| Chronic fatigue syndrome
It’s also known as ME and bewilders most doctors. This is the story so far Chronic fatigue syndrome (CFS) is an illness characterised by prolonged, debilitating fatigue and multiple non-specific symptoms such as headaches, recurrent sore throats, muscle and joint pains and memory and concentration difficulties. Profound fatigue, the hallmark of the disorder, can come on suddenly or gradually and persists or recurs throughout the period of illness. Unlike the short-term disability of say, the flu, CFS symptoms linger for at least six months and often for years. No one knows what causes it. The typical patient seeking medical care for CFS is a woman in her mid-20s to late 40s. However, anyone at any age – male or female – can develop CFS, though cases reported in children under 12 are rare. CFS does not appear to be a new illness, although it has only recently been assigned the name CFS. It is also known as myalgic encephalitis (ME). It is an uncommon illness, and although many adults complain of feeling tired only a few genuinely have CFS. It affects approximately 250,000 people in the UK. Interest in what now is called CFS was renewed in the mid-1980s after several studies found slightly higher levels of antibody to Epstein-Barr virus (EBV) in patients with CFS-like symptoms than in healthy individuals. Most of these patients had experienced an episode of infectious mononucleosis (sometimes called glandular fever) a few years before they began to experience the chronic, debilitating symptoms of CFS. Further investigation revealed that elevated EBV antibodies were not indicators of CFS. Some healthy people have high EBV antibodies and some people with CFS do not. Currently, it is not considered useful to test for antibodies to EBV in a patient with symptoms suggestive of CFS. Some studies have found that allergies are significantly more common in CFS patients than in the general population. Many sufferers have a history of allergies years before the onset of the syndrome. Sometimes patients report a worsening of allergic symptoms or the onset of new allergies after becoming ill with CFS. Because allergies are so common in people with CFS, it is important to identify symptoms caused by allergies so they can be treated independently. Symptoms Besides a debilitating fatigue unrestored by rest, common symptoms of CFS include:
The severity of CFS symptoms varies broadly among individuals. Some patients report mild to moderate symptoms of anxiety or depression. However, it is important to note that 60 per cent of carefully evaluated CFS patients do not have depression or another psychiatric illness. How is it diagnosed? The UK National Institute for Health and Clinical Excellence (NICE) guidelines suggest that a doctor should consider the diagnosis of chronic fatigue syndrome if fatigue has been present for 4 months in an adult, or 3 months in a child (and other possible diagnoses have been excluded) where:
Treatment
Sleep disturbances, pain, gastrointestinal difficulties, allergies and depression may be relieved with prescription and over-the-counter medications. Lifestyle changes may also be necessary. While they cannot cure the symptoms of CFS, they can make life more manageable and enjoyable. Increased rest, the use of stress reduction and management techniques, dietary restrictions, nutritional supplementation and minimal exercise may be recommended by your doctor. Supportive therapy, such as counselling, can also help you to identify and develop effective coping strategies. You may also benefit from keeping an energy diary. Keep a log for several weeks, noting the times when you feel the most fatigued and what activities you performed during the day. This helps some people learn the patterns of their illness and identify factors that may be contributing to fatigue or other symptoms, such as headaches. Schedule naps and adjust your schedule to fit your energy patterns. Perhaps making time to relax and meditate during certain times of the day will be useful. Avoid situations that you know to be physically or psychologically stressful. Work with your doctor on a moderate exercise plan. Some CFS sufferers will experience profound fatigue even after very modest exercise, so start off slowly. Begin with as little as five minutes of moderate exercise, increasing the level of activity slightly every two or three weeks. Diet is also an effective way to take control of your illness. Research suggests that CFS patients benefit from a diet low in animal fat and high in fibre with plenty of fresh fruits and vegetables. Talk to your doctor about foods that will increase your energy levels and help with symptoms. You may also want to avoid certain triggers that aggravate CFS symptoms, such as a chemical, pesticide or household cleaning product. In order to determine your triggers, remove all suspected toxins from your environment, then reintroduce them one by one to pinpoint what may be causing your symptoms. Talk to your doctor about how you can temporarily relieve the flu-like symptoms of CFS with over- the -counter medicines and prescription treatments. He or she may recommend a short course of nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen for muscle aches, joint pain and headaches. Deep massage, stretching and chiropractic treatment may also help minimise symptoms. Treatments to improve sleep and energy levels are also available. Low doses of antidepressants such as amitriptyline, clomipramine and fluoxetine often improve patients’ quality of sleep and help relieve both fatigue and muscle pain. Patients with CFS often respond to lower doses of antidepressant medications than patients with depression. In fact, many CFS patients cannot tolerate the typical doses used to treat depression. It often takes several weeks for these drugs to produce benefits, so be patient and work with your doctor to find the one that is best for you. Support groups can help by setting graded programmes of increasing physical activity, and Cognitive Behaviour Therapy helps the patient to reduce associated depression by teaching a new approach to how they perceive their illness. Prognosis Help is available from: Action for ME |