Chronic fatigue syndrome (CFS) or Myalgic encephalomyelitis (ME)

Chronic fatigue syndrome (CFS) or Myalgic encephalomyelitis (ME)

Definition



Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that can’t be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn’t improve with rest. Chronic fatigue syndrome has also been called myalgic encephalomyelitis (ME)

Chronic fatigue

Epidemiology

  • Overall, evidence suggests a prevalence of about 0.25% to 0.40% which represents about 40 people in every 10,000 visiting a general practice. Epidemiological data for the UK is lacking but estimates based on data from other countries suggest there may be around 4000 cases of CFS per million people.
  • The Centres for Disease Control and Prevention (CDC) states that individuals of any age, ethnicity or gender can develop CFS but the condition is more common in men than women, in people aged 40 to 60 years and in adults as opposed to children or adolescents.
  • People with a family member who has had the condition are also more likely to develop CFS. There is no evidence to support the theory that CFS is contagious.
  • The CDC estimates that over 1 million Americans have this condition and nearly 80% of these individuals are undiagnosed. According to the National Health Service, around 250,000 people in the UK have CFS.

Risk factors

Factors that may increase your risk of chronic fatigue syndrome include:
Age: Chronic fatigue syndrome can occur at any age, but it most commonly affects people in their 40s and 50s.
Sex: Women are diagnosed with chronic fatigue syndrome much more often than men, but it may be that women are simply more likely to report their symptoms to a doctor.
Stress: Difficulty managing stress may contribute to the development of chronic fatigue syndrome.

Causes

Scientists don’t know exactly what causes chronic fatigue syndrome. It may be a combination of factors that affect people who were born with a predisposition for the disorder. Some of the factors that have been studied include:
Viral infections: Because some people develop chronic fatigue syndrome after having a viral infection, researchers question whether some viruses might trigger the disorder.
Suspicious viruses include Epstein-Barr virus, human herpes virus 6 and mouse leukemia viruses. No conclusive link has yet been found.
Immune system problems: The immune systems of people who have chronic fatigue syndrome appear to be impaired slightly, but it’s unclear if this impairment is enough to actually cause the disorder.
Hormonal imbalances: People who have chronic fatigue syndrome also sometimes experience abnormal blood levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands. But the significance of these abnormalities is still unknown.

Symptoms

The main symptom of CFS/ME is feeling extremely tired and generally unwell.  In addition, people with CFS/ME may have other symptoms, including:
  • Sleep problems
  • Muscle or joint pain
  • Headaches
  • A sore throat or sore glands that aren’t swollen
  • Problems thinking, remembering or concentrating
  • Flu-like symptoms
  • Feeling dizzy or sick
  • Fast or irregular heartbeats (heart palpitations)
  • Most people find overexercising makes their symptoms worse.
  • The severity of symptoms can vary from day to day, or even within a day.
The symptoms of CFS/ME are similar to the symptoms of some other illnesses, so it’s important to see your GP to get a correct diagnosis.

Complications

Possible complications of chronic fatigue syndrome include:
  • Depression
  • Social isolation
  • Lifestyle restrictions
  • Increased work absences

Diagnosis and test

No other health problem may be responsible for the fatigue, meaning Chronic Fatigue Syndrome is a diagnosis of exclusion.  Diagnosis is also symptom-based, meaning your Physical Therapist or physician will base the diagnosis on your reported symptoms.  Unfortunately, there are no diagnostic tests to confirm the presence of Chronic Fatigue Syndrome, but often times medical tests will be conducted to eliminate other medical conditions.
Your Physical Therapist might be the first person to diagnose an onset of Chronic Fatigue Syndrome based upon the effects on your physical function.  Some questions your Physical Therapist may pose to you might include:
How long have you felt tired or fatigued?
When do you feel tired or fatigued?
Are you experiencing any widespread pain or discomfort?
Have you noticed any difficulty with sleeping?
Have you experienced any significant changes in your ability to perform physical tasks?
Have you noticed any recent changes in your ability to think clearly?
Your Physical Therapist may suggest that you complete a questionnaire to better understand your physical state, as well as to screen for the presence of other conditions.  In addition, cardiopulmonary exercise testing, including 2 tests arranged 24 hours apart, may be used to characterize the severity of your functional impairment.

Treatment and medications

Making some changes to your lifestyle can help reduce your symptoms. Limiting or eliminating your caffeine intake will help you sleep better and ease your insomnia. You should limit your nicotine and alcohol intake, too. Try to avoid napping during the day. Create a sleep routine: You should go to bed at the same time every night and aim to wake up around the same time every morning.
It’s also important to pace yourself during activities. Overexertion can make your symptoms worse and bring on an episode of fatigue. Avoid emotional and physical stress. Take time each day to relax or participate in activities you enjoy.

Therapy

Two types of therapy appear to benefit people with CFS. One is psychological counseling to help you cope with CFS and improve your mindset. The other is physical therapy. A physical therapist can evaluate you and create an exercise routine for you that gradually increase in intensity. This is known as graded exercise therapy, or GET

Medications

No one medication can treat all of your symptoms. Also, your symptoms may change over time. In many cases, CFS can trigger depression, and you may need an antidepressant to combat it. If lifestyle changes don’t give you a restful night’s sleep, your doctor may suggest a sleep aid. Pain medication can also help you cope with aches and joint pain caused by your CFS.

Alternative Medicine

Acupuncture, tai chi, yoga, and massage may help relieve the pain associated with CFS. Always talk to your doctor before beginning any alternative or complementary treatments.

Can Chronic Fatigue Syndrome Be Prevented?

  • Unfortunately, there is no sure-fire way to date to predict or prevent the onset of Chronic Fatigue Syndrome, especially since the actual mechanisms behind Chronic Fatigue Syndrome are not completely understood.
  • However, detecting the signs and symptoms early on may help tremendously in its management. Once the diagnosis is made, your Physical Therapist should work closely with you to develop strategies to better understand and help you to manage your symptoms.
  • As with many conditions, education is extremely critical. If you understand maintenance strategies, such as finding a balance between periods of activity and rest, you will have a much better chance of living a functional life.
  • As mentioned previously, short-duration exercises may be utilized without making your symptoms worse. Symptoms are also well-controlled with a pacing and self-management program.
  • In addition, cognitive behavior therapy as well as psychotherapy can be extremely beneficial in addressing possible associated disorders, mainly anxiety and depression.