What is CHRONIC FATIGUE SYNDROME (CFS)?

Do you tire out easily after a nonsterous exercise? or even a mental activity? Do you experience long term fatigue that doesn’t get relieved by bed rest? you might be suffering from chronic fatigue syndrome.

What is CHRONIC FATIGUE SYNDROME (CFS)?

Chronic Fatigue Syndrome (CFS) also known as Myalgic encephalomyelitis (ME) or Post-viral fatigue syndrome (PVFS) is a medical condition in which a person experiences extreme chronic fatigue, which disturbs and limits their routine daily life activities, without any identified underlying medical cause.

First identified as “Neurasthenia” in the 19th century, it was once a neglected concept. But now the United States Centers for Disease Control and Prevention (CDC) recognizes it as an illness. MS/CFS International Awareness Day is celebrated on 12th May every year.

Research shows that in the U.S. around 2.5 million people (i.e. 7 to 3,000 out of 1, 00,000 individuals) have CFC. While in the UK it has affected 250,000 people. CFC is more common among females than males. It affects adults especially in their 40s and 50s. It also affects young children with an incidence of approximately 1 out of 50 children.

CAUSES:

A number of physiological, genetic, pathological and psychological causes have been identified but the exact cause remains unknown. Though there is insufficient evidence, many infectious causes have been proposed. Most of the cases, about 60%, occur after viral infections.

  •  Viruses causing CFS include:
  • Human herpesvirus 6
  • Epstein-Barr virus (EBV)
  • Flavivirus ( Dengue virus)
  • Rubella
  • Ross River Virus (RRV)

Some bacterial infections have also been identified as a cause of CFS. These include:

  • Coxiella burnetii
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae

RISK FACTORS:

There are certain risk factors that predispose people to chronic fatigue syndrome. All ethnic groups are equally prone but genetics play an eminent role here as blood relatives are more likely to develop this illness.

Some other risk factors are:

  • Anxiety disorders
  • Stress
  • Allergies
  • Age
  • Psychological disorders
  • Low physical fitness
  • Hormonal disturbance (e.g. low cortisol levels)

DIAGNOSIS:

 U.S. Centers for Disease Control and Prevention (CDC) has set the following criteria for CFS’s diagnosis:

Significantly lowered ability to participate in activities that were routine before and persisting more than six months

Physical or mental activity causing worsening symptoms that would not have been problematic before this illness

Sleep problems

As yet, no screening test is available and there is no distinctive laboratory abnormality to diagnose CFS. So it’s important to rule out all other possible causes such as:

  • Lyme disease
  • Dengue fever
  • Poliomyelitis
  • Mononucleosis
  • Systemic Lupus Erythematosus (SLE)
  • Hypothyroidism
  • Alcohol or substance abuse
  • Anemia
  • Ehlers Danlos Syndrome (EDS)
  • Bipolar disorder
  • Multiple Sclerosis
  • Schizophrenia
  • Obstructive sleep apnea

 SYMPTOMS:

Symptoms vary from person to person. These symptoms also depend upon the severity of the disease. Long term fatigue lasting for more than 6 months is the chief symptom. This unexplained fatigue lasts for more than 24 hours after any normal physical or mental activity called “Post-exertional malaise” (PEM) and is not relieved by bed rest.

Chronic Fatigue Syndrome and Depression are somehow interlinked hence people having CFS may suffer from depression. Depression further exalts fatigue.

Symptoms of CFS can be classified into different categories:

PHYSICAL SYMPTOMS:

  • Myalgia (muscle pain)
  • Arthralgia (joint pain)
  • Night sweats
  • Tender lymph nodes
  • Irritable bowel syndrome
  • Sore throat

SLEEP DISORDERS:

  • Difficulty falling asleep and staying asleep
  • Non-restorative sleep (feeling unfresh even after a full night sleep)
  • Sleep apnea

A few other symptoms include:

  • Memory related illnesses
  • Difficulty in thinking
  • Hyperalgesia (i.e. increased sensitivity to pain)
  • Sensitivities to noise, chemicals, odors, etc.
  • Attention-deficit
  • Orthostatic intolerance (lightheadedness)

The onset is gradual but can be sudden. The majority of the people with CFS live a normal life however some people are bedridden and totally dependent upon others. A few people experience severe chronic pain which is strongly disabling. CFS is not easily cured and lasts for decades.

Intelligence and reasoning remain unaltered but symptoms of different neuropsychiatric and neuropsychological disorders may develop.

There are often rounds of remission and relapses which further extend the course of this illness and make the management difficult.

TREATMENT AND MANAGEMENT:

Up till now there is no certain drug or any pharmacological agent to cure or treat chronic fatigue syndrome. For many people, counseling and Graded Exercise Therapy (GET) have shown some benefits. And according to a few kinds of research, immunomodulatory drugs are found to be effective as they improve both cognitive function and exercise capacity.

Patients who develop symptoms of depression can be treated with anti-depressants and anti-depression therapies like Massage, Deep breath exercises, Stretching, Yoga etc.

For a good sleep following strategies can be used. These will improve your ability to sleep;

  • Stick to a schedule
  • Every night sleep at the same time
  • Set alarm so that you wake up at same time every day
  • Avoid any kind of exercise before sleep
  • Reduce or limit your caffeine intake

The full recovery rate is 5% and children have a better prognosis than adults. As there is no cure and symptoms are different for every person, it’s important that you find a treatment plan that completely meets your needs.

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