Chronic Fatigue Syndrome

August 5, 2011

Chronic fatigue syndrome (CFS) is defined as severe fatigue of 6 months or longer, with no medical explanation. Four or more of the following eight symptoms must also have been present over the past 6 months, starting after the fatigue: substantial impairment in short-term memory or concentration, sore throat, tender lymph nodes, muscle pain, joint pain without swelling or redness, headaches of a new type or pattern or severity, unrefreshing sleep, and malaise after exercise lasting more than 24 hours. Muscle weakness and proven psychological or physical disorders rule out the diagnosis of Chronic Fatigue Syndrome.

Chronic Fatigue Syndrome affects both genders, all races, ethnicities, and socioeconomic populations, and can begin as early as age 5. Women are twice as likely to be affected with Chronic Fatigue Syndrome compared to men. It is estimated that a half million people in the United States have a Chronic Fatigue Syndrome-like condition.


Nobody really knows what causes Chronic Fatigue Syndrome. Proposed causes include neuropsychological abnormalities; viral infection; immune and endocrine abnormalities; and metabolic, vascular, or enzymatic problems.

The neuropsychological symptoms are distinct from typical depression or anxiety disorders. Depression in Chronic Fatigue Syndrome may be a reaction to being sick for so long, but there is more depression in Chronic Fatigue Syndrome compared to other chronic diseases. Some think that Chronic Fatigue Syndrome begins as a psychiatric disorder with immune, neurologic, and endocrine abnormalities arising afterward.

Certain viruses are suspected of causing Chronic Fatigue Syndrome, including Epstein-Barr virus, coxsackie B virus, cytomegalovirus, measles, enterovirus, rubella, retroviruses, human herpes virus type 6, and human T-cell lymphotropic virus. However, there are no consistent or conclusive data to say that any specific virus causes Chronic Fatigue Syndrome.

The immune system may be involved in Chronic Fatigue Syndrome, because more than 65% of those diagnosed with Chronic Fatigue Syndrome have a history of previous allergies. Reported endocrine abnormalities associated with Chronic Fatigue Syndrome include low levels of adrenalin and related chemicals. These findings could account for the decreased energy and mood in affected individuals. Other possible metabolic abnormalities such as abnormal levels of brain chemicals, lack of adequate cerebral blood flow, and increased lung enzyme levels remain unproven.


Debilitating fatigue is the hallmark of this syndrome. Daily functioning is often impaired. Aside from those symptoms required for diagnosis, other symptoms of Chronic Fatigue Syndrome include alcohol intolerance, bloating, chest pain, chronic cough, diarrhea, dizziness, dry eyes or mouth, earaches, irregular heartbeat, jaw pain, morning stiffness, nausea, night sweats, shortness of breath, skin sensations, tingling sensations, and weight loss. The onset of Chronic Fatigue Syndrome is often associated with a viral-like syndrome consisting of extreme fatigue, lung and sinus ailments, fever, and swollen glands. Stresses such as physical exertion, headache, and sore throat tend to make the fatigue worse.


Since fatigue is a common symptom in many diseases, a search for the cause of the fatigue needs to be considered. However, avoiding unnecessary and expensive tests is also important. Before diagnosing Chronic Fatigue Syndrome, a complete history and physical examination should be performed on all patients to exclude another illness. Laboratory tests should be limited to complete blood cell counts and tests specific for the patient’s symptoms.

Depending on the results of the history and physical examination, illnesses that may need to be ruled out include fibromyalgia, chronic mononucleosis, Lyme disease, psychiatric disorders, sleep disorders, myalgic encephalomyelitis, irritable bowel syndrome, hormonal disorders, neurasthenia, chronic sinusitis, anemia, occult celiac disease, rheumatic disease, alcohol abuse, substance abuse, sick building syndrome, multiple chemical sensitivities, reactions to prescribed medications, eating disorders, cancer, autoimmune disease, obesity, and other conditions.


Patients with Chronic Fatigue Syndrome should not expect a quick fix. Sometimes using ineffective and unnecessary treatments does more harm. The best treatment strategy includes education, pain control, exercise, optimal diet, appropriate sleep schedule and antidepressants (both for mood and for chronic pain), combined with cognitive-behavioral therapy. Treatment for allergies and stress reduction may improve the quality of life for persons with Chronic Fatigue Syndrome. A multidisciplinary approach involving medical, psychiatric, behavioral, and psychological evaluation and therapy has demonstrated effective results by restoring the ability to work and keep a job.

SEE ALSO: Autoimmune disorders, Chronic pain, Sleep disorders

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