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The Unbearable Restlessness of Being

Things to know about Chronic Fatigue Syndrome

Published

By EDUARDO GONZALES, MD

NAP

What is chronic fatigue syndrome? What causes it? —elen_cg@gmail.com

Chronic fatigue syndrome (CFS), also referred to asmyalgic encephalomyelitis (ME), is a debilitating condition that is characterized by long standing (at least six months) extreme tiredness or fatigue and other persistent symptoms that limit one’s ability to carry out ordinary daily activities.

CFS affects people of every age, gender, ethnicity, and socioeconomic group, but it is primarily an illness of people in their 40s and 50s and four times more common in women than in men.

The fatigue of CFS doesn’t improve with rest, nap, or a good night’s sleep—sufferers remain exhausted upon waking up in the morning, and often worsen with physical or mental activity. The various other symptoms associated with CFS include weakness, muscle and/or joint pain, sore throat, headache, dizzy spell or vertigo, swollen lymph nodes (kulani, in Filipino) in the armpits and neck, palpitations, impaired memory and/or mental concentration, and insomnia or over sleeping. The severity of symptoms can vary from day to day, or even within a day.

CFS affects people of every age, gender, ethnicity, and socioeconomic group, but it is primarily an illness of people in their 40s and 50s and four times more common in women than in men. In the US, estimates are that CFS affects four per 1,000 adults. In the Philippines, no data on the incidence of CFS exist. The condition probably goes unrecognized and often simply dismissed as a psychosomatic disorder.

CHART

Cause of Chronic Fatigue Syndrome
The cause of CFS is not known yet. In fact, for long-standing fatigue to qualify as CFS there should be no known cause that can explain the symptoms.

Some early studies implicated a virus as a possible cause but subsequent research has acquitted the virus. Current theories include allergy, some other infectious agents, immune disorder, hormonal abnormalities, low blood pressure, decreased blood flow to the brain, lack of certain nutrients in the diet, mental health problems such as stress and emotional trauma, and one’s genes because CFS tends to run in families.

How is the condition diagnosed?
No specific diagnostic test for CFS exists. It is a diagnosis of exclusion, which means a person is diagnosed with CFS after all the other medical conditions that can give rise to the symptoms have been excluded by the appropriate tests. Illnesses that may mimic the symptoms of CFS include diabetes mellitus, thyroid disease, alcoholism, drug abuse, fibromyalgia, multiple chemical sensitivities, chronic mononucleosis, sleep apnea, major depressive disorders, bipolar affective disorders, schizophrenia, eating disorders, cancer, subacute infections, obesity, and adverse reactions to prescribed medications.

In 1994, an international panel of experts on CFS agreed that to diagnose a case as chronic fatigue syndrome,
two criteria must be met:

1. Severe chronic fatigue of six months or longer with other known medical conditions excluded by clinical diagnosis; and
2. Concurrent presence of four or more of the following symptoms, which must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue: impairment in short-term memory or concentration; sore throat; tender lymph nodes in the neck or armpit; muscle pain; multi-joint pain without swelling or redness; headaches that differ from previous headaches as to pattern or severity; unrefreshing sleep; and, malaise or feeling of illness lasting more than 24 hours after exercise.

Management of CFS
There is no known cure for CFS. Drug and non-drug therapies are currently being used. The medications are simply to control the symptoms such as pain, nausea, and sleep problems. Of the non-drug therapies two modalities look promising: cognitive behavioral therapy (CBT) and graded exercise therapy (GET).

CBT is a form of psychological therapy. It tries to help patients understand their individual symptoms and beliefs and develop strategies to improve day-to-day functioning. GET, on the other hand, is a form of physical therapy.

Recovery rates for CFS are unclear.

Most patients improve over time. Still, full recovery occurs rarely—children and young people are more likely to recover completely.

Note: Email inquiries on health matters to: medical_notes2@yahoo.com

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