CHRONIC FATIGUE SYNDROME

Symptoms

Chronic fatigue syndrome has eight official signs and symptoms, plus the central symptom that gives the condition its name:

• Fatigue
• Loss of memory or concentration
• Sore throat
• Enlarged lymph nodes in your neck or armpits
• Unexplained muscle pain
• Pain that moves from one joint to another without swelling or redness
• Headache of a new type, pattern or severity
• Unrefreshing sleep
• Extreme exhaustion lasting more than 24 hours after physical or mental exercise

When to see a doctor

Fatigue can be a symptom of many illnesses, such as infections or psychological disorders. In general, see your doctor if you have persistent or excessive fatigue.

Causes

Scientists don't know exactly what causes chronic fatigue syndrome. It may be a combination of factors that affect people who were born with a predisposition for the disorder.

Some of the factors that have been studied include:

• Viral infections. Because some people develop chronic fatigue syndrome after having a viral infection, researchers question whether some viruses might trigger the disorder.

  Suspicious viruses include Epstein-Barr virus, human herpes virus 6 and mouse leukemia viruses. No conclusive link has yet been found.

• Immune system problems. The immune systems of people who have chronic fatigue syndrome appear to be impaired slightly, but it's unclear if this impairment is enough to actually cause the disorder.
• Hormonal imbalances. People who have chronic fatigue syndrome also sometimes experience abnormal blood levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands. But the significance of these abnormalities is still unknown.

Diagnosis

There's no single test to confirm a diagnosis of chronic fatigue syndrome. Because the symptoms of chronic fatigue syndrome can mimic so many other health problems, you may need patience while waiting for a diagnosis.

Your doctor must rule out a number of other illnesses before diagnosing chronic fatigue syndrome. These may include:

• Sleep disorders. Chronic fatigue can be caused by sleep disorders. A sleep study can determine if your rest is being disturbed by disorders such as obstructive sleep apnea, restless legs syndrome or insomnia.
• Medical problems. Fatigue is a common symptom in several medical conditions, such as anemia, diabetes and underactive thyroid (hypothyroidism). Lab tests can check your blood for evidence of some of the top suspects.
• Mental health issues. Fatigue is also a symptom of a variety of mental health problems, such as depression, anxiety, bipolar disorder and schizophrenia. A counselor can help determine if one of these problems is causing your fatigue.

Diagnostic criteria

To meet the diagnostic criteria of chronic fatigue syndrome, you must have unexplained, persistent fatigue for six months or more, along with at least four of the following signs and symptoms:

• Loss of memory or concentration
• Sore throat
• Enlarged lymph nodes in your neck or armpits
• Unexplained muscle pain
• Pain that moves from one joint to another without swelling or redness
• Headache of a new type, pattern or severity
• Unrefreshing sleep
• Extreme exhaustion lasting more than 24 hours after physical or mental exercise

Preventions

Chronic fatigue syndrome (CFS) can't be prevented or cured. But treatment can help control or reduce symptoms.

Risk Factors

Factors that may increase your risk of chronic fatigue syndrome include:

• Age. Chronic fatigue syndrome can occur at any age, but it most commonly affects people in their 40s and 50s.
• Sex. Women are diagnosed with chronic fatigue syndrome much more often than men, but it may be that women are simply more likely to report their symptoms to a doctor.
• Stress. Difficulty managing stress may contribute to the development of chronic fatigue syndrome.

Complications

Possible complications of chronic fatigue syndrome include:

• Depression
• Social isolation
• Lifestyle restrictions
• Increased work absences

Treatment

Treatment for chronic fatigue syndrome focuses on symptom relief.

Medications

Because chronic fatigue syndrome affects people in many different ways, your treatment will be tailored to your specific set of symptoms. Symptom relief may include certain medications:

• Antidepressants. Many people who have chronic fatigue syndrome are also depressed. Treating your depression can make it easier for you to cope with the problems associated with chronic fatigue syndrome. Low doses of some antidepressants also can help improve sleep and relieve pain.
• Sleeping pills. If home measures, such as avoiding caffeine, don't help you get better rest at night, your doctor might suggest trying prescription sleep aids.

Therapy

The most effective treatment for chronic fatigue syndrome appears to be a two-pronged approach that combines psychological counseling with a gentle exercise program.

• Graded exercise. A physical therapist can help determine what types of exercise are best for you. Inactive people often begin with range-of-motion and stretching exercises for just a few minutes a day.

  If you're exhausted the next day, you're doing too much. Your strength and endurance will improve as you gradually increase the intensity of your exercise over time.

• Psychological counseling. Talking with a counselor can help you figure out options to work around some of the limitations that chronic fatigue syndrome imposes on you. Feeling more in control of your life can improve your outlook dramatically.