Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) refers to severe, continued tiredness ( fatigue ). It does not get better with rest and is not directly caused by other medical problems.

Causes

The exact cause of chronic fatigue syndrome (CFS) is unknown. It may be due to:

• Epstein-Barr virus or human herpes virus-6 (HHV-6); however, no specific virus has been identified as the cause
• Inflammation in the nervous system, because of a faulty immune system response

The following may also play a role in the development of CFS:

• Age
• Previous illnesses
• Stress
• Genetics
• Environmental factors

CFS is most common in women ages 30 to 50.

Symptoms

The hallmark symptom is persistent and profound fatigue, which often worsens after physical or mental exertion.

Symptoms may also include muscle aches, headache, and extreme fatigue.

The main symptom of CFS is extreme tiredness that is:

• New
• Lasts at least 6 months
• Not relieved by bed rest
• Severe enough to keep you from participating in certain activities
• Worsened when in an upright position

Other symptoms include:

• Feeling extremely tired for more than 24 hours after exercise that would normally be considered easy
• Feeling unrefreshed after sleeping for a proper amount of time
• Forgetfulness
• Concentration problems
• Confusion
• Joint pain, but no swelling or redness
• Headaches that differ from those you have had in the past
• Irritability
• Mild fever - 101°F (38.3°C) or less)
• Muscle aches ( myalgias )

  Myalgias

  Muscle aches and pains are common and can involve more than 1 muscle. Muscle pain also can involve ligaments, tendons, and fascia. Fascia are the s...

   

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• Muscle weakness , all over or multiple locations, not explained by any known disorder

  Muscle weakness

  Weakness is reduced strength in one or more muscles.

   

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• Sore throat
• Sore lymph nodes in the neck or under the arms

Exams and Tests

The Centers for Disease Control (CDC) describes CFS as a distinct disorder with specific symptoms and physical signs. Diagnosis is based on ruling out other possible causes.

Your health care provider will try to rule out other possible causes of fatigue, including:

• Drug dependence
• Immune or autoimmune disorders

  Autoimmune disorders

  An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 types of aut...

   

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• Infections
• Muscle or nerve diseases (such as multiple sclerosis )

  Multiple sclerosis

  Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system).

   

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• Endocrine diseases (such as hypothyroidism )

  Endocrine

  Endocrine glands release (secrete) hormones into the bloodstream. The endocrine glands include:AdrenalHypothalamusIslets of Langerhans in the pancrea...

   

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  Hypothyroidism

  Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....

   

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• Other illnesses (such as heart, kidney, or liver diseases)
• Psychiatric or psychological illnesses, particularly depression
• Tumors

A diagnosis of CFS must include:

• Absence of other causes of chronic fatigue
• At least four CFS-specific symptoms
• Extreme, long-term fatigue

There are no specific tests to confirm the diagnosis of CFS. However, there have been reports of people with CFS having abnormal results on the following tests:

• Brain MRI

  MRI

  A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...

   

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• White blood cell count

Treatment

There is currently no cure for CFS. The goal of treatment is to relieve symptoms.

Treatment includes a combination of the following:

• Counseling therapy - cognitive-behavioral therapy (CBT)
• Graded exercise
• Healthy diet
• Sleep management techniques
• Medicines to reduce pain, discomfort, and fever
• Medicines to treat anxiety (anti-anxiety drugs)
• Medicines to treat depression (antidepressant drugs)

Some drugs can cause reactions or side effects that are worse than the original symptoms of the disease.

People with CFS are encouraged to maintain an active social life. Mild physical exercise may also be helpful. Your health care team will help you figure out how much activity you can do, and how to slowly increase your activity. Tips include:

• Avoid doing too much on days when you feel tired
• Balance your time between activity, rest, and sleep
• Break big tasks into smaller, more manageable ones
• Spread out your more challenging tasks through the week

Relaxation and stress-reduction techniques can help manage chronic (long-term) pain and fatigue. They are not used as the primary treatment for CFS. Relaxation techniques include:

• Biofeedback
• Deep breathing exercises
• Hypnosis
• Massage therapy
• Meditation
• Muscle relaxation techniques
• Yoga

Newer medicine approaches are being researched.

Support Groups

Some people may benefit from taking part in a CFS support group .

Outlook (Prognosis)

The long-term outlook for people with CFS varies. It is hard to predict when symptoms first start. Some people completely recover after 6 months to a year.

About 1 in 4 people with CFS are so severely disabled that they cannot get out of bed or leave their home. Symptoms can come and go in cycles, and even when people feel better, they may experience a relapse triggered by exertion or an unknown cause.

Some people never feel like they did before they developed CFS. Studies suggest that you are more likely to get better if you receive extensive rehabilitation.

Possible Complications

Complications may include:

• Depression
• Inability to take part in work and social activities, which can lead to isolation
• Side effects from medicines or treatments

When to Contact a Medical Professional

Call your provider if you have severe fatigue, with or without other symptoms of this disorder. Other more serious disorders can cause similar symptoms and should be ruled out.