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What is Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS), which is also sometimes referred to as Chronic Fatigue Immune Dysfunction Syndrome (CFIDS) or Myalgic Encephalomyelitis (M.E.), is a condition characterized by the primary symptom of a prolonged, persistent debilitating fatigue not relieved by rest and not directly caused by other conditions. In general, a diagnosis for CFS requires that the tiredness is severe enough for at least a 50% decrease in the patient’s ability to participate in ordinary activities. The Centers for Disease Control (CDC) describes CFS as a distinct disorder with specific symptoms and physical signs, based on the exclusion of other possible causes.

What causes CFS?

The exact cause of CFS is unknown. A distinct or direct cause has not been positively identified.

Some studies have shown that Chronic Fatigue Syndrome may be caused by inflamed nervous system pathways, Mycoplasma bacterial infection, or viral illness (such as Epstein-Barr) complicated by an inadequate or dysfunctional immune response. For some, the condition can occur following an injury, infection preceding or following surgery (e.g., peritonitis), or other traumatic body events that weakens or adversely affects the immune system. Age, environment, genetic disposition, prior illness, or stress may also be factors. Like most autoimmune illnesses, CFS most commonly occurs in women, usually ages 30 to 50.

Symptoms of CFS

What are the symptoms of CFS?

Many of the symptoms of CFS are similar to those associated with the flu (muscle aches, headache, and fatigue).

However, unlike the flu, while with CFS these symptoms may ebb and flow, they never go away.

(Imagine dealing with flu symptoms on a daily basis and you know how someone with CFS feels on a good day.)

What are the primary symptoms of CFS?

Primary symptoms include:

  • New onset fatigue or tiredness that lasts for at least 6 months and is not relieved by normal rest
  • Full-body fatigue serious enough to restrict normal activity that develops from far less exertion than was possible before the illness

What other symptoms are sometimes present?

Additional symptoms include:

  • Constant headaches, different those previous in pattern, quality, or severity
  • Feeling unrefreshed after normally adequate sleep
  • Forgetfulness, cognitive impairment including confusion or difficulty concentrating, or irritability
  • Joint pain, often moving from joint to joint (migratory arthralgias), without joint swelling or redness
  • Low-grade fever (101F or less)
  • Lymph node tenderness and swelling in the neck or armpit
  • Muscle aches (myalgias)
  • Exercise intolerance: Muscle fatigue that lasts more than 24 hours after an amount of exercise that would normally be easily tolerated
  • Muscle weakness, all over or multiple locations, not explained by any known disorder

  • Sore throat, red but without drainage or pus

What is the difference between CFS and “chronic fatigue”?

Chronic Fatigue Syndrome (ICD10-CM or WHO ICD-10 G93.3) has a different medical diagnostic code than idiopathic Chronic Fatigue (WHO F48.O).

There are different symptom requirements used to diagnose these different entities.

Chronic Fatigue Syndrome and chronic fatigue are sometimes incorrectly used as synonymous, when in actuality they are two entirely different diagnoses. Chronic fatigue is often a symptom of other conditions, such as Chronic Fatigue Syndrome, depression, and so forth.

Patients can sometimes get relief from the chronic fatigue that accompanies other conditions. As the condition causing the chronic fatigue improves, the chronic fatigue lessens.

At present, there is no cure for (or complete relief from) Chronic Fatigue Syndrome.

CFS Tests

Everybody gets tired! How is the fatigue of CFS different?

The fatigue of CFS is all-encompassing. It involves not only the feeling of having gone without rest (even after getting a full night’s sleep, for those that fortunate; disrupted or irregular sleep patterns is often another side effect of CFS), the fatigue includes muscle weakness, cognitive impairment, and ongoing headaches of varying degrees.

Tests have shown that many CFS victims already start off with a lower-than-normal oxygen level in the brain, and exercise, instead of increasing it, actually makes it go lower. In addition, studies such as those noted in a 2004 article Muscle Metabolism with blood flow restriction in Chronic Fatigue Syndrome in the Journal of Applied Physiology have shown that blood flow to the muscles is also altered.

Melissa Kaplan describes this by saying that “the body reacts to even mild exercise, like a short walk, as if it has run a marathon on top of working an 80-hour week: extreme pain, fatigue, cognitive dysfunction…and it lasts for 36-48 hours.”

What are some of the tests for CFS?

Physical examination is usually conducted to confirm the fever, lymph node tenderness, lymph node swelling, or other symptoms, but often examination alone is not considered conclusive.

A health care provider can deduce a diagnosis of CFS only after ruling out all other known possible causes of fatigue, such as:

  • Drug dependence
  • Endocrine diseases (such as hypothyroidism)
  • Infections
  • Muscle or nerve diseases (such as multiple sclerosis)
  • Other illnesses (such as heart, kidney, liver diseases)
  • Other immune or autoimmune disorders
  • Psychiatric or psychological illnesses, particularly depression (because the severe fatigue of CFS itself may bring about depression, a diagnosis of depression does not rule out CFS; however, fatigue related to depression alone must be ruled out in order for CFS to be diagnosed)
  • Tumors

What symptoms must be present for a CFS diagnosis?

A diagnosis of CFS must include:

  • Absence of other causes of chronic fatigue (excluding depression when other symptoms are present)
  • At least 4 of the other symptoms listed
  • Extreme, prolonged fatigue

There are no specific tests to confirm the diagnosis of CFS; however, a variety of tests are usually conducted in order to exclude other possible causes of the symptoms.

Note: In order to rule out muscle or nerve diseases and/or psychiatric or psychological illnesses, a complete neuro-psych exam may be a part of the diagnosis process.

Some typical findings on tests that, while not specific enough to diagnose CFS, are seen consistently in people who are eventually diagnosed with the disorder. These include:

  • Brain MRI that shows evidence of swelling in the brain or destruction of some of the nerve cells (demyelination)
  • Higher levels of specific CD4 T white blood cells compared to other types of white blood cells (e.g., CD8 T cells)
  • Specific white blood cells (lymphocytes) containing active forms of EBV or HHV-6

What treatment is available for CFS?

At present, no treatment has been proven to be effective as a way to cure CFS. Rather than hope for a cure, the symptoms are treated instead. Many people with CFS experience depression and other psychological problems that may improve with treatment.

Some of the proposed treatments include:

  • Antianxiety drugs to treat anxiety
  • Antidepressant drugs to treat depression
  • Antiviral drugs, such as acyclovir
  • Drugs to fight “hidden” yeast infections, such as nystatin
  • Medications to reduce pain, discomfort, and fever

Unfortunately, for many with CFS, medications can cause adverse reactions or side effects that are worse than the original symptoms of Chronic Fatigue Syndrome.

While patients with CFS are encouraged to maintain active social lives, and mild physical exercise may also be helpful, for many this isn’t possible.

What long-term effects should somebody with CFS expect? (In other words: What is the prognosis?)

The long-term outlook for patients with CFS is difficult to predict at the initial onset. Some patients have been reported to completely recover after six months to a year. Others may take longer for a complete recovery. Some never recover or return to pre-illness energy and wellness levels.

What are the complications of CFS?

CFS causes what might be considered lifestyle restrictions. For people for whom the fatigue is so severe or unpredictable that they are essentially disabled and homebound during much of the course of the illness, this leads to social isolation and an inability to maintain steady employment.

What should I do if I suspect I have CFS?

Call for an appointment with your health care provider if you experience persistent, severe fatigue, with or without other symptoms of CFS. Remember: There are other serious disorders that can cause similar symptoms; those need to be excluded.


Canadian CFS Diagnostic Code

Because of the efforts of The Myalgic Encephalomyelitis Association of Ontario, Dr. Alison Bested, and others, Chronic Fatigue Syndrome (CFS) now has an official diagnostic code (OHIP Diagnostic Code 795) by the Ontario Medical Association as a Neurological Illness. According to information on the The National ME/FM Action Network, the association had hoped to get “Myalgic Encephalomyelitis (ME)” included in the diagnostic code definition, but they’re celebrating the success all the same.

Exercise While Sitting Down (with the help of the Bounce Back Chair)

Because the bounce back exercise chair increases the flow of lymphatic fluids throughout the body by as much as 10 times their normal rate, it helps the body remove toxins, strengthens the immune system, increases muscular strength, and improves blood circulation. Also sometimes referred to as the Bounce Back Fitness Chair, Bounce Back Exercise Chair, and Bounce-Back Chair.

Pictures of the Bounce Back Exercise Chair

Chronic Fatigue Syndrome Resources

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View the Chronic Illness Serenity Prayer (multi)
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