Things to Know About Chronic Fatigue Syndrome
By Sara Bennett, BSN RN
Two years ago, one of my patients, Sarah, came down with what she thought was a cold. She felt tired, had a sore throat a fever and even a slight cough. She was a busy professional so she thought a good week of rest would fix the problem. But instead of getting better, she got worse. This time, she also had headaches and dizziness. She couldn’t figure out what was happening. After months of the same lingering symptoms, Sarah went to her doctor where she was diagnosed with chronic fatigue syndrome.
Chronic fatigue syndrome (CFS) can be devastating to patients and their families. Between 836,000 and 2.5 million Americans are affected by CFS (Ganiats, 2015). CFS is often overlooked or misdiagnosed by clinicians because the symptoms are vague and similar to so many other illnesses (Centers of Disease Control and Prevention [CDC], 2012). Fatigue is the most prominent feature of CFS, as its name suggests, but accompanied by other symptoms (CDC, 2012). The fatigue is severe and incapacitating. It doesn’t improve with bed rest or sleep and is worsened by physical activity or mental exertion (CDC, 2012). The symptoms used to diagnose CFS that accompany the fatigue are increased malaise following physical activity or mental exertion, problems with sleep, difficulties with memory or concentration, persistent muscle pain, joint pain without redness or swelling, headaches, tender lymph nodes in the neck or armpit, and/or sore throat that persists for at least six months (CDC, 2012). In general, CFS patients may also experience brain fog; difficulty maintaining an upright position; dizziness; balance problems; fainting; allergies or sensitivities to foods, odors, chemicals, medications, or noise; irritable bowel; chills and night sweats; visual disturbances; and/or depression or mood problems, like irritability, mood swings, anxiety, and panic attacks (CDC, 2012).
Causes of CFS are unknown; however, there are theories to suggest it is due to Epstein-Barr virus, human herpes virus-6, or inflammation in the nervous system due to faulty immune system responses (National Library of Medicine [NLM], 2014). Age, previous illness, stress, genetics, and environmental factors are also thought to play a role in the development of CFS (NLM, 2014). CFS is most prevalent in women ages 30 to 50 years of age (NLM, 2014).
The severity of CFS varies from patient to patient. Some can maintain active lives with their families, while others are severely limited in their work, school, and family activities for periods of time (CDC, 2012). CDC studies have shown CFS to be as debilitating as multiple sclerosis, lupus, rheumatoid arthritis, heart disease, end-stage renal disease, chronic obstructive pulmonary disease, and similar chronic conditions (CDC, 2012). CFS often affects patients cyclically with periods of illness followed by periods of well-being, which makes CFS difficult to manage (CDC, 2012).
Diagnosis is based on ruling out other possible causes for the symptoms, such as drug dependence, immune or autoimmune disorders, infections, muscle or nerve disorders, endocrine disorders, tumors, heart disease, kidney disease, liver disease, or psychiatric illnesses (NLM, 2014). A diagnosis must include absence of other causes of fatigue, at least four CFS-specific symptoms, and extreme, long-term fatigue (NLM, 2014).
There is no current cure for CFS. The goal of treatment is to relieve symptoms. A combination of cognitive-behavioral therapy and graded exercise for certain patients; healthy diet; sleep management techniques; medications to reduce pain, discomfort, and fever; medications to treat anxiety; and medications to treat depression (NLM, 2014). People with CFS should be encouraged to maintain active social lives with mild physical exercise (NLM, 2014). Patients should also be advised to avoid doing too much on days when feeling tired; balancing time between activity, rest, and sleep; breaking big tasks into smaller, more manageable ones; and spreading out more challenging tasks throughout the week (NLM, 2014). Relaxation and stress-reduction techniques have been helpful in managing chronic pain and fatigue but are not used as the primary treatment of CFS (NLM, 2014).
Centers for Disease Control and Prevention. (2012). Chronic Fatigue Syndrome: Symptoms. Retrieved from http://www.cdc.gov/cfs/symptoms/
Ganiats, T.G. (2015). Redefining the Chronic Fatigue Syndrome. Annals of Internal Medicine, 162(9), 653-654. doi:10.7326/M15-0357
National Library of Medicine. (2014). Chronic fatigue syndrome. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/001244.htm