnosis requires that the

patient has been fatigued for 6 months or more and has 4 of

the 8 symptoms for CFS for 6 months or more. If, however, the patient

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Diagnosis

has been fatigued for 6 months or more but does not have four of the

eight symptoms, the diagnosis may be idiopathic fatigue.

CDC

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Living and Coping

Managing chronic fatigue syndrome can be as complex as the illness itself. There is no cure, no prescription drugs have been developed specifically for CFS, and symptoms can vary a lot over time. Thus, people with CFS should closely monitor their health and let their doctor know of any changes; and doctors should regularly monitor their patients' conditions and change treatment strategies as needed.

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Living and Coping

A team approach that involves doctors and patients is one key to successfully managing CFS. Patients and their doctors can work together to create an individualized treatment program that best meets the needs of the patient with CFS. This program should be based on a combination of therapies that address symptoms, coping techniques, and managing normal daily activities.

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Living and Coping

CFS affects patients in different ways, and the treatment plan should be tailored to address symptoms that are most disruptive or disabling for each patient. Helping the patient get relief from symptoms is the main goal of treatment. However, expecting a patient to return to usual activities should not be the immediate goal because the physical and mental exertion needed to try to reach that goal may aggravate the illness.

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Living and Coping

Because CFS is a complicated illness, its management may require input from a variety of medical professionals. Primary care providers can develop effective treatment plans based on their experience in treating other illnesses. Patients benefit when they can work in collaboration with a team of doctors and other health care professionals, who might also include rehabilitation specialists, mental health professionals, and physical or exercise therapists.

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Living and Coping

Difficulties of Living with CFSLiving with chronic fatigue syndrome can be difficult. Like other debilitating chronic illnesses, CFS can have a devastating impact on patients' daily lives and require them to make major lifestyle changes to adapt to many new limitations.

Common difficulties for CFS patients include problems coping with:

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Living and Coping

the changing and unpredictable symptoms

a decrease in stamina that interferes with activities of daily life

memory and concentration problems that seriously hurt work or school performance

loss of independence, livelihood, and economic security

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Living and Coping

alterations in relationships with partners, family members, and friends

worries about raising children

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Living and Coping

Feelings of anger, guilt, anxiety, isolation and abandonment are common in CFS patients. While it's OK to have such feelings, unresolved emotions and stress can make symptoms worse, interfere with prescription drug therapies, and make recovery harder.

CDC

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Additional Resources

CDC

Mayo clinic