Chronic Fatigue Syndrome: Causes, Diagnosis, and Treatment

What is Chronic Fatigue Syndrome?

Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is a long-term condition that causes severe tiredness that doesn't improve with rest and is not because of other medical issues. It affects daily life, with symptoms often getting worse after physical or mental activity, known as post-exertional malaise (PEM).

People who have CFS may also experience these symptoms:

• muscle and joint pain
• trouble sleeping
• difficulty concentrating
• headaches

Who Can Get CFS?

CFS can affect anyone, but it is more common in women, with three times as many cases as in men. It often develops in early adulthood to midlife, while in children, it typically starts between ages 13 and 15 but can occur earlier.

What are the symptoms of CFS?

CFS symptoms can appear suddenly within a few days or develop gradually. For a diagnosis, symptoms must last at least 3 months and not be due to another medical condition. In adults, CFS may be suspected after 6 weeks, and in children, after 4 weeks.

Main symptoms include:

• Severe fatigue that worsens with activity and does not improve with rest.
• Post-exertional malaise (PEM): Symptoms worsen after physical, mental, or emotional activity.
• Sleep problems, such as trouble falling or staying asleep.
• Headaches.
• Muscle and joint pain.
• Difficulty with memory, focus, and attention.

Other symptoms can include:

• Vision issues
• Chills
• Night sweats.
• Swollen glands.
• Digestive problems like bloating, constipation, or diarrhoea.
• Mood swings, anxiety, or irritability.
• Tingling or numbness in hands, feet, or face.
• Dizziness, weakness or nausea when standing or sitting up.
• Sensitivity to light, sound, touch, or temperature.
• Flu-like symptoms, such as a sore throat and muscle aches.

How is CFS Diagnosed?

There is no specific test for CFS. Diagnosis is based on symptoms lasting at least 3 months without another medical cause. Blood tests may be done to rule out conditions like anaemia, thyroid problems, or liver and kidney issues.

What Causes CFS?

The exact cause is unknown, but possible triggers include:

• Genetics: It may run in families.
• Viral Infections: Some theories suggest that CFS may develop after a viral illness.
• Psychological Stress: Emotional stress or trauma, like bereavement or divorce, may play a role.
• Mental Health Issues: Conditions like depression might contribute.

Ongoing research aims to identify the exact causes of CFS

Treatment and Management

There is no cure for CFS, but symptoms can be managed. A GP can diagnose the condition and refer you to a specialist if needed. Children are usually seen by a paediatrician before a care plan is made.

Treatment options include:

• Rest and Sleep: Balancing rest and activity can improve sleep quality and help manage CFS symptoms. Relaxation techniques before rest periods may be beneficial.
• Physical Activity and Mobility: Gentle exercises is crucial to maintain mobility without overexertion. Strategies include exercises to support joint mobility, muscle flexibility, posture, and cardiovascular health.
• Pain Management: Medication or specialist pain services may help.
• Medication: People with CFS may be more sensitive to medications, so treatment often starts with lower doses. Prescribed medications may include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief
  • Tricyclic antidepressants to help with sleep, pain, and fatigue
  • Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for depression and pain management
  • Antiviral drugs if an infection is suspected
  • Intravenous immunoglobulin (IVIG) to support immune function
  • Corticosteroids to manage fatigue
• Diet and Nutrition: A balanced diet with fruits, vegetables, and plenty of fluids is recommended. while fatty foods should be limited. Although some herbal supplements (including astragalus, garlic, prime rose oil, echinacea, bromelain, etc) are believed to help, medical advice should be sought before using them. Vitamin D deficiency may be a concern, particularly for housebound individuals, but there is no sufficient evidence to support routine using of supplements for CFS management. Dietitians specialising in CFS may be consulted if weight loss, malnutrition, or dietary restrictions are an issue.
• Energy Management: Managing activity levels is very important to avoid overexertion which can trigger post-exertional malaise. This approach includes mental, physical, emotional, and social activities, ensuring they remain within sustainable levels. Any physical activity programme should be guided by a specialist team, with input from a physiotherapist if necessary.
• Cognitive Behavioural Therapy (CBT): can help individuals manage their symptoms, enhance their functioning, reduce the distress linked to chronic illness and cope with the impact of CFS on daily life.

How Long Does CFS Last?

CFS varies from person to person, with symptoms often fluctuating over time. Flare-ups and relapses can occur even with good management. Some people recover fully, while others need to adjust their lifestyle to manage symptoms. Children and young people generally have better recovery rates than adults.

Outlook for CFS

The long-term outlook depends on the individual. Some people improve or go into remission, while others continue to experience symptoms. Children and young people generally have better recovery rates than adults.

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