Chronic fatigue syndrome

As the name suggests, people with chronic fatigue syndrome (CFS) — also sometimes known as myalgic encephalomyelitis (ME) — feel very tired and exhausted most of the time. The fatigue is not relieved by rest and is often much worse after physical or mental activity.

Symptoms

The main symptom of chronic fatigue syndrome is extreme, overwhelming tiredness or fatigue. The fatigue is both physical and mental, and does not improve with rest or sleep.

Other symptoms of CFS include:

  • headaches;
  • tender aching muscles;
  • joint pains;
  • sore throat;
  • enlarged, tender lymph nodes in the neck or armpits;
  • problems with memory and concentration;
  • extreme tiredness lasting 24 hours after physical or mental exertion;
  • mood changes;
  • nausea;
  • dizziness;
  • insomnia or other sleep disturbances; and
  • unrefreshing sleep.

Psychological problems such as anxiety and depression may also be associated with CFS.

Symptoms may come and go over the course of the illness, which can last months to years.

Cause

The cause of CFS is not known. Viral illnesses, such as glandular fever (caused by Epstein-Barr virus) and meningitis, have been suspected as a possible cause.

Hormonal imbalances, stress, nutritional deficiency and immune system problems may also play a role, but there is no firm evidence that they cause CFS. Chronic fatigue syndrome most commonly affects people aged in their 20s to 40s, and females tend to be affected more than males. Adolescents can also be affected.

Diagnosis

The symptoms of CFS are very variable and can be due to a number of other conditions. There is no special test to confirm the diagnosis — usually tests are done to exclude other conditions, such as abnormalities of the thyroid gland, sleep disorders, mental health disorders and anaemia, which can produce a similar picture.

CFS can be diagnosed if you have had unexplained, severe fatigue for 6 months or longer; the fatigue is not improved by rest and it significantly interferes with your daily activities and work. You also need to have experienced at least 4 of the following additional symptoms:

  • headaches of a new type, pattern or severity;
  • muscle or joint pain without redness or swelling;
  • sore throat;
  • tender lymph nodes in the neck or armpits;
  • problems with memory and concentration;
  • extreme tiredness lasting 24 hours after physical or mental exertion; and
  • unrefreshing sleep.

Treatment

Unfortunately, there is no cure for CFS, and in some cases, the condition can persist for several years. However, there are treatments available that are aimed at relieving symptoms, increasing levels of activity and improving quality of life.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) — therapy that involves identifying and challenging negative thinking patterns and developing alternative ways of thinking and acting — has been used in the treatment of chronic fatigue syndrome. There is evidence that CBT can help reduce tiredness in people with CFS, and improve school attendance among teenagers with CFS.

Graded exercise therapy

Graded exercise therapy is a treatment that involves working with a trained specialist to determine your baseline activity level and gradually increasing the length of time you can spend doing physical and mental activities. It’s important not to do too much too soon, so your therapist will recommend a gentle start to the exercises and activities and then a slow increase in the amount you do at each session. There is evidence that graded exercise therapy can improve tiredness and physical functioning.

Medicines

While there are currently no medicines that have been shown to effectively treat CFS, there are medicines that can be used to treat associated symptoms.

Antidepressants can be used to treat depression, and can help improve sleep patterns and chronic (ongoing) pain in some people with CFS. Analgesic medicines (painkillers) can be used to help relieve headaches and muscle and joint pain.

Self-help

Some people with CFS find it helpful to pace their activities — balancing periods of activities with periods of rest. Pacing involves knowing what you are capable of and not pushing yourself to do more than this.

Altering your sleep habits may also help improve symptoms over the long term. The following tips can help improve overnight sleep:

  • going to bed and getting up at the same time each day;
  • avoiding daytime naps (or keeping them under 30 minutes long); and
  • doing some gentle exercise during the day (within your limits).

Complementary therapy

Acupuncture, tai chi, massage and yoga may help people to relax and increase energy, as well as treat muscular aches and pains.

Support

Support groups can provide information, reassurance and support to people with CFS.

Last Reviewed: 2 October 2013
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References

1. Persistent unexplained fatigue (revised October 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Jul. http://online.tg.org.au/complete/ (accessed Aug 2013).
2. Centers for Disease Control and Prevention (CDC). Chronic fatigue syndrome (CFS) (updated 14 May 2012). http://www.cdc.gov/cfs/general/index.html (accessed Aug 2013).
3. Reid S, Chalder T, Cleare A, Hotopf M, Wessely S. Chronic fatigue syndrome. Clinical Evidence [online] 2011 [cited May 26]. URL: http://clinicalevidence.bmj.com/ (accessed Aug 2013).
4. BMJ Group. Patient information: Chronic fatigue syndrome (updated 31 Oct 2012). http://clinicalevidence.bmj.com (accessed Aug 2013).
5. Working group of the Royal Australasian College of Physicians. Chronic fatigue syndrome: Clinical practice guidelines 2002. Med J Aust 2002; 176 Suppl: S23-56.
6. Centers for Disease Control and Prevention. Chronic fatigue syndrome: A toolkit for providers (updated 6 Sep 2011).http://www.cdc.gov/cfs/toolkit/index.html (accessed Aug 2013).
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