Overview

Chronic fatigue syndrome (CFS) is also referred to as myalgic encephalomyelitis (ME). it is a serious long-term condition that affects various systems in the human body. It is a form of fatigue that can last for 6 months or more. Feeling too much tired interferes with normal daily activities.

In this condition, fatigue does not resolve with rest. It also worsen after engaging in physical activities.

Apart from being called myalgic encephalomyelitis or chronic fatigue syndrome, it is also called systemic exertion intolerance disease (SEID).

 Key Facts & Statistics

What are the key facts and statistics about chronic fatigue syndrome?

• This disorder is characterized by extreme fatigue that does not go away on resting and cannot be explained by an underlying health condition.
• It is estimated that CFS affects 836,000 to 2,500,000 individuals in the US.
• 9 out of every 10 people with this condition do not receive a diagnosis  despite living with it.
• About 1 in 10 persons with Eipstein-Barr Virus (EBV) or Ross River virus are likely to develop a condition that meets a CFS diagnosis.

 

 Risk Factors

What are the risk factors for chronic fatigue syndrome?

• Any person can develop ME/CFS. There are several risk factors. These are:

1. Age. CFS is most common in persons aged between 40 and 60 years old.
2. Sex. Adult women and individuals assigned female at birth (AFAB) have a higher than men and persons assigned male at birth.
3. Genetics. Studies suggest that CFS can run in families.
4. Other medical conditions. Individuals with a history of complex health problems such as fibromyalgia have increased  likelihood of developing ME/CFS.

 

 Causes

What are the causes of chronic fatigue syndrome?

• The exact causes of CFS are not yet known.
• Researchers have highlighted various factors as causative. These include:

1. Hypotension.
2. Changes in metabolism.
3. Stress.
4. Changes in the immune system.
5. Hormonal imbalances.
6. Viral infections from:

•  Eipstein-Barr virus.
•  Ross River virus.
•  Human herpes virus 6.

These viruses do not directly case CFS, but related to it such that CSF can sometimes develop after their respective viral infections.

 

 Signs & Symptoms

What are the signs and symptoms of chronic fatigue syndrome?

• There are various signs and symptoms of ME/SFS. There are 4 main symptoms. These  are:

1. Extreme and chronic fatigue or tiredness that lasts for more than 6 months.
2. Difficulty sleeping.
3. Thought, memory and concentration difficulties.
4. Post-exertional malaise (PEM).

Extreme and chronic fatigue or tiredness that lasts for more than 6 months

• This kind of tiredness  does not resolve even when you take rest or sleep.
• It becomes difficult to conduct normal daily tasks and activities.
• This fatigue is chronic (long-term). It usually lasts for more than 6 months.

 

Difficulty sleeping

Finding it hard to fall and stay asleep.

 

Thought, memory and concentration difficulties

•   Difficulty remembering specific words, names, places and even numbers.
•   Slow speech and reaction.
•  Difficulty focusing on more than one activity at a time.
•  Inability to remember recent events.

 

Post-exertional malaise (PEM)

•  This is when symptoms worsen after performing activities such as reading a book.
• It can occur for several hours or even days after the trigger.
• Recovery can take various weeks.

 

There are also other symptoms and these are:

1. Headache and muscle aches.
2. Pain in the joints.
3. Dizziness and feeling faint.
4. Chills.
5. Swollen lymph nodes.
6. Anxiety.
7. Night sweats.
8. Sensitivity to light, sound, taste and smell.
9. Muscle spasms.
10. Heart palpitation.
11. Sore throat.
12. Flu-like symptoms.
13. Food intolerance.

• These symptoms affect performance of daily activities and they vary widely from one individual to another.
• These signs and symptoms come and go. Trigger factors include;
• Emotional stress.
• Engagement in physical activity.

 

 Diagnostic Procedures  & Tests

How is chronic fatigue syndrome diagnosed?

There is no single test that can pinpoint ME/CFS.

Signs and symptoms of ME/CFS mimic those of other medical problems such as :

•  Sleep disorders.
•  Health problems. Anaemia and diabetes are also characterized by fatigue.
•  Mental health problems such as depression and anxiety.

 

Procedure for diagnosis.

This involves:

• Physical examination.
• Mental health assessment.
• Blood and urine tests to rule out other conditions with similar presentation.

 

Diagnostic criteria

• The US Institute of Medicine has proposed guidelines that define fatigue that is associated with ME/CFS as being:

1. Very severe to the extent that it interferes with  the performance of daily normal activities. It must have lasted for 6 months or more.
2. Of new or definite onset.
3. Not substantially alleviated by resting.
4. Worsened by physical and mental activities.
5. Characterized by orthostatic intolerance and problems with cognitive performance.

• Apart from these, the individual must also have experienced:

1. Difficulty with focus, concentration and memory, OR
2. Dizziness, which worsens on standing from sitting down or waking up from lying down (orthostatic intolerance).

 

 Treatment and Management

How is chronic fatigue syndrome treated?

• Treatment of CFS is aimed at lowering symptoms and enabling the individual to regain normal function.
• There are effective treatments for CFS. Treatment strategies are:

1. Alterations in sleep routine.
2. Medicines.
3. Activity management.

 

Sleep routine changes

•  Regular bedtime routine.
•  Avoid consuming heavy meals a few minutes before bed time.
•  Avoid drinking beverages such as caffeine and alcohol moments before sleep time.
•  Do not use electronic devices in the bedroom.

 

Medications

• For relieving pain, administer non-steroidal anti-inflammatory drugs (NSAIDs).
•  For pain, sleep and fatige, take tri-cyclic anti-depressants (TCAs) under a doctor’s prescription.
• Viral infections are treated with anti-viral drugs.
• To improve functioning of the immune system, take intravenous immunoglobulin (IVIG).
• For relief of pain and depression, selective serotonin re-uptake inhibitors are administered.

 

Activity management

• Pacing is an practice that balances rest and  activity levels. It is used to treat post-exertional malaise.

 

 Complications

What are the complications of chronic fatigue syndrome?

There are several complications caused by CFS. Some of these consequences are:

•  Depression.
•  Performance of normal daily activities becomes very hard.

 

Prevention

How do we prevent chronic fatigue syndrome?

Unfortunately, there are no  known preventive strategies for CFS.