From the Guidelines
Chronic Fatigue Syndrome (CFS) presents with severe, persistent fatigue as its hallmark symptom, characterized by post-exertional malaise, unrefreshing sleep, cognitive difficulties, and orthostatic intolerance, among other symptoms. The symptoms of CFS, also known as Myalgic Encephalomyelitis (ME), are complex and multifaceted, involving dysfunction in multiple body systems, including the immune, nervous, and energy metabolism systems 1.
Key Symptoms
- Severe, persistent fatigue that is not relieved by rest and worsens with physical or mental activity
- Post-exertional malaise, where patients experience profound exhaustion lasting more than 24 hours after even minimal exertion
- Unrefreshing sleep
- Cognitive difficulties, often called "brain fog", that affect concentration, memory, and information processing
- Orthostatic intolerance causing dizziness or lightheadedness when standing
- Muscle pain, joint pain without swelling, headaches of new type or severity, and tender lymph nodes in the neck or armpit
- Sore throat and flu-like symptoms These symptoms must persist for at least six months and significantly reduce the person's ability to perform daily activities compared to their pre-illness level, as noted in the management of chronic multisymptom illness 1.
Treatment Considerations
While the evidence does not provide a clear recommendation for the treatment of CFS, it does suggest that cognitive-behavioral therapy and mindfulness-based therapies may be beneficial in improving health function, health-related quality of life, and physical function in patients with CFS 1. However, the use of stimulants for the treatment of fatigue in patients with CFS is not recommended due to insufficient evidence 1.
From the Research
Symptoms of Chronic Fatigue Syndrome (CFS)
The symptoms of CFS include:
- Persistent, medically unexplained fatigue 2, 3, 4, 5, 6
- Musculoskeletal pain 2, 3, 5
- Sleep disturbance 2, 3, 4, 5, 6
- Headaches 2, 3, 4, 5, 6
- Impaired concentration and short-term memory 2, 3, 4, 5, 6
- Postexertional malaise 4, 6
- Unrefreshing sleep 4, 6
- Muscle pain 4, 6
- Polyarthralgia 4
- Sore throat 4, 6
- Tender lymph nodes 4, 6
- New headaches 4, 6
Diagnosis of CFS
CFS is a clinical diagnosis that can be made only when other disease processes are excluded 4, 6. The Centers for Disease Control and Prevention criteria for CFS include severe fatigue lasting longer than six months, as well as the presence of at least four of the above physical symptoms 4.
Common Symptoms
Common symptoms encountered in CFS patients were reviewed, and the top 10 common symptoms were described in detail with special reference to the particular features of each symptom helpful to diagnose CFS 5.
Treatment Options
Treatment options include cognitive behavior therapy and graded exercise therapy, both of which have been shown to moderately improve fatigue levels, work and social adjustment, anxiety, and postexertional malaise 4, 6.