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chronic fatigue syndrome

Alternative Names
CFS, chronic fatigue and immune dysfunction syndrome

Chronic fatigue syndrome (CFS) is a poorly understood condition that results in severe fatigue and other symptoms.

What is going on in the body?
The cause of CFS is not known, though many theories exist. It is a chronic condition with an unpredictable course. It is not diagnosed until other medical conditions that cause fatigue are excluded. Treatment is limited by a lack of understanding of the disease process itself.

What are the signs and symptoms of the condition?
In an attempt to create a standard for the diagnosis of CFS, certain symptoms must be present before a diagnosis can be made. Fatigue is the main symptom. The fatigue must be severe and last, whether constant or not, for at least 6 months. Someone with CFS has a definite time when the fatigue started; it has not been present for life. This fatigue is not relieved by rest and forces people to reduce their level of activity. Many people describe a sudden onset of fatigue triggered by a physical stress, such as an illness or injury.

A person must also have at least 4 of the following 8 symptoms or signs for CFS to be diagnosed:
  • impaired memory or concentration
  • sore throat
  • tender lymph nodes, or "glands," in the armpit or neck
  • muscle pain
  • joint pain affecting multiple joints
  • new headaches, meaning the headaches did not occur before the person started to have severe fatigue
  • unrefreshing sleep
  • feeling bad or having discomfort after any type of exertion
What are the causes and risks of the condition?
The cause of CFS is unknown. There are many theories, but hard evidence of a cause is not currently available. The main risks of this condition are due to the reduced level of activity. People with CFS may be unable to work or enjoy hobbies or relationships.

What can be done to prevent the condition?
There are no known effective measures to prevent CFS.

How is the condition diagnosed?
The most important part of the diagnosis of CFS is to rule out other causes for fatigue. There are many different medical illnesses that can cause fatigue. These include infections, hormone imbalances, immune system diseases, and even cancer. To rule out other conditions, a history and physical examination are first performed. Multiple blood tests and a urine test are then done to make sure other conditions are not causing the fatigue. Further tests, such as x-ray tests, may depend on the results of the history, examination, and blood or urine tests.

There is no one test that can make a diagnosis of CFS. The diagnosis of CFS is generally made when no other cause for a person's fatigue and other symptoms can be found.

What are the long-term effects of the condition?
The long-term effects of CFS relate to the person's severe fatigue. Affected people may be unable to work or go to school. They may lack the energy to form or keep relationships with other people. This can result in depression and a feeling of hopelessness. Friends and doctors may also have a negative attitude toward a person with CFS. This is because the condition is not well understood and treatment is frustrating for both the affected person and the person giving care.

What are the risks to others?
This condition is not contagious and poses no risks to others.

What are the treatments for the condition?
Treatment must be tailored to fit each person with CFS, depending on symptoms and response to different therapies. There are two types of therapy: behaviour therapy and drug therapy. Behaviour therapy may include:
  • moderate exercise, being careful to avoid overexertion, which can make symptoms worse
  • eating a balanced diet and avoiding caffeine and alcohol
  • relaxation methods, such as meditation and hypnosis
  • attending support group meetings or receiving regular, individual counselling
Drug therapy may include:
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • antidepressants, such as fluoxetine or amitriptyline
Other treatments are directed at more specific symptoms. For example, muscle spasms may respond to stretching exercises or muscle relaxing drugs. Bowel spasms may respond to increased fibre in the diet or drugs to reduce bowel spasm. Certain drugs may help with nasal or sinus congestion.

Because this condition is very difficult to treat, many other unproven therapies may be used or advised, as they may help a person when nothing else works.

What are the side effects of the treatments?
All medications have possible side effects. For example, NSAIDs can cause stomach upset and allergic reactions. Antidepressants may cause problems sleeping, headaches, or stomach upset. Specific side effects depend on the drugs used.

What happens after treatment for the condition?
The course of CFS is very difficult to predict. Fortunately, most people eventually get better with or without treatment, though a cure is often not possible. People may return to normal activities whenever they feel able.

How is the condition monitored?
Affected people are in the best position to monitor the condition. Symptoms and their response to any treatments should be accurately reported to the doctor.

Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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