CHRONIC FATIGUE SYNDROME

Fatigue is one of the most common symptoms in clinical medicine; nevertheless, fatigue may be difficult to define because it is rather loosely partitioned into physical and mental components. Fatigue often proves evanescent or, if chronic, relates to an underlying systemic illness. Fatigue may also be associated with a psychiatric disorder. Less commonly, patients may have chronic persistent fatigue that lasts longer than 6 months without an apparent etiology and that is associated with exercise intolerance, sleep difficulties, and an inability to perform mental or physical activities in a competent fashion.

Because a healthy body requires robust, functionally integrated organ systems to ensure optimal operation, intact organ parenchyma, intact organ regulatory systems, and intact delivery of nutrients and oxygen to the tissues by the cardiovascular-circulatory system must be present to avoid malfunction. Any defect in these 3 components causes organ dysfunction. Signals sent via the nervous system indicating such dysfunction may be perceived as pain or fatigue. If dysfunction progresses to critical organ impairment, the organ system may ultimately fail; however, more gradual and persistent decline in function of single or multiple organ systems can produce a chronic fatigue state without complete organ system breakdown.

The etiology of organ fatigue remains elusive, and, indeed, the precise definition of fatigue remains controversial. Nevertheless, standardized questionnaires and examinations are currently used to assess fatigue and to separate mental fatigue from physical fatigue on the basis of general physical condition and on the ability to perform cognitive or muscle tasks in an age-appropriate fashion.

Chronic fatigue syndrome defined

As a distinct clinical entity, chronic fatigue syndrome (CFS) has only recently been defined for adults as a distinct disorder characterized by chronic (often relapsing but always debilitating) fatigue lasting at least 6 months (occasionally lasting much greater lengths of time), which causes impaired overall physical and mental functioning.Because a precise etiology for the syndrome remains elusive, the diagnosis is largely made once specific medical and psychiatric disorders are excluded. Therefore, stating that CFS is an illness primarily characterized in adults by self-reported symptoms with a relative paucity of physical findings may be fair.

                                            DIAGNOSIS

The most recent CDC diagnostic criteria state:

In order to receive a diagnosis of chronic fatigue syndrome, a patient must satisfy two criteria: 1) Have severe chronic fatigue of 6 months or longer duration with other known medical conditions excluded by clinical diagnosis; and 2) concurrently have 4 or more of the following symptoms:

·                            Substantial impairment in short-term memory or concentration

·                            Sore throat

·                            Tender lymph nodes

·                            Muscle pain

·                            Multi-joint pain without swelling or redness

·                            Headaches of a new type, pattern or severity

·                            Unrefreshing sleep

·                            Postexertional malaise lasting more than 24 hours.

The symptoms must have persisted or recurred during 6 or more consecutive months of illness and must not have predated the fatigue.

In addition, a large number of clinically defined, frequently treatable illnesses can result in fatigue. Diagnosis of any of these conditions excludes a definition of CFS unless the condition has been treated sufficiently and no longer explains the fatigue and other symptoms. These conditions include hypothyroidism, sleep apnea and narcolepsy, major depressive disorders, chronic mononucleosis, bipolar affective disorder, schizophrenia, eating disorders, cancer, autoimmune disease, hormonal disorders, subacute infections, severe obesity, alcohol or substance abuse, and reactions to prescribed medications.

Preventing CFS

Since it's not known what causes CFS, it's difficult to prevent. There's no evidence to support the view that CFS is a contagious disease and there's no precise identified cause.

It's believed that a person’s genes may make them more susceptible, and that viral infection, stress, depression, or a major life event (for example bereavement, job loss) may act as triggers for CFS to develop in susceptible individuals.

In some cases a specific disease, such as an underactive thryoid gland or a head injury, can be identified as the underlying cause of the sort of symptoms typically found in CFS. A range of tests and investigations are done when a person first consults their doctor with symptoms, in order to check for these diagnoses and rule out them out as a cause. So CFS remains a diagnosis of exclusion (where all other identifiable medical causes for symptoms have been ruled out).

Self-Care at Home

Physical activity performed at a comfortable pace is important for everyone to maintain good health, including people with chronic fatigue syndrome. People with CFS need to learn how much activity is helpful and when to stop, so they do not increase their level of fatigue.

In general, people with CFS should pace themselves carefully and avoid excessive physical or emotional stress. Remember, the goal is to avoid increasing fatigue or pain. Maintain a regular and manageable daily routine to avoid a relapse or increase of symptoms. Exercise should be supervised by a knowledgeable health-care provider or physical therapist.

Total rest should also be avoided as it may make your fatigue worse. You should maintain physical activity at a comfortable pace. If you increase your level of physical activity, do so gradually.

Decreased consumption of alcohol and caffeine at night may help you sleep.

Try to minimize social isolation.