Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is a complex condition characterised by fatigue and exhaustion. Its cause is unknown, although it often follows a viral infection.

In New Zealand, the condition is sometimes referred to as Tapanui flu, named after an Otago town where a number of people displayed debilitating fatigue in the early 1980s.

The condition is also known as myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVS), chronic fatigue immune dysfunction syndrome (CFIDS), and more recently systemic exertion intolerance disease (SEID).

Symptoms

CFS differs from the more typical types of fatigue in that it interferes with a person’s ability to participate in the activities of everyday life, sometimes for long periods of time. It can become disabling but does not appear to be progressive or life threatening.

Chronic fatigue syndrome can occur at any age; however, it most commonly affects people in their 40s and 50s. It occurs more commonly in women than in men.

The combination, nature, and severity of symptoms can vary between individuals. In some people, there may be periods of relative wellbeing and periods where symptoms are problematic. For others, symptoms may be constant and severe.

Symptoms may include:

• Ongoing, flu-like fatigue
• Exercise may increase symptoms
• Impaired memory or concentration
• Depression
• Irritability
• Muscle and joint pain
• Sleep disturbances (eg: insomnia)
• Swollen lymph nodes (glands)
• Headaches
• Sore throat
• Gastrointestinal problems (eg: irritable bowel syndrome).

Causes

While the causes of CFS are not fully understood, it is known that many cases develop after a viral illness (eg: glandular fever, viral meningitis, gastroenteritis). However, a direct relationship between viral infection and CFS not yet been determined.

Research studies have indicated that other factors may play a role in the development of the condition, including immune system abnormalities, psychological disorders, hormone imbalances and environmental factors.

There is some thought that CFS may be caused by multiple factors, rather than one single factor, although research studies have yet to conclusively confirm this.

Diagnosis

There is no one laboratory test that can help make the diagnosis, though tests may be performed to rule out other medical conditions that have similar symptoms.

For example, sleep studies can determine whether chronic fatigue is caused by a sleep disorder such as insomnia, obstructive sleep apnoea, or restless leg syndrome. Blood tests can determine whether fatigue is caused by medical conditions such as anaemia, diabetes, or underactive thyroid (hypothyroidism).

Fatigue is also a symptom of mental health conditions such as depression, anxiety, and schizophrenia, and a counsellor can determine whether one of these conditions is the cause of fatigue.

Other chronic diseases such as HIV/AIDS and inflammatory bowel diseases (eg: Crohn’s disease, ulcerative colitis) also cause persistent fatigue.

Fibromyalgia, which has the primary symptoms of chronic muscle pain and fatigue, can be differentiated from CFS by the presence of trigger points, which are not a feature of CFS.

A diagnosis of CFS requires the presence of unexplained persistent fatigue for six months or more and at least four of the following other signs and symptoms:

• Impaired memory or concentration
• Sore throat
• Enlarged or tender lymph nodes
• Unexplained muscle pain
• Pain in multiple joints
• Headaches (new type, pattern, or severity)
• Non-refreshing sleep
• Feeling unwell for more than 24 hours after physical or mental exercise.

Treatment

While there is no proven treatment or cure for CFS, the condition can be managed using a variety of measures. These include:

Conservation of energy and gentle exercise

To avoid overexertion, daily activities should be prioritised so the most tiring tasks are done at the best time of the day. Plan to have a quiet day after a busy one. Resting regularly during the day for even brief periods (such as 5 to 10 minutes) can be helpful.

Unlike depression, where exercise may help to alleviate symptoms, exercise may worsen symptoms for people with CFS. That doesn't mean exercise should be avoided - instead, it should be done gently and not all at once.

A physical therapist can help determine what exercises are best, gradually increasing the level of exercise over time. A gentle exercise programme may begin with range-of-motion and stretching exercises for just a few minutes a day.

Relaxation and stress management

Finding methods of relaxation and stress management can be helpful in reducing symptoms in some people. Stress reduction may be achieved through techniques such as meditation, mindfulness, biofeedback, yoga and tai chi.

Some people with CFS find talking about the condition with family and friends, so they understand the implications of the condition, can also be helpful. Some people may find it helpful to work with a professional counsellor or psychologist to develop strategies to cope with CFS.

Diet

Eat a balanced diet with regular meals and avoid high sugar snacks. For some people with CFS, the elimination of problem foods and environmental chemicals may be beneficial.

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) can be helpful in relieving pain and headaches. Low doses of antidepressant medications may be prescribed in some cases. As they tend to have slight sedative affects, they can assist with sleep as well as treating depression.

Support and information

The Associated New Zealand Myalgic Encephalomyelitis Society (ANZMES) is the national organisation providing information for people who have ME/CFS.
Phone: (09) 269 6374 or (03) 471 6203
E-mail: [email protected]
Website: www.anzmes.org.nz

References

ANZMES (Date not stated). What is ME? (Web Page). Auckland: Associated New Zealand Myalgic Encephalitis Society (ANZMES). http://anzmes.org.nz/what-is-me/ [Accessed: 04/02/20]
Roberts, J. R. (2018). Chronic fatigue syndrome (CFS) [Web Page]. Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/235980-overview [Accessed: 05/02/20].
Mayo Clinic (2018). Chronic fatigue syndrome (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/basics/definition/con-20022009 [Accessed: 05/02/20]
O’Toole, M.T. (Ed.) (2017). Chronic fatigue syndrome (CFS). Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.

Last Reviewed – March 2020

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