What Is Chronic Fatigue Syndrome?

Chronic fatigue syndrome (CFS) is a complex illness involving debilitating fatigue along with other symptoms. The fatigue is severe enough to interfere with daily activities and is not relieved by bed rest. Although a standard treatment for CFS has yet to be developed, many people improve through individualized exercise and stress management programs.

Chronic Fatigue: Symptoms, Puzzles

CFS can now be diagnosed by looking for a pattern of specific symptoms -- physical and brain-related. But the causes of the illness are still a mystery. Possible culprits include a faulty immune system, nutritional deficiency, or a viral infection that somehow triggers CFS. Scientists are also exploring a possible connection to sleep disorders, anemia, low blood pressure, or other metabolic abnormalities.

CFS Symptoms: Intense Fatigue

Everyone feels sluggish now and then. The difference with CFS is that the fatigue is overwhelming and lasts for at least 6 months. It may get worse after physical or mental exertion, and a full night's sleep provides no relief. The fatigue is often accompanied by other troubling symptoms, such as chronic pain.

CFS Symptoms: Recurring Pain

Many people with CFS develop recurring pain, including headaches, sore throat, muscle pain, and joint pain. The joints may hurt without showing signs of redness or swelling. The cause of these symptoms is not well understood, but the pain can often be managed through medication or physical therapy.

Other Symptoms of CFS

Beyond fatigue and pain, people with CFS may experience:

• Memory problems
• Trouble concentrating
• Sleep disturbances
• Weakness or dizziness

Who Is at Risk?

More than a million Americans have CFS. Women are four times more likely than men to develop the illness. Although people of any age can get CFS, it occurs most frequently in people in their 40s and 50s. There may be a genetic component, but there is no evidence that CFS is contagious.

CFS in Children and Teens

CFS is very rare in children and only slightly more common in teenagers. The good news is young people with CFS are more likely to improve than older patients. If your child is diagnosed with CFS, consult a specialist to create an individualized exercise and management program. Find constructive ways for your child to cope, and seek out support groups.

Diagnosing CFS

There are no blood tests or brain scans for CFS, but your health care team may run tests to rule out other conditions. CFS is diagnosed when you have:

• Severe fatigue for at least 6 months not explained by other conditions.
  
• And at least four of these symptoms:
  • Headaches
  • Memory or concentration trouble
  • Tender neck or underarm lymph nodes
  • Muscle pain
  • Sore throat
  • Multi-joint pain without swelling or redness
  • Unrefreshing sleep
  • Exhaustion after physical or mental activity

How CFS Impacts Daily Life

CFS tends to follow a cyclical course. You may experience periods of intense fatigue followed by periods of well-being. It's vital not to overdo it when you're feeling well, because this may trigger a relapse. Most people with CFS are prone to post-exertional malaise, meaning that symptoms worsen after strenuous physical or mental activity. Work with your health care team to determine the right activity level for you.

Treatment Options for CFS

There is no cure for CFS, and no prescription drugs have been developed specifically for its treatment. Work with your health care team to develop coping strategies, such as managing your activity level and taking medications to control symptoms. Focus on feeling better rather than feeling "normal."

Graded Exercise Therapy

Studies indicate gradual, guided physical activity is helpful for people with CFS. Graded exercise therapy starts slowly and gradually increases the duration of exercise over time. The goal is to avoid overdoing it and experiencing a "crash." It's important not to avoid all physical activity, or the muscles can become deconditioned. Graded exercise therapy can help you adapt your activity level to the fluctuations in your condition.

Medications

Medications are primarily used to relieve symptoms, such as sleep problems and chronic pain. Some medications, such as tricyclic antidepressants, can reduce pain and improve sleep with just one pill. Many people with CFS are sensitive to medications and may need lower doses. Be sure to ask your doctor about the benefits and side effects of any drugs you take, even if they are over the counter.

Counseling

A counselor can help you develop coping skills that will decrease anxiety, depression, anger, and guilt. A therapist may recommend combining medication and psychotherapy. Cognitive behavioral therapy (CBT) aims to enhance coping by changing dysfunctional thinking and behavior. Recent studies show this form of therapy is a helpful component of CFS treatment. 

Complementary Therapies

Complementary treatments -- sometimes called alternative therapies -- can aid in pain management. These include stretching therapies, toning exercises, massage, hydrotherapy, and relaxation techniques. Acupuncture may also treat pain. Make sure to seek out qualified practitioners who are knowledgeable about CFS.

Herbs and Supplements

Talk with your doctor about which supplements, if any, are helpful and safe for you. Remember that supplements may interact negatively with prescribed medications. People with CFS should generally avoid comfrey, licorice root, ephedra, kava, and bitter orange.

Scam Alert

Many nutritional supplements and vitamins are targeted toward people with CFS. These products are not regulated to the same degree as prescription medications, and most have not gone through extensive testing in people.

CFS and Diet

Doctors recommend a well-balanced diet for people with CFS, but no specific dietary strategy has been widely accepted. Essential fatty acids, found in nuts, seeds, and coldwater fish, may reduce fatigue. Some people with CFS notice their symptoms are triggered by certain foods or chemicals, including refined sugar, caffeine, and alcohol.

CFS and Sleep

Most people with CFS experience sleep disturbances. This may include difficulty falling asleep, restless legs, vivid dreaming, and frequent awakening. To create healthy sleep habits, establish a regular bedtime routine and engage in light exercise and stretching at least four hours before bedtime.

CFS and Depression

CFS is not a psychiatric illness, nor a form of depression. However, up to half of people with CFS become depressed during the course of their illness. This may be the result of the difficulty in adjusting to life with a debilitating, chronic condition. Depression generally responds well to treatment, and getting it under control can make CFS easier to cope with.

Tips for Family Members

Chronic illnesses like CFS may impact the whole family. Consult with a mental health professional to learn how to cope with changes in family dynamics. Don't expect your loved one to "snap out of it" and return to his or her usual activities. Try to be supportive, because emotional health is vital for anyone coping with CFS.

Outlook for CFS

The percentage of people who make a full recovery from CFS is not known. But many people enjoy long periods of remission, especially by learning to manage their activity levels. Early treatment with stress reduction and graded exercise therapy may increase the chances for improvement. These therapies have been effective in many cases.

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