Chronic Fatigue Syndrome (CFS): Overview, Causes, Effects and Prevention.

Introduction

Chronic fatigue syndrome (CFS) is essentially a very debilitating disease that can cause persistent fatigue leading to deterioration of productive activity of the sufferer along with loss of quality of life, mental peace and happiness. It can pose a very serious threat to health.

Fatigue, even persistent fatigue, can be a common symptom of many medical conditions, but CFS is remarkably different from these conditions in many aspects. The most important being the severity of persistent fatigue with a sudden onset that is precipitated but not relieved by rest and the absence of any other fatigue producing medical condition. This CFS has been recognized as an independent clinical entity

Internationally, there is yet no consensus regarding nomenclature of this disease condition. The commonly used name is CFS. Other names that are proposed by different groups at different times are:

  • Myalgic encephalomyelitis (ME)
  • Post-viral fatigue syndrome (PVFS)
  • Akureyri disease
  • Benign myalgic encephalomyelitis
  • Chronic fatigue immune dysfunction syndrome
  • Chronic infectious mononucleosis.

Historical background

The disease has a fascinating history. In 1934, there was an outbreak of fatigue disease affecting large numbers of doctors and nurses of Los Angeles County Hospital which was very similar to CFS. It was then called atypical poliomyelitis. A similar outbreak in Royal Free Hospital, United Kingdom in 1955 was named Royal Free disease or benign myalgic encephalomyelitis. Symptomatologically, these were considered as prototypes of CFS. The name CFS was first used in 1987 to describe a condition similar to chronic active Epstein-Barr virus (EBV) infection but without any evidence of EBV infection and in 1988 CFS was recognized as a disease entity.

Epidemiology in worldwide

Though fatigue as a result of various medical conditions may be quite widespread—almost daily encountered by a busy physician, CFS, however, is not that common. It is quite rare. One million Americans and a quarter million of British are said to be suffering from CFS. Some have estimated the prevalence to be 7 cases per 100,000 whereas some think it is much more prevalent—up to 3% which obviously is an unrealistic figure. The various figures of prevalence suffer from a selection bias. Women are said to be more affected then man. There are no real population-based studies available from India that can give a picture of actual prevalence of this condition in the population. What early studies we get from India (Goa particularly) tries to grapple with the problem of trying to find a prototype an Indian female patient suffering from CFS (with some success) Beyond saying that it is a condition being increasingly recognized by Indian doctors any estimation about its prevalence in our country would be pure guesswork at the present. It will not possibly be incorrect to say that serious clinical search and research on CFS has started in India in the last decade only.

Causes

The cause of CFS is unknown, but the condition may be related to infection with effects on the immune system. Several viruses have been studied as possible causes of CFS, but no cause-and-effect relationship has been discovered.

Some evidence indicates that the bacterium Chlamydia pneumoniae (which causes pneumonia and other illnesses) may be a cause of CFS in some cases.

People with chronic fatigue syndrome related to C. pneumoniae are most likely to respond to antibiotics that kill C. pneumoniae, and their CFS symptoms may improve with antibiotic medications such as doxycycline.

Other conditions that cause symptoms similar to those of CFS must be ruled out. These include the following:

  • Adrenal insufficiency,
  • Malignancy,
  • AIDS,
  • Liver disease,
  • Kidney disease,
  • Psychosomatic illness,
  • Lyme disease,
  • Fibromyalgia,
  • Hepatitis C, and
  • Thyroid disease.

Risk factors that results in CFS

Factors that may increase your risk of chronic fatigue syndrome include:

  • Chronic fatigue syndrome can occur at any age, but it most commonly affects people in their 40s and 50s.
  • Women are diagnosed with chronic fatigue syndrome much more often than men, but it may be that women are simply more likely to report their symptoms to a doctor.
  • Difficulty managing stress may contribute to the development of chronic fatigue syndrome.

Complications

Possible complications of chronic fatigue syndrome include:

  • Depression
  • Social isolation
  • Lifestyle restrictions
  • Increased work absences

Signs and symptoms

  • The main symptom is fatigue or exhaustion. The fatigue is always of new onset which means that it was not present to any significant degree in the past. The duration of the fatigue is prolonged and to qualify as CFS it must be of more than 6 months duration.
  • The commonest symptoms being impaired memory or concentration, postexertional malaise (PEM), unrefreshing sleep, myalgia, arthralgia, headache of new kind or of greater severity, frequent sore throat and tender cervical or axillary lymph nodes.

Certain other symptoms which are rare can also occur in CFS. Some of these are quite varied in nature:

  • Irritable bowel, abdominal pain, nausea, diarrhea or bloating
  • Chills and night sweats
  • Brain fog
  • Chest pain
  • Shortness of breath
  • Chronic cough
  • Visual disturbances (blurring, sensitivity to light, eye pain or dry eyes)
  • Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise

Diagnosis and test

Diagnostic criteria

To meet the diagnostic criteria of chronic fatigue syndrome, or myalgic encephalomyelitis, you must have unexplained, persistent fatigue for six months or more, along with at least four of the following signs and symptoms:

  • Loss of memory or concentration
  • Sore throat
  • Enlarged lymph nodes in your neck or armpits
  • Unexplained muscle pain
  • Pain that moves from one joint to another without swelling or redness
  • Headache of a new type, pattern or severity
  • Unrefreshing sleep
  • Extreme exhaustion lasting more than 24 hours after physical or mental exercise

There’s no single test to confirm a diagnosis of chronic fatigue syndrome. Because the symptoms of chronic fatigue syndrome can mimic so many other health problems, you may need patience while waiting for a diagnosis. Your doctor must rule out a number of other illnesses before diagnosing chronic fatigue syndrome. These may include:

  • Sleep disorders. Chronic fatigue can be caused by sleep disorders. A sleep study can determine if your rest is being disturbed by disorders such as obstructive sleep apnea, restless legs syndrome or insomnia.
  • Medical problems. Fatigue is a common symptom in several medical conditions, such as anemia, diabetes and underactive thyroid (hypothyroidism). Lab tests can check your blood for evidence of some of the top suspects.
  • Mental health issues. Fatigue is also a symptom of a variety of mental health problems, such as depression, anxiety, bipolar disorder and schizophrenia. A counselor can help determine if one of these problems is causing your fatigue

Treatment and medications

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 symptoms.

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 if it’s hurting your ability to sleep at night. 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.

Therapy

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.

Medications

No one medication can treat all of your symptoms. Also, your symptoms may change over time. In many cases, CFS can trigger or be a part of 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-reducing medication can also help you cope with aches and joint pain caused by your CFS.

Alternative medicine

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.

Preventions

Chronic fatigue syndrome (CFS) can’t be prevented or cured. But treatment can help control or reduce symptoms.

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