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Chronic Fatigue Syndrome

Posted On: February 01, 2020

Chronic Fatigue Syndrome

Chronic Fatigue Syndrome, known medically as Myalgic Encephalomyelitis, is a disorder that causes extreme tiredness and fatigue. Chronic Fatigue Syndrome is difficult to diagnose as there is no standard testing procedure and it shares symptoms with a host of other conditions. In 2015 the Institute of Medicine estimated that CFS affected between 836,000 and 2.5 million Americans. They added that approximately 84-91% of those with CFS were undiagnosed.

CFS has been shown to affect women more often than men. On average, it is most likely to occur in your thirties, but has been known to occur in individuals of all ages.

Symptoms of Chronic Fatigue Syndrome

Primary Symptoms

  • Significant impairment in performing activities that were commonplace before the illness, accompanied by severe fatigue and lasting a minimum of six months. Fatigue experienced in chronic fatigue syndrome is different in that it
    • Did not result from any difficult or physically straining activity.
    • Cannot be improved by sleep or rest.
    • Has not been an issue previously.
  • Post-Exertional Malaise (PEM). This is a worsening of chronic fatigue syndrome symptoms following a physical or mental activity that would not have had this effect prior to the illness. This is often known as a “crash” by people with CFS. It can take days or weeks to recover from a crash. During this time the person may be house-bound or even completely bed-bound. It can be hard for people with CFS to predict when a crash will occur and how severe it will be.
  • Sleep Problems. People with CFS may not feel less tired even after a full night’s sleep. Some people with chronic fatigue syndrome may also struggle falling or staying asleep.

Secondary symptoms

In addition to primary symptoms, one of the following symptoms is required for a CFS diagnosis.

  • Cognitive Impairment. People with chronic fatigue syndrome often have difficulty concentrating, thinking and remembering things. This is often referred to as “brain fog”
  • Orthostatic Intolerance. This is a worsening of symptoms caused by standing up. People with CFS can feel lightheaded or dizzy when standing up. This will improve when they sit or lie back down.

Other symptoms

These symptoms are common among patients with chronic fatigue syndrome but not everyone will have them.

  • Headaches of new severity or type
  • Muscle and joint pain
  • Regular sore throat
  • Heart palpitations (fast or irregular heartbeat)
  • Tender lymph nodes in the neck or armpits
  • Night sweats
  • Digestive Issues
  • Earaches
  • Jaw Pain
  • Psychological problems (depression, anxiety)
  • Weight Loss
  • Diarrhea
  • Dry eyes or mouth
  • Coughing

The severity of symptoms can change over time and varies for each individual.

How do I know if I have Chronic Fatigue Syndrome?

If you are experiencing the symptoms listed above, then you should consult your GP. However, diagnosing chronic fatigue syndrome is difficult because it can take a while to rule out other conditions. Feelings of fatigue can be caused by a range of illnesses from depression to narcolepsy and hypothyroidism.

Before a diagnosis of Chronic Fatigue Syndrome can be given your doctor must perform a thorough physical examination and ask about your medical history, including any mental health issues or family history of mental health issues. You may also be required to take a blood or urine test to rule out conditions like anaemia which can also cause fatigue.

For a diagnosis of chronic fatigue syndrome to be given you must have;

  • Fatigue that has either started recently, lasted a long time or is recurring and cannot be explained by another condition
  • Worsening of symptoms after exertion
  • Reduced functionality in everyday tasks that were easy before

You must also display other symptoms such as cognitive impairment or orthostatic intolerance.

Many symptoms of chronic fatigue syndrome are shared with common illnesses that will improve on their own. However, your doctor should also rule out other severe illnesses with shared symptoms. Tell your doctor if you are experiencing:

  • Persistently swollen lymph nodes
  • Double vision or blackouts
  • Sleep apnoea (stopping breathing for short periods while asleep)
  • Chest or heart problems

If you are under 18 and showing symptoms of potential CFS you should be referred to a paediatrician within 6 weeks of seeing your doctor about these symptoms.

If you experience any new or worsening symptoms, let your doctor know immediately.

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How is Chronic Fatigue Syndrome Treated?

There is no cure for Chronic Fatigue Syndrome, treatment is instead focused on managing the symptoms. While a full recovery from the condition is rare, it is possible to improve symptoms enough to resume normal daily activities.

Adjusting to the condition can be a hard process. Patients should work together with their doctor and their family to identify which symptom is causing the greatest problem and try to treat this one first.

Along with drug and non-drug therapies, lifestyle changes such as stress reduction, dietary changes and nutritional supplements is often recommended in the treatment of CFS.

Due to the difference of symptoms between individuals, there is no single treatment that works for every person with CFS. Finding the right treatment for you can be a process in and of itself.

Treating Sleep-Related Symptoms:

People with chronic fatigue syndrome often struggle with falling and staying asleep and do not feel refreshed after sleeping. A doctor may first suggest they practice improving their sleep hygiene through tactics such as regulating caffeine intake and avoiding daytime naps. If this does not work, they may prescribe a sleeping medication such as Zopiclone or Diazepam. However, these drugs can cause you to feel sleepy or drowsy the next day. Sleeping pills should be taken in the lowest possible dose for the shortest possible time to avoid dependency.

However, even with an adequate night’s sleep provided by the medication, people with chronic fatigue syndrome may still not feel refreshed. At this stage it is recommended to visit a sleep therapist.

Treating Orthostatic Intolerance (Dizziness and light-headedness when standing up)

This can be improved by increasing daily salt and fluid intake and avoiding alcohol. If the severity of the symptoms does not decrease you may be prescribed a medication such as Fludrocortisone.

Treating Mental Health Issues

Adapting to a debilitating chronic disease can be a distressing process and many individuals with chronic fatigue syndrome will develop depression or anxiety. Treating these conditions can make it easier to cope with their illness. It is recommended that treatment begin with counselling or therapy such as CBT (Cognitive Behavioural Therapy) as antidepressant medications come with a range of side effects that may exacerbate symptoms of Chronic Fatigue Syndrome.

Individuals with CSF may find talking therapies beneficial as guilt-free environments to express their troubles and receive support in implementing strategies to improve their thought patterns. Some people may benefit from medications such as fluoxetine (Prozac) or sertraline (Zoloft).

Treating Post-Exertional Malaise (PEM)

PEM is treated through a technique called Activity Management. The aim of activity management is for the patient to organise their life in a way that balances exertion and rest so as to avoid “crashing.” To do this, the patient must first identify the upper limit of their exertion potential. This is how much mental or physical activity they can withstand before experiencing a flare-up of PEM symptoms. Once the patient is aware of their individual limitations, they can plan periods of activity and rest. Remaining within these boundaries can help avoid relapsing. Patients may find it helpful to keep a journal of their symptoms to more easily discover where their limits lie.

For some people living with chronic fatigue syndrome, even simple tasks such as brushing their teeth or talking to someone can be enough to trigger a relapse. Some of these activities are unavoidable but patients can work with specialists to find ways to make them more manageable. For example, some tasks could be performed seated rather than standing. They could also find ways to break up tasks into smaller, more manageable steps and be sure to have plenty of rest in between. Some people may also find a heart rate monitor to be helpful for activity management.

Treating Pain

People with chronic fatigue syndrome will experience pain in their muscles and joints as well as headaches and occasionally soreness of the skin. Doctors will first recommend you try over the counter pain relief such as paracetamol or ibuprofen. If these are insufficient you may need to see a pain specialist to find ways to deal with chronic pain. Massages, stretches, and acupuncture can be useful in managing and alleviating pain.

There are a variety of prescription drugs available for treating pain. However, these come with a range of side effects including drowsiness which is counterproductive for people with CFS. Some painkillers also carry the risk of addiction.

Treating Cognitive Impairment

When dealing with the memory problems caused by Chronic Fatigue Syndrome, visual aids and calendars can be helpful. Leaving post it notes around the house can help you remember your schedule rather than trying to keep it all in your head. If you are struggling with concentration your doctor may prescribe you a stimulant medication such as the kind used for treating ADHD (Attention Deficit Hyperactive Disorder). However, while these drugs improve concentration, they can also lead to a cycle wherein the person overexerts themselves leading to a post-exertional malaise relapse.

 

 

If you or someone you know is living with Chronic Fatigue Syndrome and needs support, please visit the M.E Association for further information and resources.

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