From the Guidelines
Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a complex, long-term medical condition characterized by extreme fatigue that doesn't improve with rest and worsens with physical or mental activity, as described in the most recent study by 1. This fatigue significantly impacts daily functioning and typically lasts for at least six months. Beyond fatigue, patients often experience symptoms including:
- Muscle pain
- Joint pain
- Headaches
- Unrefreshing sleep
- Cognitive difficulties (often called "brain fog")
- Sore throat
- Tender lymph nodes
- Post-exertional malaise (a worsening of symptoms after even minor exertion) The exact cause remains unknown, though researchers suspect it may involve a combination of factors including viral infections, immune system problems, hormonal imbalances, and genetic predisposition, as suggested by 1. There is no specific test to diagnose CFS; instead, doctors typically rule out other conditions with similar symptoms. Treatment focuses on symptom management through a personalized approach that may include:
- Pacing activities
- Cognitive behavioral therapy
- Graded exercise therapy (carefully implemented)
- Pain management
- Addressing sleep problems While there is no cure, many patients learn to manage their symptoms and improve their quality of life with appropriate support and treatment strategies, as supported by the findings of 1 and 1. It's essential to note that the management of CFS/ME should prioritize the patient's individual needs, goals, and preferences, as emphasized in the guidelines by 1 and 1. Additionally, the use of complementary and integrative health interventions, such as yoga or tai chi, may be considered as part of the management plan, as suggested by 1 and 1. However, it's crucial to approach these interventions with caution and carefully evaluate their effectiveness for each patient, as recommended by 1. Overall, the management of CFS/ME requires a comprehensive and multidisciplinary approach, taking into account the latest evidence and guidelines, such as those provided by 1, 1, and 1.
From the Research
Definition and Characteristics of Chronic Fatigue Syndrome
- Chronic fatigue syndrome (CFS) is an illness characterized by disabling fatigue of at least 6 months 2
- It is a multifaceted illness with many symptoms and a wide array of clinical presentations 3
- CFS produces physical and neurocognitive disability that significantly affects health-related quality of life (HRQL) 4
Diagnosis of Chronic Fatigue Syndrome
- The Centers for Disease Control and Prevention (CDC) considers it a diagnosing of exclusion, stating that self-reported fatigue for at minimum of six months and four of the following symptoms are necessary for a proper diagnosis: memory problems, sore throat, post-exertion malaise, tender cervical or axillary lymph nodes, myalgia, multi-joint pain, headaches, and troubled sleep 3
- Diagnostic criteria are used to diagnose CFS, as there is no specific diagnostic test 5
Treatment and Management of Chronic Fatigue Syndrome
- Treatment options include cognitive behavior therapy (CBT) and graded exercise therapy (GET), both of which have been shown to moderately improve fatigue levels, work and social adjustment, anxiety, and postexertional malaise 2, 6
- Exercise therapy probably reduces fatigue at end of treatment, but the long-term effect is uncertain 5
- Minimally invasive management involving transcutaneous electrical acupoint stimulation of target points has demonstrated significant improvement in fatigue and associated symptoms 3
Etiology and Pathogenesis of Chronic Fatigue Syndrome
- The etiology of CFS is unclear, is likely complex, and may involve dysfunction of the immune or adrenal systems, an association with certain genetic markers, or a history of childhood trauma 6
- There is a potential association between dysfunction of the autoimmune, neuroendocrine, or autonomic nervous systems and the development of CFS 3
- Possible triggering events, such as infections followed by an immune dysregulation resulting have also been proposed 3