What Is Chronic Fatigue Syndrome?
Chronic fatigue syndrome (CFS) is a debilitating disorder
characterized by extreme fatigue or tiredness that doesn’t go away with rest,
and can’t be explained by an underlying medical condition. CFS can also be
referred to as myalgic encephalomyelitis (ME) or systemic exertion intolerance disease
The causes of CFS aren’t well-understood. Some theories
include viral infection, psychological stress, or a combination of factors. Because
no single cause has been identified, and because many other illnesses produce
similar symptoms, CFS can be difficult to diagnose. There are no tests for CFS,
so your doctor will have to rule out other causes for your fatigue.
While CFS has in the past been a controversial diagnosis, it’s
now widely accepted as a real medical condition. CFS can affect anyone, though
it’s most common among women in their 40s and 50s. There is no current cure, so
treatment for CFS focuses on relieving your symptoms.
What Causes CFS?
The cause of CFS is unknown. Researchers
speculate that viruses, hypotension (unusually low blood pressure), a weakened immune
system, and hormonal imbalances could all be contributing factors. It’s also
possible that some people are genetically predisposed to develop CFS.
Though CFS can sometimes develop after a
viral infection, no single type of infection has been found to cause CFS. Some
viruses that have been studied in relation to CFS include Epstein-Barr virus
(EBV), human herpes virus 6, Ross River virus (RRV), rubella, Coxiella
burnetti, and mycoplasma. Researchers have found that a person who has been
infected with at least three of the implicated pathogens has a greater chance
of developing CFS.
The U.S. Centers for
Disease Control and Prevention (CDC) have
suggested that CFS may be the end stage of multiple different conditions,
rather than one unique condition. In fact, 10 to 12 percent of people with
Epstein-Barr virus, Ross River virus, and Coxiella burnetti develop a condition
that meets the criteria for a CFS diagnosis.
People with CFS sometimes have weakened
immune systems, but doctors don’t know whether this is enough to cause the
disease. Additionally, people with CFS sometimes have abnormal hormone levels,
but doctors haven’t yet concluded whether this is significant.
Risk Factors for CFS
CFS is most common among people in their 40s
and 50s. Gender also plays an important role in CFS, as women patients
outnumber men by a nearly 2 to 1 ratio. Genetic predisposition, allergies,
stress, and environmental factors may also increase your risk.
What Are the Symptoms of CFS?
The symptoms of CFS vary from person to person
and based on the severity of the condition. The most common symptom is fatigue
that is severe enough to interfere with your daily activities. For CFS to be
diagnosed, fatigue must last for at least six months and must not be curable
with bed rest, and you must have at least four other symptoms as well.
Other symptoms of CFS may include:
- loss of memory or concentration
- feeling unrefreshed after a
- chronic insomnia (and other sleep
- muscle pain
- frequent headaches
- multijoint pain without redness
- frequent sore throat
- tender lymph nodes in your neck
You may also experience illness or extreme
fatigue after physical or mental activities. This can last for more than 24
hours after the activity.
People are sometimes affected by CFS in
cycles, with periods of feeling worse and then better again. Symptoms may
sometimes even disappear completely (remission). However, it’s still possible for
them to come back again later (relapse). The cycle of remission and relapse can
make it difficult to manage your symptoms.
How Is CFS Diagnosed?
CFS is a very challenging condition to
diagnose. According to the CDC, only 20 percent of the estimated 1 to 3 million Americans with
CFS have been diagnosed. There are no lab tests to screen for CFS and its
symptoms are common to many illnesses. Many people with CFS don’t look
obviously sick, so doctors may not recognize that they are ill.
In order to be diagnosed with CFS, you must
have at least four of the above symptoms listed. You also must have severe, unexplained
fatigue that cannot be cured with bed rest. The fatigue and other symptoms must
last for six months or longer.
Ruling out other potential causes of your
fatigue is a key part of the diagnosis process. Some conditions whose symptoms
resemble those of CFS include:
- Lyme disease
- multiple sclerosis
- lupus (SLE)
- major depressive disorder
You may also experience symptoms of CFS if
you are severely obese or have depressive disorders or sleep disorders. The
side effects of certain drugs, such as antihistamines and alcohol, can mimic
CFS as well.
Because the symptoms of CFS resemble those of
other conditions, it’s important not to self-diagnose and to talk to your doctor.
How Is CFS Treated?
There is currently no specific cure for CFS.
Each afflicted person has different symptoms and may therefore benefit from
different types of treatment aimed at managing the disease and relieving their
Home Remedies and Lifestyle Changes
Making some changes to your lifestyle can
help reduce your symptoms. Limiting or eliminating your caffeine intake will
help you sleep better and ease your insomnia. You should limit your nicotine
and alcohol intake, too. Try to avoid napping during the day. Create a sleep
routine: You should go to bed at the same time every night and aim to wake up
around the same time every morning.
It’s also important to pace yourself during
activities. Overexertion can make your symptoms worse and bring on an episode
of fatigue. Avoid emotional and physical stress. Take time each day to relax or
participate in activities you enjoy.
Two types of therapy appear to benefit people with CFS. One is psychological counseling to help
you cope with CFS and improve your mindset. The other is physical therapy. A physical therapist
can evaluate you and create an exercise routine for you that gradually
increases in intensity. This is known as graded exercise therapy, or GET.
No one medication can treat all of your
symptoms. Also, your symptoms may change over time. In many cases, CFS can
trigger depression, and you may need an antidepressant to combat it. If
lifestyle changes don’t give you a restful night’s sleep, your doctor may
suggest a sleep aid. Pain medication can also help you cope with aches and
joint pain caused by your CFS.
Acupuncture, tai chi, yoga, and massage may
help relieve the pain associated with CFS. Always talk to your doctor before
beginning any alternative or complementary treatments.
What Can Be Expected in the Long Term?
Despite increased research efforts, CFS
remains a poorly understood condition with no cure. Managing CFS can therefore be
challenging. You will likely need to make major lifestyle changes in order to
adapt to your chronic fatigue. As a result, you may experience depression,
anxiety, or social isolation, so some people find that joining a support group
can be helpful.
CFS progresses differently in different people,
so it’s important to work with your doctor to come up with a treatment plan
that works for you. Many people benefit from working with a team of healthcare providers,
including doctors, therapists, and rehabilitation specialists. It’s not known
how many people recover from CFS.
The Solve ME/CFS Initiative has
resources that you may find helpful, and the CDC also offers recommendations for managing and living with CFS.