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What Is It?
Chronic fatigue syndrome is a complicated illness characterized by at least six months of extreme fatigue that is not relieved by rest, and a group of additional symptoms that also are constant for at least six months. In many people with chronic fatigue syndrome, the disorder begins suddenly, often following a flulike infection or an episode of physical or psychological trauma, such as surgery, a traumatic accident or the death of a loved one. In other cases, chronic fatigue syndrome develops gradually. The illness lasts for many months or years, and only a small percentage of people recover full health.
Many people feel tired a lot of the time, and many seek help from their doctors. By far the most common causes of chronic (long-lasting) fatigue are depression and overwork. Chronic fatigue syndrome is an unusual cause of feeling tired all the time, and the fatigue in this illness usually is much more intense than tiredness from more common causes.
The exact cause of chronic fatigue syndrome remains a mystery. Although the illness sometimes occurs after infections, such as Lyme disease or infectious mononucleosis, there is no proof that these infections cause the illness. Testing has found that people with chronic fatigue syndrome have abnormalities in the brain, particularly in the hypothalamus (a part of the brain that regulates hormones and vital functions) and the pituitary gland. Testing also has found that patients have abnormalities in the part of the nervous system called the autonomic nervous system, which controls blood pressure, body temperature and other vital body functions. For example, many patients with chronic fatigue syndrome have a condition called neurally mediated hypotension that causes abnormally low blood pressure. Finally, testing has revealed evidence that the immune system remains activated for long periods of time in people with chronic fatigue syndrome. All of these abnormalities seem to come and go. They are not permanent conditions. And not all of the abnormalities affect every patient with chronic fatigue syndrome.
In the United States, federal health authorities estimate that chronic fatigue syndrome affects one to eight of every 1,000 Americans older than age 18. Women are affected about twice as often as men. Although the illness is most common in people 25 to 45 years old, chronic fatigue syndrome can attack people of all age groups, including children. The condition also in found in people of all racial, ethnic and economic backgrounds. It appears to be more common in African-Americans and Latinos, and in people in lower socioeconomic groups. It appears to be less common in Asian-Americans.
Most cases of chronic fatigue syndrome affect isolated individuals. However, at least 30 outbreaks of chronic fatigue syndrome also have been reported, during which many people in the same area suddenly developed the illness at the same time. However, despite the larger numbers of patients involved in these outbreaks, health experts have failed to identify a cause for their chronic fatigue syndrome symptoms.
Symptoms
The most prominent symptom of chronic fatigue syndrome is an unexplained feeling of fatigue, which is not relieved by rest. This fatigue is severe enough to decrease a person's activity level at home, work or school by 50% or more. In addition, to be diagnosed with chronic fatigue syndrome, patients should have at least four of the following symptoms that also are present for at least six months:
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Impaired concentration or short-term memory severe enough to affect routine activities at home, work, school or social functions
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Sore throat
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Enlarged lymph nodes (swollen glands) in the neck or underarm area
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Muscle pain
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Pain in several joints, with no redness or swelling
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Headaches that are different in some way a new type of headache pain, a new pattern of headaches or headaches that are more severe than before
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Sleep that doesn't refresh not feeling rested on waking
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An extreme reaction to exertion sick for 24 hours or more after exercise or strenuous activity
People with chronic fatigue syndrome often have other symptoms that are not part of the official definition of the illness, such as nausea and difficulty tolerating alcoholic beverages or medicines that act on the brain. Many people also have allergies, such as hay fever (allergic rhinitis) or recurring sinus problems.
About half of people with chronic fatigue syndrome develop depression in the months and years after their illness starts. However, available evidence indicates that chronic fatigue syndrome is not a psychiatric illness. Rather, it appears to be a physical illness that leads to depression in some people.
Diagnosis
Although there is a lot of evidence that chronic fatigue syndrome is caused by a physical problem involving the nervous system and immune system, there is no laboratory test or procedure to confirm the diagnosis. Until a better way is found, doctors must diagnose chronic fatigue syndrome based on whether a person has the symptoms of the illness and by eliminating other illnesses that can cause long-lasting fatigue.
For this reason, your doctor will ask about symptoms of other illnesses including:
Your doctor will examine you and assess your mental status. Some basic blood tests may be ordered, such as a red blood cell count (hematocrit), white blood cell count and differential white blood cell count, thyroid, kidney and liver tests. Additional, more specialized testing may be needed, including a test called a tilt-table test to determine whether you have neurally mediated hypotension. In this test, the patient is placed on a table that tilts to evaluate how blood pressure, heart rate and other measurements respond to the stress of standing up.
Expected Duration
To be diagnosed as chronic fatigue syndrome, symptoms must last for at least six months. In many people, symptoms persist for several years. Symptoms tend to be worst in the first one to two years, and most people's level of functioning gradually improves over time. However, only a small percentage of people recover to full health.
Prevention
Because the cause of chronic fatigue syndrome remains unknown, there is no way to prevent it.
Treatment
There is no specific treatment for chronic fatigue syndrome. Both gradual aerobic exercise programs and cognitive behavioral therapy, which is counseling designed to change beliefs about the condition, have been shown to improve level of function, but neither can cure the illness. In patients with a similar condition, fibromyalgia, low doses of tricyclic drugs have been shown to improve symptoms, probably by improving a sleep disorder that is part of the illness. No one approach is best for everyone with chronic fatigue syndrome, and the condition rarely is cured.
In general, doctors use a combination of the following:
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Lifestyle changes Patients are encouraged to slow down and to avoid physical and psychological stress. They learn to save their energy for essential activities at home or work and to cut back on less-important activities.
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Resuming exercise gradually but steadily With the help of a physical therapist, patients begin an exercise program in which aerobic physical activity begins very slowly, and is increased very gradually. Patients can expect occasionally to feel worse the day after aerobic exercise. If that happens, many experts recommend avoiding exercise for several days and then resuming a less-intensive program, and slowly increasing the pace.
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Treating existing psychiatric problems In the approximately 50% to 60% of people with chronic fatigue syndrome who develop depression, antidepressant treatment and talk therapy can be valuable.
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Treating existing pain Aspirin, acetaminophen (Tylenol), or nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat headaches, muscle pain and joint pain. Antidepressant medications also may help to reduce chronic pain.
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Treating existing allergy symptoms Antihistamines and decongestants are used to treat allergy symptoms.
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Experimental therapies When patients with chronic fatigue syndrome have neurally mediated hypotension, they may benefit from treatment with fludrocortisone (Florinef), beta-adrenergic blocking agents and other medications. However, these are not always effective.
When To Call A Professional
Call your doctor if you have symptoms of chronic fatigue syndrome, especially if extreme fatigue prevents you from fully participating in activities at home, work or school.
Prognosis
People with chronic fatigue syndrome usually experience their most severe symptoms in the first one to two years of illness. After that time, a small number of people recover totally, and a smaller number become totally incapacitated. For most people, there is gradual improvement, although they usually do not achieve the level of activity they were capable of before getting the disease. Recovery tends to be less likely among people who:
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Have symptoms for a longer time
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Have long-standing depression
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Are older than 40 when symptoms start
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Have multiple physical symptoms
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Believe that an undiagnosed medical illness is causing the fatigue
Additional Info
National Institute of Allergy and Infectious Diseases (NIAID)
Office of Communications & Public Liaison
6610 Rockledge Drive, MSC6612
Bethesda, MD 20892-6612
Phone: (301) 496-5717
http://www.niaid.nih.gov/
Centers for Disease Control and Prevention (CDC)
1600 Clifton Road
Atlanta, GA 30333
Phone: (404) 639-3534
Toll-Free: (800) 311-3435
http://www.cdc.gov/
American Association for Chronic Fatigue Syndrome
27 N. Wacker Drive
Suite 416
Chicago, IL 60606
Phone: (847) 258-7248
Fax: (847) 748-8288
E-Mail: admin@aacfs.org
http://www.aacfs.org/
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