Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that cannot be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn’t improve with rest. Chronic fatigue may arise from more than one underlying condition. The cause of chronic fatigue syndrome is unknown, although there are many theories — ranging from viral infections to psychological stress. Some experts believe chronic fatigue syndrome might be triggered by a combination of factors. There is no single test to confirm a diagnosis of chronic fatigue syndrome, which means patients may need a variety of medical tests to rule out other health problems that have similar symptoms.
There is no single test to confirm a diagnosis of chronic fatigue syndrome. Because the symptoms of chronic fatigue syndrome can mimic so many other health problems, it could take a long time and many tests to confirm the syndrome is the issue, instead of a different medical condition. A doctor must rule out a number of other illnesses before diagnosing chronic fatigue syndrome. These may include: Sleep disorders, such as obstructive sleep apnea, restless legs syndrome, or insomnia, medical problems, such as anemia, diabetes and underactive thyroid, mental health issues, such as depression, anxiety, bipolar disorder and schizophrenia. Many of these other medical issues can be ruled out by lab tests.
There are many different things doctors look for when trying to diagnose someone with chronic fatigue syndrome, including persistent fatigue for at least six months, and at least four other symptoms: Loss of memory or concentration, sore throat, enlarged lymph nodes in your neck or armpits, unexplained muscle pain, pain that moves from one joint to another without swelling or redness, headache of a new type, pattern or severity, unrefreshing sleep, or extreme exhaustion lasting more than 24 hours after physical or mental exercise. Incredibly, even if you have the chronic fatigue along with the other symptoms, there are still many other things that you could be diagnosed with, which is a reason why it is so hard to diagnose, yet a very common disease (http://www.mayoclinic.org).
The physiological issues associated CFS are hard to pinpoint because of all the other things that could be wrong. It is usually associated with abnormal immunological response to exertion, reduced ability to recover from exertion, neuroendocrine abnormalities, reduced natural killer cell function, and forms of orthostatic intolerance including postural orthostatic tachycardia syndrome, neurally mediated hypotension, and orthostatic hypotension. In the autonomic nervous system, a 2014 review found a tentative association between autonomic nervous system dysfunction and CFS, fibromyalgia, irritable bowel syndrome, and interstitial cystitis, yet it is unclear if there is a cause-effect relationship, like so many of the other issues associated. One review found evidence of increased sleep latency, decreased sleep efficiency and decreased slow wave sleep in those with chronic fatigue syndrome. A systematic review of literature on the autonomic nervous system in CFS found abnormal heart-rate responses to tilt-table tests relative to controls, indicating autonomic abnormalities.
Roles for viral and bacterial infections have been suggested for CFS and although CFS type symptoms can occur following severe infections, current data does not support the presence of an infectious process in maintaining the disease; however, one of the most consistent findings in persons diagnosed with the illness is poor natural killer cell function. The reduction in natural killer cell function correlates with illness severity. Bowel bacteria and viruses may play a role as a trigger. People diagnosed with the illness appear to have an abnormal immune response to exercise. Specifically, complement products are increased, larger oxidative stress is generated along with reduced anti-oxidant immune response, and other issues have been found. Many of these immune responses happen after exercise, and have lasted up to 24 hours. Similarities have been drawn between cancer and CFS with regard to abnormal intracellular immunological signaling.
Some evidence suggests that CFS is a multifactorial disease. Genetic, physiological and psychological factors are thought to work together to precipitate and perpetuate the illness. People with CFS and their relatives tend to attribute their illness to physical causes such as a virus or pollution, rather than to psychological causes. Such attributions do not seem a risk factor for the development of CFS, but probably are associated with increased symptoms and worse outcomes over time. Uncertainties about the causes, prognosis, diagnosis and treatment, and the lack of clinical guidance for healthcare professionals, aggravate the impact of the disease both in those affected and their caregivers. (https://en.wikipedia.org)
Researchers in Australia explored brain involvement in CFS. They used statistical parametric mapping of brain MR images and compared against clinical scores for 25 CFS subjects and 25 normal controls. Clinical scores included CFS fatigue duration, a score based on the 10 most common CFS symptoms, the Bell score, the hospital anxiety and depression scale (HADS) anxiety and depression and hemodynamic parameters from 24-h blood pressure monitoring. Midbrain white matter volume was observed to decrease with increasing fatigue duration. A strong correlation in CFS between brainstem grey matter volume and pulse pressure suggested impaired cerebrovascular autoregulation. It can be argued that at least some of these changes could arise from astrocyte dysfunction. These results are consistent with an insult to the midbrain at fatigue onset that affects multiple feedback control loops to suppress cerebral motor and cognitive activity and disrupt local CNS homeostasis, including resetting of some elements of the autonomic nervous system (http://solvecfs.org).
Since CFS is so hard to diagnose and goes along with many other health problems or diseases, there are not many risk factors that pertain to the disease. 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, and stress; Difficulty managing stress may contribute to the development of chronic fatigue syndrome. None of these risk factors are under the control of the patient, which, again, makes it very complicated to control, diagnose, or treat (http://www.mayoclinic.org).
Because chronic fatigue syndrome affects people in many different ways, your treatment will be tailored to your specific set of symptoms. Symptom relief may include certain medications, such as antidepressants and sleeping pills. Many people who have chronic fatigue syndrome are also depressed. Treating the depression can make it easier to cope with the problems associated with chronic fatigue syndrome. Low doses of some antidepressants also can help improve sleep and relieve pain. If home measures, such as avoiding caffeine, don’t help to get better rest at night, the doctor might suggest trying prescription sleep aids.
There is no known cure for chronic fatigue syndrome, and the most effective treatment for chronic fatigue syndrome remains uncertain. However, there’s evidence that a multipronged approach may be helpful: Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days, graded exercise. In order to improve daily function, more than pacing alone is needed. Previous studies suggest that graded exercise is an effective and safe treatment, but evidence for this remains limited, a physical therapist can help determine what types of exercise are best for you. Inactive people often begin with range-of-motion and stretching exercises for just a few minutes a day. Slow, incremental increases in activity then take place over weeks to months, if you’re exhausted the next day, you’re doing too much. Your strength and endurance will improve as you gradually increase the intensity of your exercise over time, psychological counseling. Talking with a counselor can help you figure out options to work around some of the limitations that chronic fatigue syndrome imposes on you. Feeling more in control of your life can improve your outlook dramatically. Cognitive behavioral therapy and self-management strategies are among the most helpful. Not everyone who has severe chronic fatigue and post exertional malaise responds to treatment in the same way. People who have a better chance of treatment success tend to have less impairment, focus less on symptoms, comply with counseling programs and pace themselves to avoid overexertion and under exertion (http://healyourbody.org).
There are not many long-term effects of CFS that are not the same as the symptoms, but many times, people have experienced infections, cancers, and some internal issues. There are more than 200,000 US cases per year. CFS can’t be cured, but treatment may help. It is chronic, lasting for years or even lifelong. It does require a medical diagnosis, along with lab tests or imaging. Chronic fatigue syndrome occurs more commonly in women. The cause of this condition is unknown, but may include environmental or genetic factors. The main symptom is fatigue for over six months. The fatigue often worsens with activity, but doesn’t improve with rest. Treatments include graded exercise therapy and cognitive behavioral therapy. Other medications or therapies may provide symptom relief. Most people diagnosed with CFS are between the ages 19-40.