Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is a complex, long-term illness characterized by extreme fatigue that doesn’t improve with rest and worsens with physical or mental activity.

Causes

  • Unknown Origin: The exact cause of CFS is unknown. However, several factors are thought to contribute:
    • Viral Infections: Some cases of CFS are triggered by viral infections.
    • Immune System Dysfunction: There may be an abnormal immune response or autoimmunity.
    • Hormonal Imbalances: Abnormalities in hypothalamic-pituitary-adrenal axis functioning are sometimes observed.
    • Genetic Predisposition: There’s evidence suggesting a genetic susceptibility to CFS.
    • Physical or Emotional Stress: Stressful events may trigger the onset of CFS.

Diagnosis

  • History
    • Persistent Fatigue: Profound fatigue lasting six months or more, not due to ongoing exertion, not significantly relieved by rest, and causing a significant reduction in previous levels of activity.
    • Other Symptoms: Including sore throat, lymph node tenderness, muscle pain, multi-joint pain without swelling or redness, headaches, unrefreshing sleep, and post-exertional malaise lasting more than 24 hours.
  • Physical Examination
    • General Examination: To assess overall health and identify signs of related conditions.
    • Neurological Examination: To check for any neurological abnormalities.
    • Evaluation of Tender Lymph Nodes, Throat, and Joints.
  • Investigations
    • Exclusion of Other Conditions:
      • No specific tests diagnose CFS; it’s a diagnosis of exclusion.
      • Blood tests (like FBC, ESR, thyroid function tests, etc.), urine tests, and others may be done to rule out other causes of fatigue.
    • Sleep Studies: To rule out sleep disorders ie Obstructive Sleep Apnoea

Differential Diagnosis (DDx)

  • Sleep Disorders (e.g., sleep apnea, insomnia)
  • Mental Health Disorders (e.g., depression, anxiety)
  • Medical Conditions: Including anemia, thyroid disorders, autoimmune diseases, and chronic infections.
  • Nutritional Deficiencies

Management

  • Non-Pharmacological
    • Pacing and Energy Management: Balancing activity and rest to avoid exacerbations.
    • Cognitive Behavioral Therapy (CBT): To help manage symptoms and cope with the impact of CFS.
    • Graded Exercise Therapy (GET): A structured exercise program that starts very slowly and gradually increases.
  • Pharmacological
    • Pain Relief: NSAIDs or other pain relievers for muscle and joint pain.
    • Sleep Management: Medications to regulate sleep patterns.
    • Treatment of Co-occurring Conditions: Such as depression or anxiety.
  • Monitoring and Follow-up
    • Regular follow-up to monitor symptoms and adjust management strategies.
    • Addressing new symptoms or complications promptly.
  • Referral
    • Referral to specialists, including rheumatologists, neurologists, or sleep specialists, may be necessary for comprehensive care and management.
  • Patient Education
    • Educating about CFS, its potential triggers, and management strategies.
    • Emphasis on the importance of a balanced approach to activity and rest.
  • Lifestyle and Home Remedies
    • Diet: Balanced diet to improve overall health.
    • Stress Reduction: Techniques like mindfulness, meditation, or yoga.
    • Sleep Hygiene: Consistent sleep schedule and practices that promote restful sleep.

CFS management is highly individualized, focusing on symptom relief and improving quality of life. Because of the complexity and variability of symptoms, a multidisciplinary approach is often the most effective.