(C.F.S.) is one of several names given to a poorly understood, highly debilitating disorder of uncertain cause/causes, which is thought to affect approximately 4 per 1,000 adults in the United States and other countries, and a smaller fraction of children.

The disorder is marked by chronic mental and physical exhaustion, often severe, and by other specific symptoms, arising in previously healthy and active persons. Despite promising avenues of research, there remains no objective assay or pathological finding which is widely accepted to be diagnostic of C.F.S.

It remains largely a diagnosis of exclusion, made on the basis of patient history and symptomatic criteria, although a number of tests exist which can help aid diagnosis. Although there is agreement on the genuine threat to health, happiness, and productivity posed by C.F.S., various physicians’ groups, researchers, and patient activists champion very different diagnostic criteria, etiologic hypotheses, and favored treatments, resulting in ongoing controversy about nearly all aspects of the disorder.

Chronic fatigue syndrome is not the same as "chronic fatigue”. While fatigue is a common symptom in many illnesses, C.F.S. is a multi-symptom disease and is relatively rare by comparison. Definitions require a number of features, the most common being severe mental and physical exhaustion which is "unrelieved by rest" (according to the 1994 Fukuda definition), and may be worsened by even trivial exertion. Most diagnostic criteria insist that the symptoms must be present for at least six months, and all insist on there being no other cause for them: i.e. the symptoms must be idiopathic, not caused by other medical conditions such as diabetes, hypothyroidism or anemia. C.F.S. patients may report many other symptoms that are not included in all diagnostic criteria, including muscle weakness, cognitive dysfunction, hypersensitivity, orthostatic intolerance, digestive disturbances, depression, poor immune response, and cardiac and respiratory problems.

C.F.S. occurs more often, but not exclusively, in women, for unknown reasons. C.F.S. is most easily diagnosed when formerly active adults become ill, and is most commonly diagnosed in young to middle aged adults, although it is also reported in children, adolescents and the elderly.

Patients report critical reductions in levels of physical activity with the severity of symptoms and disability the same in both genders; but despite a common diagnosis, the functional capacity of C.F.S. patients varies greatly, and chronic pain is strongly disabling in C.F.S. patients. According to the Center for Disease Control, studies show that the disability in C.F.S. patients is comparable to some well-known, very severe medical conditions, such as; multiple sclerosis, AIDS, lupus, rheumatoid arthritis, heart disease, end-stage renal disease, chronic obstructive pulmonary disease (C.O.P.D.) and similar chronic conditions.

While some patients are able to lead a relatively normal life, others are totally bed-bound and unable to care for themselves. Almost all patients find they must drastically reduce their activity from pre-illness levels, regardless of their previous level of athleticism, and must severely modify or give up physical hobbies and exercise. Many patients find themselves unable to work full-time, or at all. A considerable number of C.F.S. cases in many countries are on disability benefits or private insurance, or have made claims and been denied.

One of the most common and recognizable aspects of CFS is what is called "post-exertional malaise". Patients also frequently experience rapid weakening and loss of muscle strength. When people with C.F.S. exert themselves, physically or cognitively beyond their limits in intensity or frequency, their symptoms worsen. The harder the exertion and the longer it lasts, the worse the decompensation will be afterward, and with greater recovery time.

 

 

Although symptoms may increase immediately and proportionally, the decompensation effects usually takes 24 hours or more to reach full extent, and can sometimes take several days or longer to gradually accumulate.

The fatigue must be accompanied by a minimum of 4 of the following eight symptoms: 1. Impairment of short-term memory and concentration
2. Sore throat
3. Tender lymph nodes
4. Muscle pain
5. Multi-joint pain
6. Headaches of a new type, pattern, or severity
7. Un-refreshing sleep or insomnia
8. Post-exertional malaise or fatigue lasting more than 24 hours after exertion.

At this time, no cure for C.F.S. is known. Treatment protocols that attempt to cure CFS are many, usually linked to a presumed cause, but none stand out as promising. Other treatments, that address specific symptoms such as pain, sleep deprivation and food intolerances, and some that affect the metabolism, can have a beneficial effect but do not cure C.F.S. Some management strategies can be effective to reduce the consequences of having C.F.S.

Since C.F.S. symptoms tend to vary over time, in practice it is not always clear if a change in severity is due to a received treatment. The same difficulty arises in research, even while it seems that C.F.S. patients are significantly less susceptible to placebo effects than patients of many other diseases (about 20% v 30%).

Alternative medicine such as acupuncture, orthomolecular or herbal medicine, is sometimes proposed for C.F.S., especially when conventional treatments are poorly tolerated or fail to relieve symptoms.

Several rehabilitation programs have been proposed which involve supervised or self-monitored graded exercise or activity. Such programs are designed to overcome deconditioning, increase strength and cardiovascular health. The program should incorporate considerable education wherein the sufferer learns to start at an appropriate level of activity (based upon intensity and duration) which is incrementally increased, at a rate which does not substantially increase symptoms.

Self-controlled rest and exercise, "pacing": "Pacing" is being advocated by many patients as one of the few really effective means of minimising homeostatic disequilibrium. The principles involve acceptance of the patient’s limitations (by both the patient and any coaches), awareness of the early signals of deterioration e.g. increased cognitive difficulties, pain, clumsiness, muscle weakness, respiratory problems; and stopping exercise/activity before exceeding limitation or "crashing." A good rule of thumb is to never exert more than 70% of capacity. An understanding nurse, doctor or physical therapist may be of help.

Various hormones have been tried from time to time, including specifically steroids (such as cortisol) and thyroid hormones. Though conventional steroidal treatment may produce short-term pain relief, it has not been shown to be of any general benefit. Studies performed by Dr. Jacob Teitelbaum incorporating low-dose cortisol therapy in a have demonstrated positive results, but other studies have shown little benefit from cortisol itself. Thyroid hormones occasionally are effective for certain people who may either have a thyroid hormone deficiency or lack an enzyme that allows them to effectively use thyroid hormones. As Hypothalamic-pituitary-adrenal axis (HPA axis) dysfunction seems to be implicated in C.F.S., standard thyroid tests (including TSH) may not produce accurate results[citation needed]. Therefore, a short trial of either T3, T4, or a combination supplementation may be warranted if clinical signs seem to indicate possible hypothyroidism.