CHRONIC FATIGUE SYNDROME

General Information

DEFINITION--Chronic fatigue syndrome is characterized primarily by profound fatigue. There is usually an abrupt onset of symptoms that come and go for at least six months. It is unknown whether it represents one or many disorders. It is difficult to diagnose because there is no specific laboratory test, or a defined set of signs and symptoms. Currently, the major criteria used to define cases are: 1) persistence of relapsing fatigue that does not resolve with bed rest and is severe enough to reduce average daily activity by at least 50% for at least 6 months, and 2) other chronic clinical conditions have been satisfactorily excluded, including pre-existing psychiatric disease. Other signs and symptoms aid in the diagnosis.

BODY PARTS INVOLVED--Endocrine system, muscles, gastrointestinal system, central nervous system.

SEX OR AGE MOST AFFECTED--It is observed primarily in young adults between 20 and 40, and women outnumber the men about two to one.

SIGNS & SYMPTOMS

• Fatigue.
• Low grade fever.
• Pharyngitis.
• Painful lymph glands.
• Sore throat.
• Generalized muscle weakness.
• Muscle aches.
• Headaches.
• Sleep disturbances (hypersomnia or insomnia).
• Joint pain.
• Neuropsychological complaints (photophobia, forgetfulness, irritability, confusion, difficulty in concentrating, depression, vision changes).

CAUSES--Unknown. Immunological abnormalities may be involved. Many theories center on an infectious agent, but no such agent has been identified. Epstein-Barr virus and others have been implicated. New research points to abnormalities in blood pressure, or orthostatic intolerance.

RISK INCREASES WITH--Unknown.

HOW TO PREVENT--Unknown.

What To Expect

DIAGNOSTIC MEASURES--

• No specific medical test is available. The 2 major criteria mentioned in definition plus about 8 of the other signs and symptoms are necessary to establish the diagnosis.
• Medical history and social history plus physical exam by a doctor.
• Laboratory blood and urine studies as necessary to rule out other disorders.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Psychotherapy may be helpful for some patients.

POSSIBLE COMPLICATIONS--None specific to the disorder. Symptoms are usually most severe during the first 6 months. POSSIBLE OUTCOME--Generally very slow improvement over months or years.

How To Treat

GENERAL MEASURES--

• Basic management involves four areas: 1) validation of the diagnosis and your education about the disorder 2) general treatment measures 3) treatment of specific symptoms 4) experimental therapy
• Try to remain optimistic.
• Keep involved in life; don't isolate yourself.
• Sometimes a change of scenery can help. Take a vacation if possible.
• Be patient with family and friends and their understanding and acceptance of your disorder.
• Join a local or national support group.
• See Resources for Additional Information.

MEDICATION--

• Medications must be individually tailored but may include pain medicine, local injections, antidepressants or others. Many patients improve after taking medications that increase the volume of blood flow.
• Other experimental medication therapies are being studied.

ACTIVITY--

• Rest if you feel tired.
• Exercise is important. Begin a gradual program that may be just 3-5 minutes a day to start with. Increase the activity by about 20% about every 2-3 weeks. Setbacks will occur, so don't be discouraged.

DIET--Try to maintain good nutrition, even if appetite is decreased. Eat a low-fat, high-fiber diet (see both in Appendix). Take vitamin supplements.

Call Your Doctor If

• You have signs and symptoms of chronic fatigue syndrome.
• Symptoms worsen after treatment is started.
• New or unexplained symptoms develop. Drugs used in treatment may cause side effects.