Discover chronic fatigue syndrome symptoms, causes, and management options. Find support on Meri Sehat.

Chronic Fatigue Syndrome

PNS SHIFA

Online Consultation

Syed Intisar Hussain

Overview

Chronic Fatigue Syndrome (CFS) refers to a disorder that is characterized by restricted movement of an individual due to extreme tiredness. It is different from the usual feeling of tiredness, &ldquo;chronic&rdquo; referring to the duration of the condition i.e., it can go on for months or even years.

Ever had a day or two where you feel extremely tired all the time? Imagine feeling like that for months. This is chronic fatigue syndrome. It is a very complex disorder. The individual does not stop feeling tired or feeling fatigue despite hours or even days of resting. It is also known as myalgic encepalomyelitis (ME) or systemic exertion intolerance disease (SEID)<a href="#accordion">[2]</a>.

The disorder is not prevalent in Pakistan. However, with the United States having a similar ratio of population and ethnical diversity, numbers can be compared. Around 836,000 to 2.5 million people in the US had ME or chronic fatigue syndrome back in 2015. The alarming issue is that despite the developed healthcare system of the US, only 20% of the estimated number were known to have received a proper CFS diagnosis from their healthcare provider. According to the data provided, women were found to be 4 times more likely to suffer from CFS than men<a href="#accordion">[11]</a>.&nbsp;

Research conducted in 2011 recorded a prevalence of CFS in different ethnic minority groups. It was revealed that white people had the lowest prevalence of CFS at 0.8% and the prevalence was recorded to be the highest in Pakistanis at around 3.5%<a href="#accordion">[4]</a>.

&nbsp;

Signs And Symptoms

Symptoms of CFS vary from person to person. In fact, they might not be the same throughout the course of the disease for the same person too, given the cause is still unknown and there is a wide range of factors that could be influencing the syndrome.&nbsp; 
&nbsp;

These symptoms include:&nbsp;

<ul>
	<li>Feeling sleepy and tired despite getting proper sleep&nbsp;</li>
	<li>Photosensitivity</li>
	<li>Headaches</li>
	<li>Chronic insomnia</li>
	<li>Amnesia</li>
	<li>Muscle or joint pain</li>
	<li>Weakness</li>
	<li>Low concentration&nbsp;</li>
	<li>Confusion</li>
	<li>Fever</li>
	<li><a href="https://www.merisehat.pk/disease/depression" target="_blank">Depression</a></li>
	<li>Sore throat</li>
	<li>Swollen lymph nodes 
	&nbsp;</li>
</ul>

<h5>Symptom Severity Levels</h5>

Mild CFS, symptoms are mild, that is, you are able to carry out daily tasks. Nevertheless, you feel like giving up on your hobbies because they require too much energy from you.&nbsp;

Moderate CFS, in particular, refers to when you find it difficult to move around and perform daily tasks and have this compulsive need to rest after every little thing that you have done. It affects your education and your job.

Severe and very severe CFS cases hinder the individual&rsquo;s performance. You could barely attempt daily tasks, like brushing your teeth. People at this stage are bound to their beds and unable to leave their houses. Their very basic movement from one room to another might necessitate the use of a wheelchair.&nbsp;

In very severe cases, the individual is completely bed bound and dependent on caretakers. This means that the individual cannot feed themselves or even use the toilet on their own.&nbsp;

&nbsp;

Causes

The disorder is considered complex primarily because the root cause and the mechanism of the syndrome are still unknown.&nbsp;However, there are several causative factors that have an influence on the prevalence of this condition. These include: 
&nbsp;

<ul>
	<li>
	<h5>Hormonal Imbalance</h5>
	</li>
</ul>

Hormones are a silent causative agent of many issues in our body and chronic fatigue syndrome is believed to be one of them. Abnormal levels of hormones in the body produced by multiple glands could be a reason. However, there is still uncertainty regarding the different hormones and their levels. There is no reported specification of the increase or the decrease in a specific hormone known to cause CFS<a href="#accordion">[6]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Poor Immunity</h5>
	</li>
</ul>

The culprit of it all. Compromised or weakened immunity tends to weaken our daily productivity. People who are suffering from chronic fatigue syndrome seem to have weakened immunity and tend to get sick easily. Again, much like the other causative agents, there has been no clear link of the factor to the actual syndrome. 
&nbsp;

<ul>
	<li>
	<h5>Viral Or Bacterial Infections</h5>
	</li>
</ul>

Many people with CFS had previously suffered from a severe viral infection. However, there is no certain infection that has been found to have a direct link with the syndrome. Past reports of patients with CFS have had Epstein-Barr virus (EBV), human herpesvirus 6, Ross River virus (RRV) and rubella virus. In bacterial infections, causative bacteria include Coxiella burnetii and Mycoplasma pneumonia. Researchers believe that individuals who have suffered a severe case of such infections are at an elevated risk of suffering from CFS<a href="#accordion">[3]</a>.

&nbsp;

<ul>
	<li>
	<h5>Stress And Trauma</h5>
	</li>
</ul>

Many individuals who have suffered from some kind trauma or severe stress have reported the symptoms of CFS.

&nbsp;

So far, there is no strong or widely-accepted screening test to help in the prediction of chronic fatigue syndrome. The only tests that have been created are known to only differentiate a healthy individual from one suffering from CFS. But they are not widely accepted and not considered official for the screening.

&nbsp;

Diagnosis

According to the National Institute for Health and Care Excellence (NICE), chronic fatigue syndrome is put into consideration only if the patient&rsquo;s condition cannot be explained by other possible diseases<a href="#accordion">[8]</a>.

The United States Institute of Medicine has proposed guidelines to define chronic fatigue syndrome and points that people need to check to get considered for the possibility of suffering from the syndrome<a href="#accordion">[7]</a>. They include: 
&nbsp;

<ul>
	<li>Severe tiredness or feeling of fatigue; it hampers the ability to perform basic daily tasks</li>
	<li>The issue has been present for a long time; doesn&rsquo;t matter if it&rsquo;s experienced consistently or on and off</li>
	<li>Worsening of the condition with any physical or mental exertion</li>
	<li>Trouble remembering things, inability to focus or concentrate</li>
	<li>Dizziness and inability to stand or sit&nbsp;</li>
</ul>

&nbsp;

Treatment

The treatment for myalgic encephalomyelitis is targeted toward treating the symptoms rather than curing the issue as a whole.&nbsp;Depending on your symptoms and what you are currently experiencing, the medications are altered. However, the syndrome does not get better just with the use of medicines; it has to be coupled with lifestyle changes.&nbsp;

Management of CFS/ME varies from person to person and is something that you may have to tweak until you know what works for you and your set of symptoms. Your healthcare practitioner would discuss all the possible changes that are required to be made in your lifestyle for faster recovery. Keep in mind that the syndrome lasts for a very long time so the treatment process itself could be very tiring to deal with.&nbsp;

&nbsp;

Some of the special treatments involve:

<ul>
	<li>Cognitive Behavioral Therapy: This is a very common type of therapy that involves changes in your behavior as well as your perspective regarding your environment. This is a form of talking psychotherapy that is effective only in mild or moderate cases.&nbsp;</li>
	<li>Medicines: As discussed before, there is no direct treatment for CFS/ME. Chronic fatigue syndrome is never just limited to the chronic feeling of tiredness and fatigue. There is always something more at play which, in many cases, is depression.&nbsp;Orthostatic intolerance is yet another common factor. It is characterized by a feeling of dizziness along with pain when you stand up. Common medications for these issues are prescribed<a href="#accordion">[7]</a>.</li>
	<li>Energy Management: CFS leaves very little room for movement and the target is to make the best of it in ways that increase your energy capacity. The treatment monitors the individual&rsquo;s activities and energy levels; a detailed plan for their exercise and diet is created with the aim to increase their current physical movement and energy levels<a href="#accordion">[8]</a>.</li>
</ul>

&nbsp;

These include:

&nbsp;

Post-Exertional Malaise: People with CFS experience a mental, physical, and emotional strain along with worsening of their symptoms whenever they perform any energy-requiring task. This becomes a great hindrance in cases of therapies that make them exercise or involve some sort of physical movement.&nbsp;

To avoid this, it is best to know when you need to stop pushing yourself and to give yourself a break from the treatment every once in a while<a href="#accordion">[8]</a>. 
&nbsp;

Oxidative Stress: Individuals suffering from CFS are reported to have increased oxidative stress. This aspect also involves a drastic decrease in antioxidants like glutathione.

The biggest and the main issue of oxidative stress is the cell damage that is caused because, in most cases, the reactive oxygen species targets mitochondria and greatly impacts its ability to produce energy for the nourishment and basic functioning of body cells.&nbsp;

 
Increased Neuronal Stimulation: This refers to how the syndrome impacts the neurons. Increased neuronal sensitization leads to the individual feeling more pain than what is normally felt by a healthy individual. It means that the syndrome greatly alters the nervous system and its response to many stimuli<a href="#accordion">[12]</a>.

&nbsp;

Not much is known about the origins of CFS, what causes it, what worsens it or how it occurs in the body. That is, the bodily changes that accompany chronic fatigue syndrome have not been identified, and this is why the risk factors are very vague, too: 
&nbsp;

<ul>
	<li>Age: Any person of any age group can get CFS. But based on the reports, it is most common in people aged 40-60 years<a href="#accordion">[10]</a>. 
	.</li>
	<li>Gender: According to research, women were reported to be 4 times as likely to suffer from chronic fatigue syndrome as compared to men. Even in the younger lot, who by the way rarely suffer from CFS, the statistics are still higher among girls than boys. 
	&nbsp;</li>
	<li>Genes: If you have a family history of chronic fatigue syndrome, you have a greater risk of having it compared to someone without a similar history.&nbsp; 
	&nbsp;</li>
	<li>Other Illnesses: Diseases like irritable bowel syndrome, fibromyalgia, temporomandibular disorder, post-concussion syndrome, tension headache, chronic pelvic, chronic prostatitis, etc. increase the risk of getting CFS. However, there is no direct link reported to the syndrome<a href="#accordion">[1]</a>.</li>
</ul>

&nbsp;

With no cure out there for chronic fatigue syndrome, there are no specific measures to take in terms of prevention of the syndrome. The mild cases frequently go unnoticed, unreported or they are disregarded as normal. This results in the worsening of the disease into moderate or severe forms. The only solution is rigorous treatment of the symptoms and slow and steady therapy<a href="#accordion">[10]</a>. 
&nbsp;

Research conducted by the scientists at University of Otago uncovered another virus that triggered chronic fatigue syndrome in many people. Individuals who suffered for a longer time from <a href="https://www.merisehat.pk/disease/covid-19" target="_blank">COVID </a>than the usual 7-14 days of infections were reported to have suffered from some sort of fatigue syndromes. The virus was also found to have triggered a similar pattern of bodily changes and most importantly the virus caused similar neuroinflammation that is seen in chronic fatigue syndrome<a href="#accordion">[13]</a>.

DePaul University reported in their research on the younger demographic regarding the prevalence of chronic fatigue syndrome. The research discussed the chances of a higher number of young individuals possibly suffering from CFS. Only 5% of the youth that was reported to have CFS was previously diagnosed. People of color were believed to have more unreported cases of youth CFS than white people<a href="#accordion">[5]</a>.

&nbsp;

Key Points

<ul><li>Chronic fatigue syndrome is a highly complex disorder that is characterized by an individual’s inability to perform basic daily life tasks due to fatigue and severe tiredness.</li><li>The root cause of CFS is unknown, which is why the treatment of the disorder revolves around the symptoms. There is no known cure yet.</li><li>Individuals suffering from highly severe cases of CFS require caretakers and it gets worsened to the point where the individuals are unable to perform basic tasks like eat or use the toilet.</li><li>Women are 4 times more likely to suffer from CFS as compared to men.</li><li>People who are 40-60 years old are at a higher risk of getting CFS.</li><li>Viruses such as Epstein-Barr virus, human herpes virus etc. are known contributing agents towards the disorder. New research suggests long-<a href="https://www.merisehat.pk/disease/covid-19" target="_blank">COVID </a>to cause the same impact on the nervous system as CFS does.</li></ul>

[1] Arefa Cassoobhoy, M. M., 2020. What Makes Chronic Fatigue Syndrome More Likely?. [Online]

[2] Healthline, 2020. CFS (Chronic Fatigue Syndrome). [Online]

[3] Healthline, 2020. CFS (Chronic Fatigue Syndrome). [Online]

[4] Kamaldeep S Bhui, S. D. D. A. J. N. S. W. a. P. D. W., 2011. Chronic fatigue syndrome in an ethnically diverse population: the influence of psychosocial adversity and physical inactivity. BMC Med, 9(26).

[5] Leonard A. Jason, B. Z. K. M. S. C. T. J. C. S. B., 2020. The Prevalence of Pediatric Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in a Community-Based Sample. Child & Youth Care Forum, Volume 49, p. pages563–579.

[6] Mayo Clinic, 2022. Chronic fatigue syndrome. [Online]

[7] Mayo Clinic, 2022. Chronic fatigue syndrome. [Online]

[8] NHS, 2021. Diagnosis - Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). [Online]

[9] Poole, J., n.d. Prevention and outlook for chronic fatigue syndrome. [Online]

[10] Poole, J., n.d. What are the risk factors and complications of chronic fatigue syndrome?. [Online]

[11] Prevention, C. f. D. C. a., 2021. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. [Online]

[12] Sapra, A. & Bhandari., P., 2022. Chronic Fatigue Syndrome. StatPearls.

[13] Warren Tate, M. W. E. S. A. H. K. P. C. E. A. B. A. C., 2022. Molecular Mechanisms of Neuroinflammation in ME/CFS and Long COVID to Sustain Disease and Promote Relapses. Frontiers in Neurology, 2022, Volume 13, p.