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Chronic Fatigue Syndrome

People with chronic fatigue syndrome (CFS) experience persistent and overwhelming fatigue that does not improve with rest and interferes with their daily lives. CFS is also known as myalgic encephalomyelitis (ME) or systemic exertion intolerance disease (SEID). In addition to pain, cognitive problems, sleep disturbances, and mood disorders, they may also experience many other symptoms. People suffering from CFS can experience significant changes in their quality of life and well-being.

CFS may be caused by a combination of genetic, environmental, infectious, immunological, hormonal, and psychological factors, but they are not fully understood. CFS cannot be diagnosed with a specific test or biomarker, so the diagnosis relies on ruling out other possible causes of fatigue and meeting certain criteria. The symptoms of CFS cannot be cured, but there are treatments that can help manage their symptoms and improve their function and coping abilities. CFS can be prevented by avoiding or reducing the risk factors that trigger or exacerbate it.

The purpose of this blog post is to discuss the causes, symptoms, diagnosis, treatment, and prevention of CFS in more detail.

Causes of CFS

The exact cause of CFS is unknown, but it is likely that it is caused by a combination of factors that affect the body's ability to produce and use energy.

  • A viral infection, such as Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), Ross River virus (RRV), rubella virus, or Coxiella burnetii, can cause CFS. It is possible for these viruses to trigger abnormal immune responses or to persist in the body and cause chronic inflammation.

  • Inflammatory molecules or antibodies may be produced excessively or inappropriately by people with CFS due to a weakened or overactive immune system. The nerve system or the endocrine system may be disrupted by this or tissues or organs may be damaged.

  • An imbalance of hormones that regulate metabolism, stress response, sleep cycle, mood, and cognition may occur in people with CFS. It is possible that these imbalances may affect energy production and use in cells, or alter the perception of pain or fatigue. These hormones include cortisol, thyroid hormones, melatonin, serotonin, dopamine, and norepinephrine.

  • Genetic predisposition: People with CFS might have inherited specific genes that increase their risk of developing the condition or influence how they respond to environmental triggers. The immune system, nervous system, endocrine system, or energy metabolism may be affected by these genes.

  • Some environmental factors can trigger or worsen CFS symptoms, including physical or emotional stress, trauma, toxins, allergens, pollutants, or infections.

  • CFS patients may have pre-existing psychological conditions or personality traits that can affect their coping skills or perception of their illness. These factors include depression, anxiety, perfectionism, low self-esteem, or catastrophizing.

Symptoms of CFS

Symptoms of CFS include persistent, severe fatigue that interferes with daily activities and does not improve with rest. Fatigue may be physical or mental. It may also vary in intensity and duration from day to day.

Additionally to fatigue, people with CFS may experience a variety of other symptoms affecting different body systems. These symptoms include:

  • Pain

  • Cognitive problems

  • Sleep disturbances

  • Mood disorders

  • Sensitivity to stimuli

  • Post-exertional malaise (PEM)

  • Orthostatic intolerance (OI)

There are a number of factors that can influence the symptoms of CFS, including stress, infection, weather, hormones, or medications. They also vary from person to person and from time to time. A person's ability to work, study, socialize, or perform daily tasks can be negatively affected by the severity of the symptoms.

Diagnosis of CFS

A diagnosis of CFS is based on ruling out other possible causes of fatigue and meeting certain criteria. The criteria may vary depending on the country or source. The following are some of the most common criteria:

  • It was developed by a group of experts convened by the Centers for Disease Control and Prevention (CDC) in 1994. For at least six months, these symptoms must be present: post-exertional malaise; impaired memory or concentration; unrefreshing sleep; muscle pain; joint pain; headache; sore throat; tender lymph nodes.

  • A group of Canadian clinicians and researchers developed the Canadian consensus criteria in 2003. Post-exertional malaise, sleep dysfunction, bread, and two of the following symptoms are required: cognitive impairment, autonomic dysfunction, neuroendocrine dysfunction, immune dysfunction.

  • A group of international experts developed these criteria in 2011. It requires post-exertional neuroimmune exhaustion, at least one symptom from three categories: neurocognitive impairments, bread, sleep disturbances, and at least one symptom from three categories: neuroendocrine manifestations, immune manifestations, or autonomic manifestations.

  • The Institute of Medicine (IOM) criteria: These were developed by a committee appointed by the Institute of Medicine (now the National Academy of Medicine) in 2015. A substantial reduction in pre-illness activities for at least six months is required, along with post-exertional malaise, unrefreshing sleep, and either cognitive impairment or orthostatic intolerance.

Treatment and Prevention of CFS

CFS cannot be cured, but there are treatments that can help manage the symptoms and improve function and coping. These include:

  • Medication: Painkillers, antidepressants, antivirals, and immunomodulators may be prescribed depending on symptoms, response to treatment, and side effects.

  • It also helps patients cope with stress, depression, anxiety, and other emotional issues through cognitive behavioral therapy (CBT).

  • It is a type of physical therapy that helps the patients gradually increase their physical activity level without triggering post-exercise malaise. It also improves their fitness, strength, and endurance.

  • It involves planning and prioritizing their activities, setting realistic goals, and avoiding overexertion or underactivity. Pacing helps patients balance energy expenditure and recovery.

  • Acupuncture, massage, yoga, meditation, or herbal remedies are examples of alternative therapies that may help patients relax, reduce pain, or enhance their well-being, but the evidence for their effectiveness and safety is limited.

CFS can be prevented by avoiding or reducing factors that may trigger or worsen the condition. These include:

  • Avoiding or treating viral infections

  • Strengthening or modulating the immune system

  • Balancing or regulating the hormones

  • Reducing or managing stress

  • Eating a healthy and balanced diet

  • Getting enough and quality sleep

  • Staying hydrated and avoiding alcohol

  • Quitting smoking and avoiding secondhand smoke

  • Seeking professional help for psychological problems

Millions of people worldwide suffer from chronic fatigue syndrome (CFS), a complex and debilitating condition that does not improve with rest and interferes with daily activities. The disease also causes various symptoms that can affect different body systems. Although there is no clear explanation of the causes of CFS, it may involve a mixture of genetic, environmental, infectious, immunological, hormonal, and psychological factors. The diagnosis of CFS is based on ruling out other possible causes of fatigue and meeting certain criteria. There is no cure for CFS, but treatments can help manage its symptoms and improve the function and coping of patients. CFS can be prevented by avoiding or reducing the risk factors that may trigger or worsen it.

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