Sunshine Clinic
The Private Health Clinic
Chronic Fatigue Syndrome
What is Chronic Fatigue Syndrome
Chronic Fatigue Syndrome (CFS)
Since the early 1980's, doctors have recognised this syndrome in people of all ages, races, and social and economic classes from many countries around the world.
Chronic fatigue syndrome (CFS) is now the name most generally used by doctors and the one they mostly prefer. In medical language `Chronic`means that an illness has been present for a long time, usually more than six months. (Acute means an illness of rapid and severe onset but often short duration.)
A syndrome is an illness or condition that is diagnosed on the basis of a combination of symptoms and/or signs (as opposed to abnormalities in tests). In CFS, the symptoms shared by all sufferers is known as severe fatigue. Other symptoms commonly present are muscle aches, poor concentration, and feeling unwell after exertion.
What is fatigue ?
It may mean different things to different people, for example, feeling of sleepiness, a reluctance to start a task, an inability to keep going at a task, or feeling unwell after exertion. Fatigue, however, may also refer to the normal weariness experienced after having worked hard. When talking about fatigue its important to be specific what sort of fatigue we mean, fatigue experienced by sufferers of CFS is usually very different from everyday tiredness. Those who suffer from fatigue, which is sufficiently severe fatique to the extent that it interferes with their daily activities, should consult their doctor, as it may be diagnosed as an illness, such as CFS.
Other names used alongside this illness are:
Myalgic encephalomyelitis (ME)
This name was given to an acute, unexplained illness that occurred in the 1950s, Myalgia means muscle pain, there is no good evidence to support encephalomyelitis which means (inflammation of the brain and spinal cord). ME is a name commonly used by the general public, the media, and some doctors.
Post-viral fatigue syndrome (PVFS)
This label is sometimes used by doctors in cases which appear to have started with a viral illness. Post-viral means after a virus, it is difficult to be certain whether any one viral infection was the cause or not.
Neurasthenia
This name was used in the late 1800s to describe a condition that was similar to CFS. the term literally means `weak nerves`
Symptoms of Chronic Fatigue Syndrome
Symptoms of Chronic Fatigue Syndrome are:
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Malaise (feeling ill) after exertion
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Difficulties with memory and concentration
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Sore Throat
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Tender Lymph Nodes (glands in the neck, armpit, and groin)
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Myalgia (Muscle pain)
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Arthralgia (Joint Pain)
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Headaches
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Disturbed and unrefreshing sleep
As well as these symptoms, people with CFS/ME often experience other symptoms. These include:
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Abdominal and digestive problems
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Chest pain
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Nausea (feeling sick)
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Feeling inappropriately hot or cold
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Night sweats
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Looking pale when tired
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Feeling dizzy or light headed
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Problems with balance
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Worsening symptoms before a period
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Hearing problems such as hyperacusis (painful sensitivity to noises)
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Eye problems such as pain round the eyes, difficulty focusing, and sensitivity to bright lights.
Some of these symptoms may seem frightening, and you may fear they indicate a life-threatening disease. Its important to discuss your fears with your doctor, where routine medical tests are likely to rule out certain conditions, and provide information, diagnosis, reassurance, and treatment as necessary.
Testing for Chronic Fatigue Syndrome
A diagnosis of Chronic Fatigue Syndrome (CFS) is made on the basis of the symptoms and medical history. There will be no findings on examination (clinical signs) and so far there are no definitive medical tests that can positively identify this condition. The physical examination and the laboratory investigations or tests are however important to exclude other conditions that could be caused by the same or similar symptoms.
In order to rule out other conditions the doctor will assess you and will question you about your medical history. The doctor will also examine you, and arrange any necessary tests. It is important to rule out other diseases that may be readily treatable.
Laboratory Tests
Some very common illnesses should probably be tested for in everyone who has symptoms of Chronic Fatigue Syndrome. These are:
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anaemia
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evidence of inflammation or infection
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disturbance of blood chemistry due to liver, kidney, or hormonal dysfunction
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low level of thyroid hormone and diabetes mellitus
The tests for these are:
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Full blood count
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ESR (erythrocyte sedimentation rate)
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CRP (C reactive protein)
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Urea and electrolytes
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Liver function tests
Treatment for Chronic Fatigue Syndrome
The bad news is that there is at present no cure for CFS; the good news is that there is a lot that can be done to manage the symptoms and any resulting disability, and to speed recovery.
The first requirement of someone suffering from such symptoms and disability is for sympathetic understanding both from their doctor and from those around them. This is not always the case some doctors feel uneasy with a condition such as CFS because they can find no physical cause, they may dismiss the symptoms as being caused by some mental state. This can be distressing and frightening. Luckily, medical opinion is changing and more and more doctors are recognizing CFS/ME as a real illness, even if its causes are not yet understood.
Its beneficial to work towards a better relationship with the doctor. Discussions about chronic fatigue syndrome often begin with questions such as Does it really exist ? or is it a `real`illness or is it `all in the mind? These questions are usually based on lack of understanding. They can be hurtful and unhelpful to those suffering from the illness.
Definition of Chronic Fatigue Syndrome (CFS)
Clinically evaluated, unexplained, persistent, or relapsing chronic fatigue of at least 6 months duration which is:
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of new or definite onset (not life long)
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not the result of ongoing exertion
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not substantially alleviated by rest, and results in substantial reduction in previous levels of occupational, educational, social, or personal activities.
Four or more of the following symptoms are present for a minimum of 6 months:
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impaired memory or concentration
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sore throat
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tender cervical or axillary lymph nodes
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muscle pain (Myalgia)
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multi joint pain (arthralgia)
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new type of headaches
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unrefreshed sleep
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postexertional malaise
Its important to stress the doctor can offer scientific information about chronic fatigue syndrome CFS and its treatment, but those who suffer from the illness are the experts on the territory of their own illness, the doctor can also offer advice about management strategies that others have found helpful, and give information that will improve understanding of CFS, and hopefully improve sufferers health and quality of life.
There are different approaches to treating CFS, the wait and see approach is often appropriate, and many with CFS have accepted this without being aware of alternatives. Listed are some of the alternative treatments:
Drug Treatments
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Anti-Virals. As many believe their illness began with a viral infection
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Drugs to help the immune system
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Drugs to help low blood pressure
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Antidepressants
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Analgesics. (Painkillers) Pain can be one of the most distressing symptoms of CFS
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Sedatives. Difficulty getting to sleep, the doctor may prescribe a sedative
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postexertional malaise
Complementary/Alternative Therapies
Cognitive behaviour therapy (CBT) and graded exercise therapy (GET). Both of these therapies involve therapists, and both aim for rehabilitation using a gradual change in behaviour working together with a therapist, looking at ways to think about the illness, and ways to cope with the illness. The effectiveness of treatments depends on how CFS affects you. Early diagnosis, balancing rest with activity, medication is used to control certain symptoms and self-help measures can help to varying degrees.
Adjusting your daily routine so that you have regular sleep patterns can help, cognitive behavioural therapy (CBT) may identify the thoughts and feelings causing certain behaviour, and help you develop new ways of coping.
One of the most effective treatments for CFS is claimed to include graded exercise, the gradual increase in aerobic exercise, such as swimming or walking. It’s based on a theory that not doing anything can make illness worse.
Any exercise programme should be discussed with your Doctor before getting started. Pacing is an important way of controlling symptoms, this means finding a balance between activity and rest, and avoiding large bursts of exercise that may set you back, learning how to make the most of your energy can help to increase the amount you can do.
