Understanding Chronic Fatigue Syndrome

Understanding Chronic Fatigue Syndrome

More than 1 million people in the United States have chronic fatigue syndrome (CFS), yet less than 20% have been diagnosed. While there’s no cure for CFS yet, treatment strategies do exist.

Chronic fatigue syndrome (CFS) can be as isolating as it is debilitating, especially when those around you don’t understand what you’re going through. But you’re not alone. Learning about CFS can help you recognize whether you or a loved one could have this illness. Fortunately, there is now a wealth of credible information available about CFS to help guide you and your health care team through the process of diagnosing and treating CFS.

Contrary to old myths, CFS strikes people of every age, ethnic origin and socioeconomic bracket. Women seem to be at greater risk for developing CFS, with four times more cases reported in women than men. People in their 40s and 50s are more likely to get CFS, but it’s found in people of all ages, including children. Anyone can get CFS. If you’re experiencing prolonged, extreme exhaustion coupled with difficulty sleeping and concentrating, body pain and flu-like symptoms, you could have CFS. Consult a health care professional to learn more about options that are available for you.


Get Diagnosed

Chronic fatigue syndrome can resemble other illnesses, including mononucleosis, lupus, fibromyalgia, chronic Lyme disease and multiple sclerosis. Because CFS can mimic these disorders, it’s especially important for patients not to self-diagnose CFS. It’s also important not to delay seeking a diagnosis.

Research conducted by the Centers for Disease Control and Prevention (CDC) suggests that early diagnosis and treatment of CFS can increase the likelihood of improvement. Your physician will first take a detailed medical history, then perform a complete physical examination. Next, a battery of laboratory tests will be performed to help determine if you have another illness that resembles CFS. Because there’s no diagnostic lab test for CFS, other illnesses have to be excluded before a CFS
diagnosis can be confirmed.

A diagnosis of CFS is made if the patient meets the following criteria:

1. Unexplained, persistent fatigue that’s not due to ongoing exertion, isn’t relieved by rest, is of new onset (not lifelong) and results in a significant reduction in previous levels of activity.


2. Four or more of the following symptoms are present for six months or more:
• Impaired memory or concentration


• Postexertional malaise (extreme, prolonged exhaustion following physical or mental activity)


• Unrefreshing sleep


• Muscle pain


• Multijoint pain


• Headaches of a new type


• Sore throat


• Tender lymph nodes

A CFS diagnosis is complicated by the fact that it’s an invisible illness, and people with CFS often don’t look sick. Only a health care professional can diagnose CFS.


Get Help

Although CFS can be challenging to manage, there are treatment options that can improve symptoms, increase function and enhance quality of life for patients. Chronic fatigue syndrome is best treated with a combination of coping strategies, symptomatic treatments and activity management. The symptoms of CFS may create the need for revisions in daily living routines. These can include changes in diet; exercise modifications; planning daily activities according to energy level; and sleep/rest management. All may require the assistance of professional clinicians such as a dietitian, physical and/or occupational therapist, mental health professional or sleep therapist.


Coping

The severity of CFS varies greatly, with some patients able to maintain fairly active lives. For others, CFS has a profound impact on work, school and family life. Patients often experience guilt, anger, denial, financial pressures, anxiety and depression because of the limitations imposed by this illness.
Learning to cope with these emotions and to make appropriate lifestyle changes is one of the best ways of managing CFS and improving your prognosis. Therapies that help people improve coping skills include counseling for emotional and mental health, deep breathing and muscle relaxation techniques, cognitive behavioral therapy, massage and movement therapies like yoga and tai chi.

Although CFS is not a form of depression, many patients eventually become depressed as a result of the illness, just as patients with MS, cancer and other chronic illnesses do. When depression does occur, it needs to be addressed. Learning to cope with the impact of CFS can be effective in managing depression. Prescription medication and professional counseling may also help. Any chronic illness, including CFS, can affect the patient’s family. Family education and counseling may promote good communication and reduce the adverse effects of CFS on the family.


Symptom Management

Since no cause for CFS has been identified, many treatment options are directed at relieving individual symptoms. There are many over-the-counter and prescription drug therapies that can be
used to treat sleep difficulties, cognitive problems, pain and other symptoms of CFS. Antidepressants can also be used to treat a variety of symptoms, including depression. Because CFS patients are often sensitive to medications, the usual treatment strategy is to begin with very low doses and to gradually increase dosage as tolerated.

Alternative therapies are often explored by CFS patients to relieve symptoms. Patients are encouraged to discuss such options with a health care professional to make sure they are safe and effective. Acupuncture, hydrotherapy, yoga, tai chi and massage therapy have been found to help some patients and are often prescribed for CFS symptom management.


Physical Activity

For patients with CFS, learning to manage activity levels is key to managing the illness itself. This requires a new way of defining exercise. While vigorous aerobic exercise is beneficial for many chronic illnesses, CFS patients can’t tolerate traditional exercise routines. Exercise programs aimed at optimizing aerobic capacity are not recommended.

It’s important, however, not to avoid activity and exercise altogether. Such avoidance leads to serious deconditioning and can actually worsen other symptoms. Instead, CFS patients must learn to pace activities and work with their health care practitioner to create an individualized exercise program that focuses on interval activity or graded exercise. The goal is to improve mood, sleep, pain and other symptoms so patients can function better and engage in activities of daily living.

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Source:

* U.S. Centers for Disease Control and Prevention, Atlanta, GA, http://www.cdc.gov/cfs.