Chronic fatigue syndrome – Causes, Symptoms, and Treatment

Chronic Fatigue Syndrome (CFS) is a medical condition characterized by extreme weariness or fatigue that does not go away with rest and is not caused by a specific medical illness. CFS is also known as Myalgic Encephalomyelitis (ME) or Systemic Exertion Intolerance Disease (SEID).

Many other conditions can also cause fatigue, such as viral infections, psychological stress, hormonal imbalances, poorly controlled diabetes etc but CFS is now identified as a unique syndrome.

CFS cannot be diagnosed, as well, because there are no tests available. The doctor will need to rule out other possible explanations of the weariness and diagnose CFS only by exclusion.

CFS is now widely recognized as a medical disorder.

CFS can affect anybody, but it is most frequent in women in their 40s and 50s. Although there’s no cure at this time, medicines can help with symptoms.

Other factors that may raise the chances of getting CFS are:

• genetic predisposition
• allergies
• stress
• environmental factors
• Postural Orthostatic Tachycardia Syndrome (POTS)

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What are the causes of chronic fatigue syndrome?

Some people are predisposed to the illness from birth, and it is subsequently activated by a combination of events such as :

• Infections caused by viruses- Some people get chronic fatigue syndrome following a viral illness; the Epstein-Barr virus, human herpesvirus 6, Ross River Virus (RRV) and, rubella virus are the suspect viruses. A conclusive link is yet to be discovered.
• Immune system issues- People with chronic fatigue syndrome tend to have a somewhat weakened immune system, but it’s unclear if this is what predisposes to the condition.
• Hormonal imbalances- These are a common problem. Hormones produced in the adrenal glands, hypothalamus and pituitary glands are occasionally abnormally high in the blood of people with chronic fatigue syndrome. However, the relevance of these anomalies remains uncertain.
• Trauma, either physical or emotional- Some people claim that their symptoms started after an injury, surgery, or a period of intense mental stress.

Bacterial infections, including Coxiella burnetii and Mycoplasma pneumonia, have also been studied in the context of CFS.

CFS, as per to the Centers for Disease Control and Prevention (CDC), could represent the culmination of several distinct illnesses rather than a single illness. One out of every 10 patients infected with EBV, Ross River virus or Coxiella Burnetii will develop a disease that satisfies the CFS diagnostic criteria.

What are the symptoms of chronic fatigue syndrome?

CFS symptoms vary depending on the person and the severity of the disorder.

Fatigue that is severe enough to impede everyday activities is the most prevalent symptom.

A considerably diminished capacity to perform typical daily activities with fatigue for at least 6 months to diagnose CFS. The fatigue does not reduce with rest.

The patient may also feel extremely tired after engaging in physical or mental activities, known as post-exertional malaise (PEM). This can linger for up to 24 hours after the activity is completed.

Other symptoms that patients with CFS may experience include:

• Feeling unrefreshed after a night’s sleep
• Chronic insomnia
• Muscle or joint discomfort
• Headaches
• A sore throat
• Swollen glands
• Trouble thinking, remembering, or focusing
• Flu-like symptoms
• Dizziness or sickness
• Fast or irregular heartbeats (heart palpitations)
• Intolerance to orthostatic pressure (going from lying or seated to standing positions makes the patient light-headed, dizzy, or faint)

According to the majority of people, overexercising exacerbates their symptoms. Symptoms might fluctuate in severity from day to day, or even within a single day.

Because the symptoms of CFS are similar to those of other conditions, it’s important to consult a doctor to get a proper diagnosis.

Some people are affected by CFS in cycles, with times of feeling worse followed by periods of feeling better.

Symptoms may even go away completely in certain cases, and the condition is known as remission. It’s still conceivable that symptoms will return later, which is known as a relapse.

It can be tough to control the symptoms in this cycle of remission and relapse, but it is achievable.

How is chronic fatigue syndrome diagnosed?

Chronic Fatigue Syndrome (CFS) does not have a test.

A general practitioner should inquire about the medical history and conduct a physical examination.

Your doctor may also recommend testing. Blood tests or urine tests to rule out other issues like anemia (a lack of red blood cells), an underactive thyroid gland, or liver and kidney issues, as other disorders with comparable symptoms must be checked out first. Diagnosing CFS might take some time.

CFS diagnostic guidelines

As per the National Institute for Health and Care Excellence (NICE), doctors should consider diagnosing CFS if a patient experiences extreme fatigue that other factors cannot explain. It implies the patient cannot do the things they used to do, and it worsens after movement or light exercise, such as a brief walk.

If a child or young person under the age of 18 exhibits suspected CFS symptoms, they should be sent to a paediatrician within six weeks .

How can chronic fatigue syndrome be treated?

Chronic fatigue syndrome has no known remedy. The focus of treatment is on symptom alleviation. The symptoms that are the most bothersome or incapacitating should be addressed first.

Medications

Prescription and over-the-counter drugs can help with some of the symptoms of chronic fatigue syndrome. Here are several examples:

• Depression- Many people who suffer from long-term illnesses, such as chronic fatigue syndrome, are also depressed. Treatment for depression may make it simpler for the patient to deal with the symptoms of chronic fatigue syndrome. Antidepressants in low doses can also aid with sleep and pain relief.
• Orthostatic intolerance- It is a condition in which a person  feels dizzy on standing or sitting upright from a lying down position. When standing or sitting upright, some people with chronic fatigue syndrome, particularly adolescents, feel dizzy or queasy. Blood pressure or heart rhythm medications may be beneficial.
• Pain- If over-the-counter pain relievers like ibuprofen  and naproxen sodium  aren’t adequate, prescription pharmaceuticals for fibromyalgia may be a choice. Pregabalin,  duloxetine, amitriptyline, and gabapentin are examples.

Therapy

A majority of people who suffer from chronic fatigue syndrome benefit from the following:

• Counseling- Talking to a counsellor can help the patient to develop coping skills for chronic disease, resolve work or school obstacles, and enhance family dynamics. It can also help in the treatment of depression.
• Taking care of sleep issues- Sleep deprivation can make dealing with other symptoms more challenging. The doctor may advise the patient to avoid coffee or alter the bedtime routine. Sleep apnea (a sleep disorder in which breathing stops and starts regularly) can be treated with a gadget that uses a mask to deliver air pressure while the patient sleeps.
• Exercise- Aggressive exercise routines can increase symptoms, but it’s crucial to keep up with exercises that the patient can handle,  to avoid deconditioning. Exercise routines that begin at a low intensity and gradually rise in intensity over time may be beneficial in improving long-term function.

Managing the symptoms of post-exercise malaise (PEM)

PEM is when even moderate physical, mental, or emotional exertion causes CFS symptoms to worsen

Worsening symptoms typically appear 12 to 48 hours after the activity and might continue for days or even weeks.

Activity management, also known as pacing, can help prevent PEM flare-ups by balancing rest and activity. To stay inside the particular boundaries for mental and physical tasks, the patient will need to identify them, schedule them, and then rest.

The “energy envelope” is a term used by certain clinicians to describe staying within these parameters. Keeping a journal of the activities can assist the patient in determining personal boundaries.

It’s crucial to remember that, while intensive aerobic activity is beneficial for most chronic diseases, it’s not tolerated by patients with CFS.

Changes in lifestyle and home treatments

Making simple lifestyle modifications could help the patient feel better.

• There is benefit in limiting or eliminating caffeine .
• Nicotine and alcohol should also be limited or avoided.
• If napping throughout the day is affecting the ability to sleep at night, try to avoid it.Make a sleep schedule. Every night, go to bed at the same time and try to wake up at the same time every day.

Relapses or Setbacks

When the symptoms worsen over time, this is known as a setback or relapse.

They’re a common symptom of CFS and can be brought on by a variety of things, including an illness or an unexpected activity. There are occasions when there is no obvious cause.

The doctors who are treating the patient can assist them in coping with a setback or relapse by:

• Incorporating more pauses into the present level of activity
• Teaching the patient, relaxation and breathing techniques
• Encouraging the patient to remain optimistic about achieving a normal life .