Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME) or post-viral fatigue syndrome (PVFS), is a syndrome characterized by extremely low levels of energy over a prolonged period, affecting the central nervous system (CNS), immune system, and many other systems and organs.
Incidence Of Chronic Fatigue Syndrome
Several studies in the United States have found between 75 and 420 cases of chronic tiredness syndrome for every 100,000 adults. Research also proved that 60 to 85% of all patients are women. Members of ethnic minorities and low-income classes are slightly more likely to develop this problem. [1]
Symptoms Of Chronic Fatigue Syndrome
There are many other symptoms that could be a part of this syndrome, and the most common ones are [2]:
Pain
Pain in this syndrome is very common and present in almost all cases. It may include:
- Muscle pain
- Joint pain
- Headaches
- Lymph node pain
- Sore throat
- Abdominal pain
- Some patients have also experienced bone, eye and testicular pain, neuralgia and painful skin sensitivity.
Cognitive problems
This doesn’t happen very often, but people with chronic fatigue syndrome may experience some cognitive problems and some of the most common symptoms are forgetfulness, confusion, difficulty thinking and concentration difficulties. Some experts have also reported possible aphasia, agnosia, loss of cognitive body map and other neurological symptoms. [2, 3]
Hypersensitivity
It is reported that some people with chronic fatigue syndrome are sensitive to light, sound, and some chemicals and foods. [4]
Poor temperature control
Several studies have proven that people with chronic fatigue syndrome often have big problems with controlling their body temperature. For example, they report big temperature fluctuations. This is probably due to the involvement of the hypothalamus whose malfunction may be the cause of the syndrome. However, a study has proven that patients with chronic fatigue syndrome have normal core body temperatures despite frequent self-reports of subnormal body temperature and low-grade fever. [4]
Sleep problems
One of the most common symptoms of chronic fatigue syndrome is unrefreshing sleep. Some people also report insomnia and difficulties in maintaining a sleep schedule.Common complaints are [5]:
- Difficulty falling asleep
- Extreme sleepiness
- Frequent awakening
- Intense and vivid dreams
- Restless legs and/or nocturnal myoclonus (night-time muscular spasm)
Psychological symptoms
Some of the most common psychological problems associated with chronic fatigue syndrome are [6]:
- Emotional fluctuations
- Anxiety
- Depression
- Irritability
- Emotional flattening
In addition, patients with chronic fatigue syndrome have been reported to be more likely to have psychiatric diseases such as major depressive disorder, panic disorder, generalized anxiety disorder, and personality disorder.
Hormone disturbances
Experts are saying that some abnormalities in the autonomic nervous system are very common. The most commonly reported are low blood volume, orthostatic intolerance, dizziness and light-headedness, especially when standing up quickly. Hormonal abnormalities may include abnormal vasopressin metabolism, abnormal ACTH response leading to hypothyroidism, and a reduced ability to respond to physiological and emotional stress. [7]
Other symptoms
There are several less frequent symptoms of chronic fatigue syndrome, such as:
- Abdominal pain
- Alcohol intolerance
- Bloating
- Chest pain
- Chronic cough
- Diarrhea
- Dizziness
- Dry eyes and mouth
Possible causes of chronic tiredness
The fact is that doctors really don't know the cause of chronic fatigue syndrome. It is known that the fatigue is characterized by a very slow recovery of muscle power. So, a moderate amount of exercise will involve at least two or three days of recovery for a person affected by chronic fatigue syndrome.
Several other possible theories have been proposed, including [8]:
- Iron deficiency anemia
- Low blood sugar (hypoglycemia)
- History of allergies
- Virus infection, such as Epstein-Barr virus, herpes virus or glandular fever
- Bacterial infections, such as pneumonia
- Dysfunction in the immune system
- Changes in the levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands
- Mild, chronic low blood pressure (hypotension)
- A hormone imbalance
- Mental health problems, such as stress, depression and emotional trauma
- Your genes – chronic fatigue syndrome seems to be more common in some families
The problem is, however, that in most cases no serious underlying infection or disease can be recognized as the cause of the chronic fatigue syndrome.
Are There Any Risk Factors?
Although many experts have proposed some risk factors, none of those have yet been proven to be related to this syndrome. The fact is that women are diagnosed with chronic fatigue syndrome two to four times more often than men, but sex isn't a proven risk factor for the condition.
Diagnosis Of Chronic Fatigue Syndrome
Examination
The fact is that many people suffering from chronic fatigue syndrome look surprisingly well and no one could really tell that they have any problems. However, it is believed that an appropriate examination is necessary because:
- The lymph glands in the neck, under the arms or in the groin may be tender and swollen
- The throat may be inflamed
- Muscles may be tender
A Diagnosis Of Chronic Fatigue Syndrome Is Based On Exclusion
Many diseases that display similar symptoms to those of CFS have to be ruled out [10]:
- Infections such as brucellosis, toxoplasmosis, tuberculosis, AIDS and Epstein-Barr virus (which is responsible for glandular fever)
- Anaemia
- Certain forms of cancer
- Endocrine abnormalities such as Addison's disease and Cushing's syndrome
- Thyroid problems
- Liver disease
- Multiple sclerosis
- Epilepsy
- Auto-immune problems
- Drug addiction
- Alcoholism
- Depression
- Anxiety and conversion disorders
Complications Of Chronic Fatigue Syndrome
There are several possible complications of chronic fatigue syndrome and some of the most common include [8]:
- Depression, which is related both to symptoms and a lack of the timely diagnosis
- Side effects and adverse reactions related to medication treatments
- Side effects and adverse reactions associated with lack of activity
- Social isolation caused by fatigue
- Lifestyle restrictions because of the triggers
- Frequent absence from work
Treatment of chronic tiredness syndrome
The big trouble is that there is no specific treatment for chronic fatigue syndrome. However, doctors try to help patients by using a combination of treatments, which may include [11]:
Lifestyle Changes
Some lifestyle changes such as avoiding excessive physical and psychological stress could be a crucial part of an effective treatment.
Steady Exercise
Patients may be advised to begin an exercise program in which physical activity gradually increases. This is very important because it can prevent muscle weakness caused by the prolonged inactivity. Gentle exercise that stretches the muscles, such as calisthenics or yoga, will stimulate the lymphatic system.
Psychiatric Treatment
Most psychiatrists can treat problems which are often related to chronic fatigue syndrome such as depression, with medication or behavioral therapy. If a person is depressed, medications such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may help.
Some of the most commonly used antidepressants are:
- Amitriptyline (Limbitrol ®, Triavil®)
- Desipramine (Norpramin®, Pertofrane®)
- Nortriptyline (Aventyl®, Pamelor®)
- Fluoxetine (Prozac®, Sarafem®)
- Paroxetine (Paxil®, Seroxat®)
- Sertraline (Zoloft®)
- Bupropion (Wellbutrin®)
Treatment Of The Allergy-Like Symptoms
Food allergies need to be identified and eliminated. Antihistamines could be very helpful and the most commonly used are fexofenadine (Allegra®, Telfast®)) and cetirizine (Zyrtec ®) and decongestants that contain pseudoephedrine (Sudafed®, Dimetapp®).
Treatment For Problems Of The Nervous System
Symptoms such as dizziness can sometimes be relieved by clonazepam (Klonopin®, Rivotril®).
Homeopathic Treatment
Although most of the companies that produce various dietary supplements and herbal remedies claim these substances have many benefits for people with chronic fatigue syndrome, their effectiveness still hasn't been proven in controlled studies. [12]
Natrum mur
It is used for swollen, painful glands in the neck, muscular pain, fever, pain going from the back of the head to the front; tired eyes, blurred vision; digestive acidity; flatulence etc.
Calcarea
It is used for constant chilliness, painful joints, poor memory, depression, great anxiety, great tearfulness, panic attacks, confusion, itchy scalp etc.
Arsenicum
This is the best remedy for painful joints and muscular pain, headache with fever, migraine, sore or tired eyes, blurred vision etc.
Belladonna
It has been used for many years in the treatment of swollen, tender glands in the neck, muscular pain and painful joints, difficulties with concentrating, poor memory, difficulty with articulation, dizziness, cramping abdominal pains, insomnia, and thrush.
Lycopodium
Lycopodium is used for pain in the temples; sore, tired eyes, bloated stomach, flatulence, cramping abdominal pains, numb fingers, aching arms and irritable bowel syndrome.
Causticum
Causticum is used for constant chilliness, muscle pain and painful joints, weakness after the slightest exertion, premenstrual irritability, great tearfulness, anxiety and depression, poor memory, blurred vision, aching arms etc.
- Photo courtesy of Daniel Lombraña González by Flickr : www.flickr.com/photos/teleyinex/5900625168/