Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a disorder that causes extreme fatigue.

This fatigue is not the kind of tired feeling that goes away after you rest. Instead, it lasts a long time and limits your ability to do ordinary daily activities.

The main symptom of CFS is severe fatigue that lasts for 6 months or more.

You also have at least four of these other symptoms:
  • Feeling unwell for more than 24 hours after physical activity
  • Muscle pain
  • Memory problems
  • Headaches
  • Pain in multiple joints
  • Sleep problems
  • Sore throat
  • Tender lymph nodes

CFS is hard to diagnose. There are no tests for it, and other illnesses can cause similar symptoms. Your doctor has to rule out other diseases before making a diagnosis of CFS.

No one knows what causes CFS. It is most common in women in their 40s and 50s, but anyone can have it. It can last for years. There is no cure for CFS, so the goal of treatment is to improve symptoms. CFS affects people in different ways. You should work with your doctors to create a treatment program that best meets your own needs. It may include therapies to manage your symptoms, such as medicines to treat pain, sleep disorders, and other problems. It may also include coping techniques, and ways of managing your daily activities.

The exact cause of chronic fatigue syndrome (CFS) is unknown. It may be due to:

Epstein-Barr virus or human herpes virus-6 (HHV-6); however, no specific virus has been identified as the cause
Inflammation in the nervous system, because of a faulty immune system response

The following may also play a role in the development of CFS:
  • Age
  • Previous illnesses
  • Stress
  • Genetics
  • Environmental factors

CFS is most common in women ages 30 to 50.

The hallmark symptom is persistent and profound fatigue, which often worsens after physical or mental exertion.

Symptoms may also include muscle aches, headache, and extreme fatigue.

The main symptom of CFS is extreme tiredness that is:
  • New
  • Lasts at least 6 months
  • Not relieved by bed rest
  • Severe enough to keep you from participating in certain activities
  • Worsened when in an upright position
Other symptoms include:
  • Feeling extremely tired for more than 24 hours after exercise that would normally be considered easy
  • Feeling unrefreshed after sleeping for a proper amount of time
  • Forgetfulness
  • Concentration problems
  • Confusion
  • Joint pain, but no swelling or redness
  • Headaches that differ from those you have had in the past
  • Irritability
  • Mild fever - 101°F (38.3°C) or less)
  • Muscle aches (myalgias)
  • Muscle weakness, all over or multiple locations, not explained by any known disorder
  • Sore throat
  • Sore lymph nodes in the neck or under the arms

The Centers for Disease Control (CDC) describes CFS as a distinct disorder with specific symptoms and physical signs. Diagnosis is based on ruling out other possible causes.

Your health care provider will try to rule out other possible causes of fatigue, including:
  • Drug dependence
  • Immune or autoimmune disorders
  • Infections
  • Muscle or nerve diseases (such as multiple sclerosis)
  • Endocrine diseases (such as hypothyroidism)
  • Other illnesses (such as heart, kidney, or liver diseases)
  • Psychiatric or psychological illnesses, particularly depression
  • Tumors
A diagnosis of CFS must include:
  • Absence of other causes of chronic fatigue
  • At least four CFS-specific symptoms
  • Extreme, long-term fatigue

There are no specific tests to confirm the diagnosis of CFS.

However, there have been reports of people with CFS having abnormal results on the following tests:
  • Brain MRI
  • White blood cell count

There is currently no cure for CFS. The goal of treatment is to relieve symptoms.

Treatment includes a combination of the following:
  • Counseling therapy - cognitive-behavioral therapy (CBT)
  • Graded exercise
  • Healthy diet
  • Sleep management techniques
  • Medicines to reduce pain, discomfort, and fever
  • Medicines to treat anxiety (anti-anxiety drugs)
  • Medicines to treat depression (antidepressant drugs)

Some drugs can cause reactions or side effects that are worse than the original symptoms of the disease.

People with CFS are encouraged to maintain an active social life. Mild physical exercise may also be helpful. Your health care team will help you figure out how much activity you can do, and how to slowly increase your activity.

Tips include:
  • Avoid doing too much on days when you feel tired
  • Balance your time between activity, rest, and sleep
  • Break big tasks into smaller, more manageable ones
  • Spread out your more challenging tasks through the week

Relaxation and stress-reduction techniques can help manage chronic (long-term) pain and fatigue. They are not used as the primary treatment for CFS.

Relaxation techniques include:
  • Biofeedback
  • Deep breathing exercises
  • Hypnosis
  • Massage therapy
  • Meditation
  • Muscle relaxation techniques
  • Yoga

Newer medicine approaches are being researched.

The long-term outlook for people with CFS varies. It is hard to predict when symptoms first start. Some people completely recover after 6 months to a year.

About 1 in 4 people with CFS are so severely disabled that they cannot get out of bed or leave their home. Symptoms can come and go in cycles, and even when people feel better, they may experience a relapse triggered by exertion or an unknown cause.

Some people never feel like they did before they developed CFS. Studies suggest that you are more likely to get better if you receive extensive rehabilitation.