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Chronic fatigue syndrome, abbreviated as CFS, is a poorly understood condition that results in severe fatigue and other symptoms.

What is going on in the body?

The cause of chronic fatigue syndrome is not known, although many theories have been offered. It is a chronic condition with an unpredictable course. It can only be diagnosed if other medical conditions that cause fatigue have been excluded. Treatment is limited by a lack of understanding of the disease process itself.

What are the signs and symptoms of the condition?

The U.S. Centers for Disease Control and Prevention (CDC) has established criteria for a diagnosis of chronic fatigue syndrome. First of all, the individual must have a recent history of fatigue. The fatigue must be severe and last, whether constant or not, for at least six months. This fatigue is not relieved by rest and forces people to reduce their level of activity.

• feeling bad or having discomfort after any type of exertion
• impaired memory or concentration
• joint pain affecting multiple joints
• muscle pain
• new headaches, meaning the headaches did not occur before the person started to have severe fatigue
• sore throat
• tender lymph nodes in the armpit or neck
• unrefreshing sleep

What are the causes and risks of the condition?

• Low blood pressure caused by the autonomic nervous system may cause CFS. It is more prevalent in people with CFS than in the general population.
• Immune disorders, such as allergies or an autoimmune disorder, may cause CFS. An autoimmune disorder is a condition in which the person creates antibodies against his or her own tissue.
• Infection alone does not cause CFS. However, an infection may be one of multiple causes that bring about CFS in an individual.
• Nutritional deficiencies may play a role in causing CFS. However, there is no definitive proof.
• Stress stimulates centers in the brain, known as the hypothalmic-pituitary-adrenal axis. These centers produce cortisol and other hormones. Overstimulation from stress may influence the immune system to bring on CFS.

What can be done to prevent the condition?

There are no known effective measures to prevent chronic fatigue syndrome.

How is the condition diagnosed?

The most important part of the diagnosis of CFS is to rule out other causes for fatigue. There are many medical illnesses that can cause fatigue. These include infections, hormone imbalances, immune system diseases, and many different kinds of cancer.

To rule out other conditions, a medical history and physical exam are performed. Multiple blood tests and a urine test are then done. Further tests, such as X-ray tests, may be ordered. There is no one test that can make a diagnosis of CFS. The diagnosis of CFS is generally made when no other cause can be found for a person's fatigue and other symptoms.

What are the long-term effects of the condition?

The long-term effects of CFS relate to the person's severe fatigue. Affected people may be unable to work or go to school. They may lack the energy to form or keep relationships with other people. This can result in depression and a feeling of hopelessness. Friends and healthcare professionals sometimes have a negative attitude toward a person with CFS.

What are the risks to others?

Chronic fatigue syndrome is not contagious and poses no risks to others.

What are the treatments for the condition?

Treatment must be tailored to fit each person with chronic fatigue syndrome, depending on symptoms and response to different therapies. There are two types of therapy: behavior therapy and drug therapy.

• attending support group meetings
• avoiding caffeine and alcohol
• cognitive behavioral therapy, to help the person change perceptions and beliefs about his or her health status
• eating a balanced diet
• moderate exercise, being careful to avoid overexertion
• receiving regular, individual counseling
• relaxation methods, such as meditation, biofeedback, and hypnosis

Drug therapy may include:

• antidepressants, such as fluoxetine (i.e., Prozac, Sarafem), sertraline (i.e., Zoloft), paroxetine (i.e., Paxil, Pexeva), venlafaxine (i.e., Effexor), and bupropion (i.e., Wellbutrin)
• antihistamines, such as astemizole (i.e., Hismanal) and loratadine (i.e., Alavert, Claritin)
• blood pressure medications, such as fludrocortisone (i.e. Florinef) and atenolol (i.e., Tenormin)
• decongestants for nasal or sinus congestion
• muscle relaxing medications to relieve muscle spasms
• nonsteroidal anti-inflammatory drugs, also called NSAIDs, such as naproxen (i.e., Naprosyn, Aleve, Anaprox, Naprelan), ibuprofen (i.e., Advil, Motrin), and piroxicam (i.e., Feldene)
• tricyclic medications to relieve pain and promote sleep, including doxepin, amitriptyline, desipramine (i.e., Norpramin), and nortriptyline (i.e., Pamelor, Aventyl HCl)

• acupuncture
• chiropractic treatment
• craniosacral therapy, which addresses the flow of cerebrospinal fluid within the body
• hydrotherapy, which is also called water therapy
• massage therapy
• tai chi, which combines exercise and balance
• therapeutic touch
• yoga

What are the side effects of the treatments?

NSAIDs can cause stomach upset and allergic reactions. Antidepressants may cause problems sleeping, headaches, or stomach upset.

What happens after treatment for the condition?

The course of CFS is very difficult to predict. Fortunately, most people eventually get better with or without treatment, though a cure is often not possible. People may return to normal activities whenever they feel able.

How is the condition monitored?

Affected people are in the best position to monitor the condition. Any new or worsening symptoms should be reported to the healthcare professional.