Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a condition that causes chronic, debilitating fatigue. It continues for at least six months. The fatigue is not relieved by bed rest. People who have CFS perform at a significantly lower level compared to their activity prior to the onset of the illness.

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The cause of CFS is unknown. Some believe there may be a link between CFS and stress, the immune system, toxins, the central nervous system, or activation of latent virus.

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Women are more likely to have CFS than men. It is also more common in people between 25-55 years of age.

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Symptoms vary from person to person. They include:

  • Unexplained, new onset, persistent fatigue that is not relieved with bed rest and often worsens with physical or mental activity
  • Unexplained muscle aches
  • Joint pain without swelling or redness over six months
  • Headaches over six months
  • Trouble with short-term memory or concentration, a “brain fog”
  • Forgetfulness or confusion
  • Irritability, anxiety, panic attacks, mood swings, or depression
  • Sore throat over six months
  • Tender lymph nodes over six months
  • Trouble sleeping or not feeling refreshed after sleep
  • Visual disturbances (eyes sensitive to light, blurring, pain)
  • Reduced activities (social, job-related, educational, and personal)
  • Dizziness, balance problems, or fainting
  • Chills and night sweats
  • Allergies or sensitivities to foods, chemicals, odors, medications, or noise

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The doctor will ask about your symptoms and medical history. A physical exam will be done. There are no specific diagnostic tests for CFS. Your doctor may do several other tests to rule out other conditions that can have similar symptoms. The doctor will look for the following signs to determine if you have CFS:

  • Severe, chronic fatigue for at least six months that is not due to another illness or medical cause, along with:
  • At least four of the following symptoms according to the International Chronic Fatigue Syndrome Study Group Criteria:
    • Impairment of short-term memory or concentration
    • Sore throat
    • Tender lymph nodes
    • Muscle pain
    • Joint pain without swelling or redness
    • Headaches of a new type, severity, or pattern
    • Unrefreshing sleep
    • Prolonged fatigue lasting 24 hours or more after exercise

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The main goal of CFS treatment is to achieve symptom relief.  The goal of physical therapy is to help maintain or increase your capacity for physical activity. A physical therapist will work with you to create an individualized exercise program that focuses on interval activity or graded exercise. The goal is to balance rest and activity to avoid both deconditioning from lack of activity and flare-ups of illness due to overexertion. Effective activity management may help improve mood, sleep, pain, and other symptoms so patients can function better and engage in activities of daily living. Your program may include:

  • Light to low impact activities
  • Strength and conditioning exercises
  • Graded exercises
  • Therapeutic massage
  • Stretching to improve flexibility and range of motion
  • Learning modified ways to complete daily tasks

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There are no guidelines for preventing CFS because the cause is unknown.

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RESOURCES:
  • Centers for Disease Control and Prevention

http://www.cdc.gov/

  • Chronic Fatigue and Immune Dysfunction Syndrome Association of America

http://www.cfids.org/

CANADIAN RESOURCES:
  • Health Canada

http://www.hc-sc.gc.ca/

  • Women’s Health Matters

http://www.womenshealthmatters.ca/

REFERENCES:
  • Chronic Fatigue Syndrome. American Academy of Family Physicians Familydoctor website. Available at: http://familydocto… . Updated November 2010. Accessed December 28, 2012.
  • Chronic Fatigue Syndrome. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/cfs/index.html . Updated May 16, 2012. Accessed December 28, 2012.
  • Chronic Fatigue Syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 10, 2012. Accessed December 28, 2012.
  • Craig T, Kakumanu S. Chronic fatigue syndrome: evaluation and treatment. Am Fam Physician.2002;65(6):1083-1090.
  • Darbishire L, Ridsdale L, Seed PT. Distinguishing patients with chronic fatigue from those with chronic fatigue syndrome: a diagnostic study in UK primary care. Br J Gen Pract. 2003;53(491):441-445.
  • Prins JB, Bleijenberg G, Bazelmans E, et al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicertre randomized controlled trial. Lancet. 2001;357(9259):841-847.
  • Reeves WC, Wagner D, Nisenbaum R, et al. Chronic fatigue syndrome—a clinically empirical approach to its definition and study. BMC Medicine. 2005;3:19.
  • Reid S, Chalder T, Cleare A, et al. Chronic fatigue syndrome. Clin Evid. 2004;(12):1578-1593.
  • Rimes KA, Chalder T. Treatments for chronic fatigue syndrome. Occup Med. 2005;55:32-39.
  • 3/3/2011 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : White P, Goldsmith K, Johnson A, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011 Feb 17.
  • 10/1/2013 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Patterson E, Wan YW, Sidani S. Nonpharmacological nursing interventions for the management of patient fatigue: a literature review. J Clin Nurs. 2013 Oct;22(19-20): 2668-78.

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