Chronic fatigue syndrome

Causes

The cause of chronic fatigue syndrome is yet to be fully understood. Factors that may be causing or contributing towards the syndrome include:

• Viral infection;
• An immune system disorder;
• Glandular fever;
• Hormonal imbalance;
• Nutritional deficiency;
• Stress;
• Emotional trauma, and;
• Genetic predisposition.

Signs and symptoms

Chronic fatigue syndrome does not necessarily follow a predictable course. Symptoms can change in their severity and frequency between people. Symptoms can also vary for one person at different times.

The main symptom is overwhelming weariness that usually follows exertion. The person quickly becomes very tired physically, and can find it difficult to focus or think clearly.

Other symptoms can vary widely between people, but some of the more typical symptoms may include:

• Anxiety or depression;
• Joint and muscle aches;
• Headache, sore throat, and tender lymph nodes;
• Fevers, night sweats;
• Difficulty sleeping;
• Allergies;
• Upset stomach;
• Weight loss or weight gain, and;
• Rapid pulse and chest pain.

People with a mild form of chronic fatigue syndrome can generally continue their regular lives, but they may need to switch to part-time work or study, reduce their recreational activities, and may need occasional assistance.

The moderate form of chronic fatigue syndrome usually makes it too difficult for a person to continue work or study. They may need considerable help with routine tasks. Quality of sleep can also suffer.

The severe forms of chronic fatigue syndrome typically leave people unable to work or study. Some people may need to use a wheelchair for mobility and may find it very hard to leave the house. They are highly dependent on others.

Severe forms of chronic fatigue affect work performance and the carrying out of routine tasks. 

Methods for diagnosis

There is no single test used to diagnose chronic fatigue syndrome. The diagnosis is made by ruling out other conditions that can cause fatigue, such as:

• Adrenal insufficiency;
• Cancer;
• Fibromyalgia;
• HIV/AIDS;
• Lyme disease;
• Hepatitis C, or;
• Epstein-Barr virus infection.

For a diagnosis of chronic fatigue syndrome, the symptoms need to have been severe enough to significantly impair a person's normal activity level for at least six months (three months in children). The fatigue needs to be:

• Persistent and unexplained;
• Not alleviated by rest, and;
• Not due to ongoing exertion.

Four or more of the following symptoms also need to persist or recur during six or more consecutive months:

• Unrefreshing sleep;
• Sore throat;
• Tender cervical or axillary nodes;
• Muscle pain;
• Headaches (new, more frequent, or more severe);
• Problems with short-term memory or concentration, and;
• Post-exertion tiredness.

Laboratory tests

Your doctor may also perform blood tests to evaluate your overall health and to look for any underlying conditions or problems, such as inflammation or thyroid disorders.

Types of treatment

There is no universally successful treatment for chronic fatigue syndrome. Treatment focuses on managing symptoms to improve the quality of life. The treatment depends on the individual and their specific symptoms.

There is currently no clear evidence that medication or dietary supplements help treat chronic fatigue syndrome.

Graded exercise therapy

This involves working with a trained healthcare professional to establish your baseline activity level, and a program to gradually increase the amount of time you can tolerate physical and mental activities. A target heart rate range is set, to avoid over-exertion.

Although exercise may temporarily worsen symptoms, completely ceasing all exercise can make symptoms worse. There is considerable evidence that graded therapy can help improve tiredness and physical functioning.

Cognitive behaviour therapy

This 'talking therapy' typically involves a series of sessions designed to identify beliefs and behaviours that may be delaying recovery, to alter negative thinking patterns, and to develop alternative ways of thinking and acting.

This therapy has been shown to offer long-term improvement in fatigue and physical function and can help improve school attendance for teenagers with the condition.

Complementary therapy

Acupuncture, massage and yoga may help people to relax, increase their energy, and treat muscular aches and pains.

Potential complications

Complications of this syndrome include depression, social isolation, lifestyle restrictions and increased absences from study or work.

Prognosis

Although there is no known cure for chronic fatigue syndrome, the relief of symptoms is possible, to some extent. The length of the illness is difficult to predict and can vary between people. For some, symptoms may last for months or years, while others may have relapses and periods of remission over a matter of years.

Prevention

There is no known prevention for chronic fatigue syndrome.