Chronic Fatigue Syndrome (CFS)

Chronic Fatigue Syndrome (CFS)

Article
Health & Wellness
Diseases & Conditions
Contributed byKrish Tangella MD, MBAOct 16, 2023

What are the other Names for this Condition? (Also known as/Synonyms)

  • Akureyri Disease
  • Benign Myalgic Encephalomyelitis
  • CFIDS (Chronic Fatigue and Immune Dysfunction Syndrome)

What is Chronic Fatigue Syndrome? (Definition/Background Information)

  • Chronic Fatigue Syndrome (CFS) is a disorder having an unknown or as yet unidentified cause that leads to substantial reduction of an individual’s physical and mental exertion levels, for great lengths of time (over six months)
  • The main characteristic feature of Chronic Fatigue Syndrome is an unexplained and stubborn chronic fatigue, which is not diminished/removed by rest, or there is a completely reduced activity level
  • These may manifest as improper sleep and lightheadedness while standing up. Individuals with such an extreme fatigue are not able to perform their regular (work) activities, or study, or indulge in any personal/social activity
  • The condition is also termed Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). It is believed that the condition may develop from multiple factors. The condition is being increasingly referred to as Systemic Exertion Intolerance Disease (SEID)
  • Other commonly noted signs and symptoms apart from severe fatigue/tiredness include a lack of concentration, headaches, sore throat, and joint pain

Who gets Chronic Fatigue Syndrome? (Age and Sex Distribution)

  • Chronic Fatigue Syndrome (CFS) is commonly seen in women who are between 30-50 years’ old
  • Adults are more prone to CFS than children
  • No racial or ethnic predilection is noted, and the condition is seen worldwide

What are the Risk Factors for Chronic Fatigue Syndrome? (Predisposing Factors)

The following risk factors are noted with Chronic Fatigue Syndrome:

  • Women are at an increased risk for the condition than men (by a factor of four)
  • Adults in the 40-50 years’ age group
  • Those with a positive family history of Chronic Fatigue Syndrome maybe at a higher risk
  • Individuals with certain viral infections (Epstein-Barr virus, human herpes virus, enterovirus, rubella virus), whose immune systems are weakened by immunodeficiency infections (HIV infection or AIDS), or other such debilitating conditions, may have a higher susceptibility
  • Individuals with an impoverished health status, having low blood pressures, and a high stress, are more prone to be affected
  • Individuals with certain allergic conditions
  • Psychological stress that may be severe
  • Genetic predisposition - the condition may run in one’s family

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chronic Fatigue Syndrome? (Etiology)

Chronic Fatigue Syndrome (CFS) is a complex disorder and the exact cause of this condition is presently unclear.

  • It may be due to combination of factors such as viral infections (particularly due to Epstein-Barr virus or human herpes virus 6), immunodeficiency disease, hormonal imbalances, or the outcome of other health-related triggers
  • Other CFS causes speculated include physical and emotional trauma, nutritional deficiencies, very low blood pressures, and acute stress

What are the Signs and Symptoms of Chronic Fatigue Syndrome?

Most of the signs and symptoms associated with Chronic Fatigue Syndrome are identical to those found with other infections and disorders. Hence, many a times CFS is overlooked. Apart from a severe energy-draining fatigue that does not improve with more than ample rest or sleep, some of the significant factors (that are used to diagnose the disorder), which last up to six months, are:

  • Absolutely reduced physical and mental activity levels; much less than what the individual was previously capable of
  • Extreme exhaustion, particularly after any physical or mental activity termed post-exertional malaise (PEM); these develop within 12 hours to 2 days and may last for days and weeks after the activity
  • Lack of concentration, memory problems
  • Nagging pain of the joints and muscles
  • Headaches that may be frequent
  • Lack of sleep (chronic insomnia); sleep that is not refreshing
  • Sore throat
  • Lymph nodes in the armpits and neck; the lymph nodes feel soft and tender
  • Dizziness while standing up from a seated position or while sitting from a sleeping position

Other secondary symptoms that are noted in some individuals include:

  • Loss of balance, dizziness, feeling faint
  • Bowel problems
  • Mild fever
  • Feeling chilly
  • Night sweats
  • Allergic to medications, foods, odors, even noise
  • Increased sensitivity to light; visual/eye problems
  • Fogginess of the brain
  • Anxiety and depression, irritability

In some individuals, a remission and relapse of the condition is noted.

How is Chronic Fatigue Syndrome Diagnosed?

Diagnosing a disorder of unknown cause is complicated, especially when the signs and symptoms are similar to those of other illnesses. In general, the diagnosis of Chronic Fatigue Syndrome (CFS) is difficult and challenging.

  • Diagnostic tests that are performed for Chronic Fatigue Syndrome mainly look to exclude other diseases, which cause fatigue and other related symptoms that overlap with those of CFS. CFS is hence, a diagnosis of exclusion
  • No definite test for Chronic Fatigue Syndrome exist; however, the physician studies the medical history of the patient (including medications currently taking), conducts a physical examination, identifies CFS-related symptoms, checks for long-term extreme fatigue, and signs of periodic waxing and waning of the conditions. These steps may help the healthcare provider diagnose the syndrome

A differential diagnosis is necessary to exclude other conditions that present similar signs and symptoms. These may include:

  • Depressive disorders
  • Fibromyalgia
  • Infectious mononucleosis
  • Lyme disease
  • Morbid obesity
  • Multiple sclerosis (MS)
  • Sleep disorders
  • Systemic lupus erythematosus (SLE)
  • Thyroid function disorders

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chronic Fatigue Syndrome?

Complications due to Chronic Fatigue Syndrome (CCFS) include:

  • Sleep disorders
  • Absence from work
  • Social isolation, being cut-off from work and social activities for a prolonged period
  • Side effects of medications used in treating CFS
  • Depression, anxiety, and mood swings
  • Overall quality of life is affected

How is Chronic Fatigue Syndrome Treated?

  • Individualized treatment strategies may be evolved by the healthcare team to manage Chronic Fatigue Syndrome due to its complex nature and considering the fact that there is presently no specific cure for CFS. Often, a team of medical specialists may be involved in the management of the condition
  • Rehabilitation of health, professional mental support, physical therapy, in addition to administering medications that treat specific symptoms is typically considered
  • Physical and mental exertions may worsen the condition, and hence, activity management, light exercising, and bed rests are recommended

How can Chronic Fatigue Syndrome be Prevented?

  • Chronic Fatigue Disorder is an illness of unknown cause with no standard treatment methods available
  • Staying healthy, being aware of the risk factors, and understanding the associated symptoms, would help in preventing the disorder
  • Seeking timely treatment including adjusting one’s lifestyle may help decrease the symptoms
  • Some individuals may find relief through complementary treatment practices such as yoga, acupuncture, or tai chi. It is recommended to consult with one’s primary care physician prior to commencing such treatments

What is the Prognosis of Chronic Fatigue Syndrome? (Outcomes/Resolutions)

  • The severity and progression of Chronic Fatigue Syndrome (CFS) differs from one individual to another. Some can maintain a regular active life with certain limitations; in others, it considerably restricts their daily activities for great lengths of time
  • The disabling condition and weakness caused by CFS can parallel those seen with similar chronic disorders, such as multiple sclerosis, heart disease, chronic obstructive pulmonary disorder, and others
  • CFS has a cyclical nature most times, with periods of worsening symptoms and periods of relatively good health. Such a pattern of decline and rise makes it hard on the patient to manage themselves. A complete recovery has been observed in some patients, typically after six months or more
  • Proper treatment of the symptoms and a good quality healthcare is beneficial for a speedy recovery. Nevertheless, the current recovery rates average around 55%

Additional and Relevant Useful Information for Chronic Fatigue Syndrome:

Chronic Fatigue Syndrome may involve making drastic changes to one’s lifestyle and daily routine, by adapting to the changed conditions and limitations.

Following are certain facts that help understand, the differences between Chronic Fatigue Syndrome and Fibromyalgia:

  • Fibromyalgia and Chronic Fatigue Syndrome can have similar symptoms
  • Both may co-exist, which makes the diagnosis of either fibromyalgia, or CFS very challenging, in such individuals
  • Generally, in fibromyalgia the primary symptom is generalized pain, whereas CFS main symptom is chronic fatigue, which does not get better even with rest
  • It is estimated that 3 in 4 individuals with fibromyalgia may have Chronic Fatigue Syndrome and vice versa
  • In fibromyalgia, a chemical in the brain, called substance P is increased in levels. But in CFS, there is no increase in the substance. Substance P is responsible for pain perception
  • A protein called RNasel is increased in cells with CFS, but such increase is not seen in fibromyalgia
  • Generally, fibromyalgia symptoms are initiated by physical stresses to the body (such as a major surgery, or an injury to the body due to an accident). On the other hand, Chronic Fatigue Syndrome often starts after an individual has suffered a flu-like illness
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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