Chronic Fatigue Syndrome




Introduction

Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that doesn't improve with bed rest and may worsen with physical or mental activity. Of all chronic illnesses, chronic fatigue syndrome is one of the most mysterious. Unlike infections, it has no clear cause. Unlike conditions such as diabetes or anemia, there's essentially nothing to measure. And unlike conditions such as heart disease, there are relatively few treatment options.

Chronic fatigue syndrome may occur after an infection such as a cold or viral syndrome. It can start during or shortly after a period of high stress or come on gradually without any clear starting point or any obvious cause. Chronic fatigue syndrome is a flu-like condition that can drain your energy and sometimes last for years. People previously healthy and full of energy may experience a variety of symptoms, including extreme fatigue, weakness and headaches as well as difficulty concentrating and painful joints, muscles and lymph nodes.

Women are diagnosed with chronic fatigue syndrome two to four times as often as men are. However, it's unclear whether chronic fatigue syndrome affects women more frequently or if women report it to their doctors more often than men do.

Signs and symptoms

People with chronic fatigue syndrome exhibit signs and symptoms similar to those of most common viral infections. Unlike flu (influenza) symptoms, which usually subside in a few days or weeks, the signs and symptoms of chronic fatigue syndrome can last for months or years. They may come and go frequently with no identifiable pattern.

Primary signs and symptoms
In addition to persistent fatigue, not caused by other known medical conditions, chronic fatigue syndrome has eight possible primary signs and symptoms. These include:
  • Loss of memory or concentration
  • Sore throat
  • Painful and mildly enlarged lymph nodes in your neck or armpits (axillae)
  • Unexplained muscle soreness
  • Pain that moves from one joint to another without swelling or redness
  • Headache of a new type, pattern or severity
  • Sleep disturbance
  • Extreme exhaustion after normal exercise or exertion
According to the International Chronic Fatigue Syndrome Study Group — a group of scientists, researchers and doctors brought together by the Centers for Disease Control and Prevention (CDC) to determine a standard method for defining and diagnosing chronic fatigue syndrome — a person meets the diagnostic criteria of chronic fatigue syndrome when unexplained persistent fatigue occurs for six months or more with at least four of the eight primary signs and symptoms also present.

Additional signs and symptoms
In addition, people with chronic fatigue syndrome have reported other various signs and symptoms that aren't part of the official definition of chronic fatigue syndrome determined by the International Chronic Fatigue Syndrome Study Group. These include:
  • Abdominal pain
  • Alcohol intolerance
  • Bloating
  • Chest pain
  • Chronic cough
  • Diarrhea
  • Dizziness
  • Dry eyes and mouth
  • Earache
  • Irregular heartbeat
  • Jaw pain
  • Morning stiffness
  • Nausea
  • Night sweats
  • Psychological problems, such as depression, irritability, anxiety disorders and panic attacks
  • Shortness of breath
  • Tingling sensations
  • Weight loss
If you have chronic fatigue syndrome, your symptoms may peak and become stable early on, and then come and go over time. Some people go on to recover completely, while others grow progressively worse.

Causes

Doctors don't know the cause of chronic fatigue syndrome. Several possible causes have been proposed, including:
  • Iron deficiency anemia
  • Low blood sugar (hypoglycemia)
  • History of allergies
  • Virus infection, such as Epstein-Barr virus or human herpesvirus 6
  • Dysfunction in the immune system
  • Changes in the levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands
  • Mild, chronic low blood pressure (hypotension)
The cause of chronic fatigue syndrome may be an inflammation of the pathways of the nervous system as a response to an autoimmune process, but with nothing measurable in the blood like in other autoimmune diseases, such as rheumatoid arthritis or lupus. Chronic fatigue syndrome may also occur when a viral illness is complicated by a dysfunctional immune system. Some people with chronic fatigue syndrome may have a low blood pressure disorder that triggers the fainting reflex.

In many cases, however, no serious underlying infection or disease is proved to specifically cause chronic fatigue syndrome. Lack of medical knowledge and understanding of chronic fatigue syndrome has made determining and describing the characteristics of the condition difficult.



Treatment

There's no specific treatment for chronic fatigue syndrome. In general, doctors aim to relieve symptoms by using a combination of treatments, which may include:
  • Lifestyle changes. Your doctor may encourage you to slow down and to avoid excessive physical and psychological stress. This may save your energy for essential activities at home or work and help you cut back on less important activities.
  • Gradual but steady exercise. Often with the help of a physical therapist, you may be advised to begin a graduated exercise program in which physical activity gradually increases. This can help prevent or decrease the muscle weakness caused by prolonged inactivity. In addition, your energy level can often improve significantly.
  • Treatment of psychiatric problems. Doctors can treat problems often related to chronic fatigue syndrome, such as depression, with medication or behavior therapy — learning to change your behavior to reduce the symptoms of a certain disease or condition — or a combination of the two. If you're depressed, medications such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may help. Antidepressants may also help improve sleep and relieve pain. Tricyclic antidepressants include amitriptyline (Limbitrol, Triavil — both of which are multi-ingredient drugs that contain amitriptyline), desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and bupropion (Wellbutrin).
  • Treatment of existing pain. Acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin, others) may be helpful to reduce pain and fever.
  • Treatment of allergy-like symptoms. Antihistamines such as fexofenadine (Allegra) and cetirizine (Zyrtec) and decongestants that contain pseudoephedrine (Sudafed, Dimetapp) may relieve allergy-like symptoms such as runny nose.
  • Treatment of low blood pressure (hypotension). The drugs fludrocortisone (Florinef), atenolol (Tenormin), and midodrine (ProAmatine) may be useful for certain people with chronic fatigue syndrome.
  • Treatment for problems of the nervous system. Symptoms such as dizziness and extreme skin tenderness can sometimes be relieved by clonazepam (Klonopin). Your doctor may prescribe medications such as lorazepam (Ativan) and alprazolam (Xanax) to relieve symptoms of anxiety.
Some medications can cause side effects or adverse reactions that may be worse than the symptoms of chronic fatigue syndrome. Talk to your doctor before starting any treatment for chronic fatigue syndrome.

Prevention

Because the cause of chronic fatigue syndrome remains unknown, there's no known way to prevent the illness from occurring. Be aware of the symptoms and signs of chronic fatigue syndrome and seek the help of your doctor to manage them if they occur.

Informations obtained from National Institute of Health.
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