What is chronic fatigue syndrome?

Chronic fatigue syndrome (CFS) is also known as myalgic encephalomyelitis or systemic exertional intolerance disease (SEID) which is characterized by unexplained profound fatigue that is exacerbated by exertion and does not improve with rest.  This profound fatigue is often accompanied by impairment of daily activities that may last for more than 6 months.  It is important to note that CFS is a biologic illness and not a psychological disorder.  Other common symptoms of CFS are unrefreshing sleep, difficulty concentrating and dizziness. 

Unfortunately, there are no tests available for CFS.  Therefore, your doctor will make the diagnosis by ruling out other conditions.  CFS most commonly affects women who are in their 40s and 50s.  Till date, there is no cure for CFS but there are treatment options which may relieve your symptoms.

What are the causes and risk factors for chronic fatigue syndrome?

The exact cause of CFS is still unknown.  However, there are some factors which may increase your risk of developing CFS and these include:

• Viral infections: Since people often develop CFS after having a viral infection, some researchers suggest that it may play a role in developing the syndrome.
• Hormonal imbalances: Hormonal imbalances have been associated with CFS as these people often have abnormal blood levels of hormones/

• A weakened immune system: People who have a weakened immune system are at increased risk of developing CFS.
• Age: CFS mainly affects people who are in their 40s and 50s.
• Emotional or physical trauma: Some affected people report that their symptoms started just after experiencing a significant emotional stress, injury or surgery.
• Sex: Women are more at risk of developing CFS than men.

What are the signs and symptoms of chronic fatigue syndrome?

The signs and symptoms CFS varies from person to person and the severity of symptoms fluctuates daily.  The signs and symptoms of CFS include:

• Excessive fatigue that worsens with exertion and is not relieved by rest.
• Headaches.
• Difficulty concentrating.
• Problems with memory.
• Sore throat.
• Unrefreshing sleep.
• Enlarged lymph nodes in your armpits and neck.
• Extreme exhaustion after exertion.
• Unexplained joint or muscle pain.
• Dizziness when shifting from a sitting position to a standing position.

There are other conditions which may resemble CFS which need to be ruled out by your doctor, these include:

• Depression.
• Anaemia.
• Coeliac disease.
• HIV infection and AIDS.
• Adrenal insufficiency.
• Lyme disease.
• Hypothyroidism.
• Multiple sclerosis.
• Restless legs syndrome.
• Postural tachycardia syndrome.
• Obstructive sleep apnoea.
• Orthostatic hypotension.
• Polymyalgia rheumatica.
• Fibromyalgia.

Making a diagnosis

To make a diagnosis, your doctor will first take a detailed history from you to know more about your symptoms.  After the history taking, your doctor will perform a thorough physical examination to look for signs of CFS.  Unfortunately, there is no single test to confirm the diagnosis of CFS.  However, this diagnosis is made by ruling out other conditions by doing some blood and imaging tests.  In addition, the Unites States Institute of Medicine define the fatigue associated with CFS as being so severe that it interferes with activities of daily living, new onset, not relieved by rest and worsened by emotional, physical and mental exertion.  In addition to that kind of fatigue, for the diagnosis of CFS to be made the people also has to experience difficulty concentrating, problems with memory or dizziness when shifting from a sitting position to a standing position.

Very often the people affected by CFS have other conditions such as irritable bowel syndrome, sleep disorders, depression, anxiety or fibromyalgia concurrently.

What are the treatments of chronic fatigue syndrome?

Unfortunately, there is no cure for CFS.  The treatment focuses mainly on relieving the symptoms by starting by the most disabling ones.   Your doctor may prescribe medications for your depression.  By treating the depression, it can make it easier for you to cope with the difficulties associated with the condition.  In addition, low doses of antidepressants can also improve your sleep and help to relieve your pain.

In addition to antidepressants, your doctor may also prescribe pain killers such as ibuprofen, naproxen sodium, pregabalin, amitriptyline, gabapentin or duloxetine may be given to relieve your muscle and joint pains.

Furthermore, people with dizziness when shifting from a sitting position to a standing position may be prescribed medications that regulates blood pressure or heart rhythms in order to relieve the dizziness.

In addition to medications, several therapy are available to help to cope with your daily activities and learn new ways to improve your symptoms.  Talking with a counsellor may provide you with coping skills to improve family dynamics or address limitations at school or work.  If you suffer from sleep problems from obstructive sleep apnoea, your doctor may suggest the use of a machine that delivers air pressure and oxygen through a mask while you sleep to keep your airway open so that you can sleep properly.  Avoiding drinks or food containing caffeine and changing your bedtime routine may also help to improve your sleep.  Doing aggressive exercise regimens may worsen your symptoms.  However, it is advised to maintain an acceptable or tolerable amount of physical exercises so that to prevent deconditioning of your body.

What are the complications of chronic fatigue syndrome?

If CFS is left untreated, the following complications may ensue:

• Depression.
• Social phobia or isolation.
• Activities of daily living restrictions.

• Increased school or work absences.

Expectations (prognosis)

Unfortunately, there is no cure for CFS and its symptoms may persist for years and the clinical course may include remissions and relapses.  However, an early diagnosis and proper management will help to improve your symptoms and quality of life.

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