Chronic Fatigue Syndrome(CFS) is an emerging illness characterized
by debilitating fatigue (experienced as exhaustion and extremely poor
stamina), neurological problems, and a variety of flu-like symptoms.
The illness is also known as chronic fatigue immune dysfunction
syndrome (CFIDS), and outside of the USA is usually known as myalgic
encephalomyelitis (ME). In the past the syndrome has been known as
chronic Epstein-Barr virus (CEBV).
Some patients are bedridden; others consider themselves fortunate if
they can work or attend school at least part time, since any exertion
typically worsens their symptoms. Many are denied disability insurance
benefits because doctors and employers believe they are lazy or have a
mental illness rather than a serious physical condition.
Symptoms include fatigue, substantial impairment of short-term
memory or concentration, sore throat, tender lymph nodes, muscle and
joint pain, headaches, unrefreshing sleep, and fatigue lasting more
than 24 hours following exertion.
CFS is diagnosed when these symptoms persist for more than six
months and cannot be explained by any other medical or psychological
condition.
Many veterans of the Persian Gulf war have a symptom complex that
has been determined by scientists to be virtually identical to CFS.
Research is being done on many fronts, from cardiology to immunology
to endocrinology, but the disease remains a mystery. Even the most
promising treatments seem to work only for some patients and improve
their lives by only small degrees.
It is not improved by bed rest and may be worsened by physical or
mental activity. Persons with CFS must often function at a
substantially lower level of activity than they were capable of before
the onset of illness. In addition to these key defining
characteristics, patients report various nonspecific symptoms,
including weakness, muscle pain, impaired memory and/or mental
concentration, insomnia, and post-exertional fatigue lasting more than
24 hours. In some cases, CFS can persist for years. The cause or causes
of CFS have not been identified and no specific diagnostic tests are
available. Moreover, since many illnesses have incapacitating fatigue
as a symptom, care must be taken to exclude other known and often
treatable conditions before a diagnosis of CFS is made.
A number of illnesses have been described that have a similar
spectrum of symptoms to CFS. These include fibromyalgia syndrome,
myalgic encephalomyelitis, neurasthenia, multiple chemical
sensitivities, and chronic mononucleosis. Although these illnesses may
present with a primary symptom other than fatigue, chronic fatigue is
commonly associated with all of them.
People diagnosed with CFS often describe its onset as sudden but not
alarming because many of the syndrome's symptoms--headache, tender
lymph nodes, fatigue and weakness, muscle and joint aches, inability to
concentrate--mimic those of the flu. But whereas flu symptoms usually
go away in a few weeks, CFS symptoms either persist or recur frequently
for more than six months.
For many people, CFS begins after an acute infection such as a cold,
bronchitis, hepatitis, or an intestinal bug. For some, it follows a
bout of mononucleosis, the "kissing disease" that temporarily saps the
energy of teenagers and young adults. In others, CFS develops more
gradually, with no clear triggering event. Often a patient reports that
the illness emerged during a period of high stress.
Contrary to the popular stereotype, CFS is not a new "yuppie flu."
Similar syndromes, known by different names, date back to the late
1800s. The modern stereotype arose because those who sought help for
and stimulated scientific interest in CFS in the early 1980s were
mainly well-educated, affluent women in their thirties and forties.
Since then, physicians have seen the syndrome in people of all ages,
races, and socioeconomic classes from several countries around the
world.
Still, CFS is diagnosed two to four times more often in females than
in males, which may be the result of biological, psychological, and
social influences. For example, a real gender difference may exist in
CFS, similar to diseases such as lupus and multiple sclerosis that
affect more women than men. Or, women may be more likely than men to
consult doctors about CFS-like symptoms. Also, some members of the
medical community and the public remain unaware or skeptical of the
syndrome. An increasingly diverse patient population will likely emerge
as more physicians recognize CFS as a legitimate disorder.
There is not yet any consensus on a treatment protocol for CFS. The following appear to be typical prescriptions:
- Teaching the patient energy management and recognition of limits
- Low dose tricyclic anti-depressants such as doxepin and amitriptyline, for sleep disorder, and muscle and joint pain
- NSAIDs such as ibuprofen and naproxen for headache, and muscle and joint pain.
Other treatments often prescribed are Klonopin, intra-muscular gamma
globulin (IMgG), nutritional supplements (particularly anti-oxidants,
B-vitamins generally and B-12 specifically), herbs, and acupuncture.
A variety of vitamin supplements, medications, and other substances
have been described as having potential therapeutic benefits for CFS
patients. Many of the treatments recommended for CFS patients are
intended to provide relief for symptoms of this condition. However,
some proposed treatments are unproven and potentially dangerous. As a
service to CFS patients and other interested persons, this section
provides some basic information about different therapies that have
been used for the treatment of CFS patients. These descriptions are
intended to be used only for general informational purposes. Decisions
regading the use of these or other treatments should be made only in
consultation with a physician. If you have doubts about a particular
treatment, contact your local medical society, university medical
school, or another physician for additional information.
Pharmacologic therapy is directed toward the relief of specific
symptoms experienced by the individual patient. Patients with CFS
appear particularly sensitive to drugs, especially those that affect
the central nervous system. Thus, the usual treatment strategy is to
begin with very low doses and to escalate the dosage gradually as
necessary.
Prescription medications
Low-dose Tricyclic Agents: Tricyclic agents are sometimes prescribed for CFS patients to improve sleep and to relieve mild, generalized pain.
Antidepressants: Antidepressants have been used to treat
depression in CFS patients, although non-depressed CFS patients
receiving treatment with serotonin reuptake inhibitors have been found
by some physicians to benefit from this treatment as well or better
than depressed patients.
Anxiolytic agents: Anxiolytic agents are used to treat panic disorder in CFS patients.
Nonsteroidal Anti-inflammatory Drugs: These drugs may be used to relieve pain and fever in CFS patients. Some are available as over-the-counter medications.
Dietary Supplements and Herbal Preparations
General Comments: A variety of dietary supplements and herbal
preparations are claimed to have potential benefits for CFS patients.
With few exceptions, the effectiveness of these remedies for treating
CFS patients has not been evaluated in controlled trials. Contrary to
common belief, the "natural" origin of a product does not ensure
safety. Dietary supplements and herbal preparations can have potential
side reactions and some can interfere or interact with prescription
medications. CFS patients should seek the advice of their physician
before using any unprescribed remedy.
Vitamins, Coenzymes, Minerals: Preparations that have been
claimed to have benefit for CFS patients include adenosine
monophosphate, coenzyme Q-10, germanium, glutathione, iron, magnesium
sulfate, melatonin, NADH, selenium, l-tryptophan, vitamins B12, C, and
A, and zinc. An early CFS study found reduced red blood cell magnesium
sulfate in CFS patients, but two subsequent studies have found no
difference between patients and healthy controls. The therapeutic value
of all these preparations has not been validated.
Herbal Preparations: Plants are known sources of pharmacological materials. However, unrefined plant preparations contain variable levels of the active compound as well as
many irrelevant, potentially harmful substances. Preparations that have been claimed to have benefit to CFS patients include astragalus, borage seed oil, bromelain, comfrey, Echinacea.html">echinacea, garlic, Ginkgo biloba, ginseng, primrose oil, quercetin, St. Johns Wort, and Shiitake
mushroom extract. Only primrose oil was evaluated in a controlled
study, and the beneficial effects noted in CFS patients have not been
independently confirmed. Some herbal preparations, notably comfrey and
high-dose ginseng, have recognized harmful effects.
The
nutrients mentioned above reflect the major nutritional supplements
that may help the condition. Please do remember however that
nutritional supplementation is an adjunct to medical treatment and in
no way replaces medical treatment.
