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CHRONIC FATIGUE SYNDROME - a patient's guide
Editorial Team
Overview
Chronic Fatigue Syndrome is a condition characterised by ongoing fatigue.
It is also known as Myalgic Encephalomyelitis (M.E.) and Post-Viral
Fatigue Syndrome.
The cause is unknown, although there are many theories, including possible
reaction to viral infection.
About 2% of the population suffer from the illness.
Women are more at risk then men.
There is no specific treatment for the condition but exercise and cognitive
behavioural therapy have been shown to be effective.
It is important to have underlying medical problems thoroughly checked
for by a doctor.
What is Chronic Fatigue Syndrome?
Chronic Fatigue Syndrome is a debilitating condition characterised by
severe fatigue that cannot be explained by an underlying medical condition.
It is also known as "Chronic Fatigue and Immune Dysfunction Syndrome"
(CFIDS), "Myalgic Encephalomyelitis" (ME), and "Post-Viral Fatigue
Syndrome".
The cause of CFS is not known but a popular theory is a reaction to
a virus. The Epstein Barr virus (glandular fever) and Lyme disease in
particular have been linked to CFS. However, there is no convincing evidence
that most cases of CFS are caused by an infection.
Other theories suggests that chronic fatigue is related
to overwork, stress, problems with the immune system, low
blood pressure, hormonal imbalance or environmental toxins.
In some cases it may follow the death of a close relative
or an operation.
Several studies have shown that CFS patients are more
likely to suffer from allergies. However, not all CFS patients
have an allergy.
The majority of patients complain of symptoms that could
be related to the central nervous system (brain and spinal
cord).
The illness is not an imaginary one or the result of people's
anxiety. In the past decade, medical science has found some
biological abnormalities occur more often in patients with
CFS.
Up to two percent of the population suffer from CFS. It is estimated
that half a million Americans suffer from a chronic fatigue illness.
CFS affects all racial groups, but women are more at risk of CFS than
men.
Children with the syndrome are more likely to make a full
recovery. One surveillance study found 31 percent of adult
patients recovered within the first five years of the illness,
and 48 percent had recovered within 10 years. However, some
of these patients still experienced some symptoms.
What are the symptoms?
The main symptoms are unexplained fatigue which is not
the result of exercise, and problems with intellectual functioning
such as short-term memory loss or lack of concentration.
The fatigue must be present all the time to be defined
as CFS, and it is so debilitating that a person can no longer
maintain their previous levels of functioning in their work
and social lives.
Other physical symptoms may include a sore throat, enlarged
lymph nodes, muscle pain and joint pain without swelling,
unrefreshing sleep and unusual headaches.
Other medical conditions such as anaemia and hypothyroidism
must be ruled out before a diagnosis of CFS can be made.
Therefore, your doctor may order some blood and urine tests
to exclude other conditions.
In the first six months of the illness, there is a big
decrease in people's level of functioning followed by a
gradual improvement. It is unknown whether the slow improvement
is linked to an improvement in the illness itself or related
to the patient's increasing ability to cope with the syndrome.
In some instances the illness waxes and wanes over a period
of years.
There is a difference between the American and British
criteria for chronic fatigue syndrome. The British criteria
requires the presence of mental fatigue, whereas the American
criteria requires the presence of a number of physical symptoms.
Some patients also report problems with nausea, irritable
bowel syndrome, bloating, chronic cough, diarrhoea, dry
eyes, irregular heartbeat, chest pain, jaw pain, night sweats,
alcohol and drug intolerance, dizzy spells, tingling sensations
and lack of appetite.
The US Centers for Disease Control and Prevention defines
CFS as debilitating fatigue which lasts for at least six
months, has a sudden onset, is not improved by resting,
and is associated with at least four of the following symptoms:
Sore throat
Swollen lymph nodes
Joint pain
Muscle pain
New headaches
Unrefreshing sleep
Discomfort and exhaustion after exercise and exertion
The following conditions exclude a diagnosis of CFS:
Medical conditions which may explain the presence of tiredness
and fatigue such as sleep apnoea, narcolepsy, hypothyroidism,
and side effects to some pharmaceuticals.
Slow recovery from a medical condition which may produce
fatigue such as cancer, or hepatitis B or C.
Past or current mental illness such as major depression,
bipolar disorder (manic depression), schizophrenia, or anorexia
nervosa or bulimia.
Severe obesity with a BMI over 45.
Alcohol or substance abuse anytime within the past two
years.
The following conditions may still allow for a diagnosis
of CFS:
Any condition which cannot be confirmed by a laboratory
test such as fibromyalgia, anxiety disorders, and non-psychotic
depression.
Any condition such as Lyme disease that was properly treated
before the development of chronic fatigue.
Any condition for which successful treatment has been
documented such as hypothyroidism and asthma in which subsequent
tests have proved adequate treatment.
Any finding on physical examination or laboratory test
which is insufficient to explain the existence of another
medical condition.
What can be done to help?
There is no specific treatment for CFS as there is no
known cure. However, several agents can be used to relieve
symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are useful
for treating muscle pains, joint pain and headaches. However,
they should be used with caution in the long term because
of their potential to cause kidney damage, and stomach upset.
Some patients are prescribed antihypotensive medications
if they have low blood pressure on standing.
Others who suffer from allergies may benefit from non-sedating
antihistamines such as astemizole and loratadine. Sedating
antihistamines may be beneficial before bedtime.
People with CFS should try to avoid stress, follow a regular
routine and remain as active as possible. Regular exercise
has been found to be helpful.
A review in the British Medical Journal has looked at
the evidence for the following treatments and rated them
accordingly:
Beneficial:
Exercise
Cognitive behavioural therapy
Unknown effectiveness:
Corticosteroids
Antidepressants
Dietary supplements
Oral nicotinamide adenine dinucleotide (NADH)
Unlikely to be beneficial:
Immunotherapy
Likely to be ineffective or harmful:
Prolonged rest
Exercise
Two studies have found a good exercise programme can produce
a substantial reduction in fatigue among chronic fatigue
sufferers.
Cognitive Behavioural Therapy
A review of all random clinical trials has found cognitive
behavioural therapy by skilled therapists is effective in
improving the outcome of the illness.
Corticosteroids
Studies have found any benefit from low dose glucocorticoid
treatment appears to be short lived, and higher doses have
unwanted side effects.
Antidepressants
There is limited evidence to support the use of antidepressants
in the treatment of CFS. However, if depression is present,
they may play an important role. Some doctors believe many
cases may represent atypical depression, and a trial of
antidepressant medication can be considered.
Dietary supplements
One small study found limited benefit from magnesium injections
over a six week period. Two small studies of evening primrose
oil produced mixed results.
Immunotherapy
Four small studies have found limited benefit and unwanted
side effects in people treated with IgG. Other forms of
immunotherapy showed no benefit.
Prolonged Rest
There is no evidence that this is effective in the management
of CFS. There is some indirect evidence that prolonged rest
could actually worsen fatigue in sufferers.
Future trends in Chronic Fatigue Syndrome
Several studies are underway in order to find a cause
for CFS (it is unlikely however that there is a single cause),
and to find better treatments for the illness.
One properly controlled study is looking at whether medications
to improve low blood pressure (neurally mediated hypotension)
are effective in the treatment of CFS.
More research is also necessary into the theory that CFS
is related to hormonal abnormalities.
Researchers are studying the drug Ampligen which stimulates
the immune system. One report found the drug led to modest
improvements in intellectual functioning among CFS patients.
However, more research is required. The drug dehydroepiandrosterone
(DHEA) is also under investigation.
Getting help
People with chronic fatigue syndrome should be under the supervision
of a doctor. See your doctor if you are suffering from ongoing fatigue.
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