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PostSubject: Chronic fatigue syndrome   Chronic fatigue syndrome EmptyThu Jan 20, 2011 3:12 pm

Chronic fatigue syndrome
Filed under: Boomer's Health
Chronic fatigue syndrome (CFS) is a complicated disorder characterized
by extreme fatigue that may worsen with physical or mental activity, but
doesn't improve with rest. Although there are many theories about what
causes this condition — ranging from viral infections to psychological
stress — in most cases the cause is still unknown.

Because its symptoms are difficult to measure, CFS wasn't widely
accepted as a real medical condition for several years. Today, however,
doctors and researchers agree that this chronic condition should be
taken seriously.

Although an underlying cause often isn't found, effective treatments for
the signs and symptoms of CFS are available. Many people recover from
chronic fatigue syndrome over time.


People with chronic fatigue syndrome may experience a variety of signs
and symptoms that come and go frequently with no identifiable pattern.

Primary signs and symptoms
Chronic fatigue syndrome has eight official symptoms, plus the central symptom that gives the condition its name:

* Fatigue
* Loss of memory or concentration
* Sore throat
* Painful and mildly enlarged lymph nodes in your neck or armpits
* Unexplained muscle pain
* Pain that moves from one joint to another without swelling or redness
* Headache of a new type, pattern or severity
* Unrefreshing sleep
* Extreme exhaustion lasting more than 24 hours after physical or mental exercise

Additional signs and symptoms
In addition, people with chronic fatigue syndrome have reported other
various signs and symptoms that aren't part of the official definition.
These include:

* Abdominal pain
* Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise
* Bloating
* Chest pain
* Chronic cough
* Diarrhea
* Dizziness, balance problems or fainting
* Dry mouth
* Earache
* Irregular heartbeat
* Jaw pain
* Morning stiffness
* Nausea
* Chills and night sweats
* Psychological problems, such as depression, irritability, anxiety disorders and panic attacks
* Shortness of breath
* Tingling sensations
* Visual disturbances, such as blurring, sensitivity to light, eye pain and dry eyes
* Weight loss or gain

If you have chronic fatigue syndrome, your symptoms may peak and become
stable early on, and then come and go over time. Some people go on to
recover completely, while others grow progressively worse.

When to see a doctor
Fatigue can be a symptom of many illnesses, such as infections or
psychological disorders. In general, see your doctor if you have
persistent or excessive fatigue.

The earlier a person with CFS receives medical treatment the greater the
likelihood that the illness will resolve. In addition, severe fatigue
that prevents you from fully participating in activities at home, work
or school may be a symptom of an underlying medical problem.


Of all chronic illnesses, chronic fatigue syndrome is one of the most
mysterious. Several possible causes have been proposed, including:

* Depression
* Iron deficiency anemia
* Low blood sugar (hypoglycemia)
* History of allergies
* Virus infection, such as Epstein-Barr virus or human herpesvirus 6
* Dysfunction in the immune system
* Changes in the levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands
* Mild, chronic low blood pressure (hypotension)
* An autoimmune process causing inflammation of certain nervous-system pathways
* A viral infection complicated by a dysfunctional immune response
* A low blood pressure disorder that triggers the fainting reflex

Symptoms similar to those of chronic fatigue syndrome sometimes have straightforward, correctable causes, such as:

* An active, identifiable medical condition that often results in fatigue
* Medication side-effects

Risk factors

Women are diagnosed with chronic fatigue syndrome at least four times as
often, but sex isn't a proven risk factor for this condition. It may be
that women are simply more likely to report their symptoms to a doctor.

The condition is most common in people in their 40s and 50s, but it can affect people of all ages.

Because the cause of the condition is unknown, doctors have yet to determine and confirm definite risk factors for the disease.


Possible complications of chronic fatigue syndrome include:

* Depression, related both to symptoms and lack of diagnosis
* Side effects and adverse reactions related to medication treatments
* Side effects and adverse reactions associated with lack of activity (deconditioning)
* Social isolation caused by fatigue
* Lifestyle restrictions
* Missing work

Preparing for your appointment

You're likely to start by first seeing your family doctor or primary
care provider. Because the symptoms of chronic fatigue syndrome can
mimic so many other health problems, you may need patience while waiting
for a diagnosis. Your doctor must rule out a number of other illnesses
before diagnosing chronic fatigue syndrome.

Here's some information to help you prepare for your first appointment, and what to expect from your doctor.

What you can do

* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
appointment. For example, while fatigue may be affecting you most, other
symptoms, such as memory problems or headache, are important to share
with your doctor.
* Write down key personal information, including any recent changes
or major stressors in your life. These psychological challenges can play
a very real role in your physical well-being.
* Make a list of your key medical information, including any other
conditions for which you're being treated and the names of any
medications, vitamins or supplements you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to soak up all the information provided to you during
an appointment. Someone who accompanies you may remember something that
you missed or forgot.
* Write down questions to ask your doctor. Creating your list of
questions in advance can help you make the most of your time with your

For CFS, some basic questions to ask your doctor include:

* What are the possible causes of my symptoms or condition?
* What tests do you recommend?
* If these tests don't pinpoint the cause of my symptoms, what additional tests might I need?
* On what basis would you make a diagnosis of chronic fatigue syndrome?
* Are there any treatments or lifestyle changes that could help my symptoms now?
* What activity level should I aim for while we're seeking a diagnosis?
* Do you recommend that I also see a mental health provider?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to spend
more time on. Your doctor may ask:

* What are you symptoms? In what part of your body do they occur?
* When did you first notice these symptoms?
* Have your symptoms gotten worse over time?
* Does anything make your symptoms better or worse?
* Do your symptoms include any problems with memory or concentration?
* Do your symptoms include problems with sleep?
* How often do you feel down or depressed?
* How often do you feel stressed or anxious?
* How much do your symptoms limit your ability to function? For
example, have you ever had to miss school or work because of your
* Are your symptoms causing difficulty in your marriage or other important personal relationships?
* What treatments have you tried so far for this condition? How have they worked?
* Have you been diagnosed with any other medical conditions, including mental health problems?
* What do you think is causing your pain?

What you can do in the meantime
While you're waiting for your appointment, you may find some relief by
using over-the-counter pain relievers such as aspirin, ibuprofen (Advil,
Motrin, others) or acetaminophen (Tylenol, others).

To boost your chances of sleeping well at night, skip naps during the
day and go to bed at a regular time each night. Other adjustments that
may help you rest well at night include light exercise and stretching
several hours or more before bedtime, as well as avoiding caffeine,
alcohol and nicotine.

Tests and diagnosis

To meet the diagnostic criteria of chronic fatigue syndrome, you must
have unexplained, persistent fatigue for six months or more, along with
at least four of the eight primary signs and symptoms.

Primary signs and symptoms of CFS include:

* Loss of memory or concentration
* Sore throat
* Painful and mildly enlarged lymph nodes in your neck or armpits
* Unexplained muscle pain
* Pain that moves from one joint to another without swelling or redness
* Headache of a new type, pattern or severity
* Unrefreshing sleep
* Extreme exhaustion lasting more than 24 hours after physical or mental exercise

There's no diagnostic or laboratory procedure to confirm the presence of
chronic fatigue syndrome. The diagnosis is based on exclusion. This
means that before arriving at the diagnosis, your doctor has ruled out
other well-defined diseases or conditions that may be causing your
fatigue and related symptoms. Conditions your doctor may rule out or
identify as contributing factors early on include:

* Low levels of thyroid hormone (hypothyroidism)
* Sleep apnea
* Depression
* Eating disorders
* Substance abuse
* A relapse of a previously treated illness, such as cancer
* Severe obesity, defined by a body mass index (BMI) of 40 or greater

Treatments and drugs

There's no specific chronic fatigue syndrome treatment. In general,
doctors aim to relieve signs and symptoms by using a combination of
treatments, which may include:

* Moderating daily activity. Your doctor may encourage you to slow
down and to avoid excessive physical and psychological stress. However,
too much rest can make you weaker, worsening your long-term symptoms.
Your goal should be to maintain a moderate level of daily activity and
gently increase your stamina over time.
* Gradual but steady exercise. With the help of a physical
therapist, you may be advised to begin an exercise program that slowly
becomes more challenging. Research has proved that gradually increasing
exercise can improve the symptoms of chronic fatigue syndrome.
* Cognitive behavior therapy. This treatment, often used in
combination with graduated exercise, also has been found to improve the
symptoms of chronic fatigue syndrome. In cognitive behavior therapy, you
work with a mental health provider to identify negative beliefs and
behaviors that might be delaying your recovery and replace them with
healthy, positive ones.
* Treatment of depression. If you're depressed, medications such as
tricyclic antidepressants and selective serotonin reuptake inhibitors
(SSRIs) may help. Antidepressants may also help improve sleep and
relieve pain. Commonly prescribed antidepressants include amitriptyline
(Amitid, Amitril), desipramine (Norpramin) and nortriptyline (Aventyl,
Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil)
and sertraline (Zoloft).
* Treatment of existing pain. Acetaminophen (Tylenol, others) and
nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and
ibuprofen (Advil, Motrin, others) may be helpful to reduce pain and
* Treatment of sleep problems. Changing your sleep habits may be
enough to help you start getting restorative nighttime sleep. But if
techniques such as sticking with a regular bedtime, skipping daytime
naps, and avoiding substances such as caffeine and alcohol don't help,
your doctor may prescribe a short course of sleep medication.
* Treatment of allergy-like symptoms. Antihistamines such as
fexofenadine (Allegra) and cetirizine (Zyrtec), and decongestants that
contain pseudoephedrine (Sudafed) may relieve allergy-like symptoms such
as runny nose.
* Treatment of low blood pressure (hypotension). The drugs
fludrocortisone (Florinef) and atenolol (Tenormin) may be useful for
certain people with chronic fatigue syndrome.
* Treatment for problems of the nervous system. Symptoms such as
dizziness and extreme skin tenderness can sometimes be relieved by
clonazepam (Klonopin). Your doctor may prescribe medications such as
lorazepam (Ativan) and alprazolam (Xanax) to relieve symptoms of

Experimental therapies
Research aimed at finding new treatments for chronic fatigue syndrome has included studies of the following medications:

* Methylphenidate (Ritalin, Concerta, others). This psychostimulant
appears to boost and balance levels of the brain chemicals called
neurotransmitters. It's commonly used to treat
attention-deficit/hyperactivity disorder (ADHD). One study found that
methylphenidate lessened fatigue and improved concentration in some
people with chronic fatigue syndrome.
* Corticosteroids. Some studies have found that oral hydrocortisone
may improve symptoms of chronic fatigue syndrome, while other studies
have found no benefit.
* Immune globulins and interferons. These medications are used to
boost your immune system's ability to fight infection. Studies have not
found them to be consistently effective in treating chronic fatigue
syndrome, and some participants have experienced severe side effects.
* Antiviral drugs, such as acyclovir. The possible connection
between chronic fatigue syndrome and Epstein-Barr virus led researchers
to test whether powerful antiviral medications could improve the
symptoms of chronic fatigue syndrome. This approach has not been found
effective, and the connection between Epstein-Barr virus and chronic
fatigue syndrome has since been disproved.
* Cholinesterase (ko-lin-ES-tur-ase) inhibitors, such as
galantamine. These drugs improve the effectiveness of acetylcholine, a
chemical messenger that is believed to be important for memory, thought
and judgment. Galantamine is used in the treatment of Alzheimer's
disease, but it has not been found beneficial for chronic fatigue

Lifestyle and home remedies

Learning how to manage fatigue can help you improve your level of
functioning and your quality of life despite your symptoms. You may work
with a rehabilitation medicine specialist who can teach you how to plan
activities to take advantage of times when you usually feel better.

These important self-care steps can help you to maintain good general health:

* Reduce stress. Develop a plan to avoid or limit overexertion and
emotional stress. Allow yourself time each day to relax. That may mean
learning how to say no without guilt.
* Get enough sleep. Getting sufficient sleep is essential. In
addition to allotting enough time for sleep, practice good sleep habits,
such as going to bed and getting up at the same time each day and
limiting daytime napping.
* Exercise regularly. You may need to start slowly and build up
gradually. But exercising regularly often improves symptoms. Many people
find exercises such as walking, swimming, biking and water aerobics to
be helpful. A physical therapist may help you develop a home-exercise
program. Stretching, good posture and relaxation exercises also can be
* Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days.
* Maintain a healthy lifestyle. Try to eat a balanced diet, drink
plenty of fluids, limit your caffeine intake, stop smoking, get adequate
rest, and exercise regularly. Find a hobby or career that's enjoyable
and fulfilling for you.

Alternative medicine

Many alternative therapies have been promoted for chronic fatigue
syndrome, but few have been evaluated in clinical trials. Among those
that have been studied, two that may offer benefit for CFS include.

* D-ribose. Also called ribose, this form of sugar is an essential
energy source for your cells. Scientists believe that impaired cellular
metabolism — some kind of disorder in the way your cells do their work —
may play a role in chronic fatigue syndrome. Some research has found
that natural D-ribose supplements may significantly improve energy and
decrease pain associated with chronic fatigue syndrome.
* Acupuncture. Acupuncture has been evaluated as a treatment for the
symptoms of fibromyalgia, a disease that is considered similar to CFS
and is also characterized by fatigue and muscle soreness. Studies
suggest that acupuncture may decrease fatigue, pain, anxiety and other
symptoms associated with CFS.

Other complementary therapies that may reduce anxiety and promote well-being in people with chronic fatigue syndrome include:

* Deep-breathing and muscle-relaxation techniques
* Meditation
* Massage and healing touch
* Movement therapies such as stretching, yoga and tai chi

Natural doesn't mean safe
Makers of various dietary supplements and herbal remedies claim these
substances have potential benefits for people with CFS. However, in most
cases the effectiveness of these therapies hasn't been proved in
controlled studies.

Though a product may be of "natural" origin, that origin doesn't ensure
its safety. Dietary supplements and herbal preparations can have
potentially harmful side effects and may dangerously interfere or
interact with prescription medications.

Talk to your doctor before using any unprescribed remedy or new complementary therapy.

Coping and support

The experience of chronic fatigue syndrome varies from person to person.
For many people, however, the symptoms are more bothersome early in the
course of the illness and then gradually decrease. Some people recover
completely with time. Emotional support and counseling may help you and
your loved ones deal with the uncertainties and restrictions of chronic
fatigue syndrome.

You may find it therapeutic to join a support group and meet other
people with chronic fatigue syndrome. Support groups aren't for
everyone, and you may find that a support group adds to your stress
rather than relieving it. Experiment and use your own judgment to
determine what's best for you.

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