Chronic Fatigue Syndrome

Generality

Chronic fatigue syndrome is a somewhat complicated disorder, characterized by a sense of persistent fatigue and no apparent reasons. Those affected do not suffer from any particular pathology and do not benefit from rest.

The causes that cause this syndrome to appear remain unknown; in this regard some hypotheses have been formulated, which however have not yet found sufficient scientific confirmation.

In addition to always feeling tired, patients suffering from chronic fatigue syndrome experience other disorders, similar to flu symptoms.

Unfortunately, no specific cure has yet been identified.

What is chronic fatigue syndrome?

Chronic fatigue syndrome - also called chronic fatigue syndrome, CFS or myalgic encephalomyelitis - is a very complex disorder, characterized by a sense of persistent, unexplained fatigue that cannot be mitigated in any way. In fact, in those affected, the sense of prostration does not diminish with rest and does not depend (in the sense that it is not related) to health problems or particularly intense physical activities.

What does myalgic encephalomyelitis mean?

Encephalomyelitis means inflammation of the brain and spinal cord. The term mialgica, on the other hand, derives from myalgia and means muscle pain.

Epidemiology

According to an Anglo-Saxon statistical study, in the UK there are about 250, 000 people suffering from chronic fatigue syndrome.

Myalgic encephalomyelitis can affect anyone, however it is more common in people between the ages of 40 and 50, and prefers the female sex (in 60-85% of cases they are women).

Affected children are usually between 13 and 15 years old.

Causes

Despite numerous studies on the subject, researchers have not yet succeeded in identifying the precise causes of chronic fatigue syndrome.

The various hypotheses formulated so far have taken into consideration:

Viral type infections . The idea of a link with some viruses stems from the fact that many patients with chronic fatigue syndrome have previously suffered (that is before they became ill with myalgic encephalomyelitis) of some viral diseases. The viruses under investigation are Epstein-Barr virus (responsible for mononucleosis), human herpesvirus 6 and mouse leukemia virus.
Defects of the immune system . Some scholars have observed that the immune system of certain individuals, suffering from chronic fatigue syndrome, works inadequately. However, it is not clear what the link between the two anomalous situations is.
Hormonal imbalances . A large number of patients with chronic fatigue syndrome have abnormal hypothalamic-pituitary-adrenal axis hormone values. It must be established whether the two conditions are the outcome of the other.
Psychological problems . Several people with chronic fatigue syndrome have experienced stressful periods or severe emotional trauma in the past. It remains to be clarified how these situations may have affected the appearance of the disease.

Main risk factors:

Age between 40 and 50 years
Female sex
Tendency to stress

Symptoms and Complications

To learn more: Symptoms Chronic fatigue syndrome

The chronic fatigue syndrome is characterized by a sense of persistent fatigue (it is the main symptom), flanked by a series of secondary disorders, always of a chronic nature, which in some respects recall an influence.

These pathological expressions can be collected in eight points, namely:

Memory and concentration deficit
Muscle pain (myalgia) for no reason
Frequent / recurrent sore throat
Swollen lymph nodes, both on the neck and on the armpits
Very intense headaches
Joint pain ( arthralgia )
Non-restorative sleep
Intense and prolonged tiredness, even after more than 24 hours have passed since the last physical or mental effort

FEATURES OF FATIGUE

The sense of fatigue is described by the patients as exhaustion, exhaustion. Furthermore, this feeling:

it does not seem to be alleviated in any way, even with appropriate rest
tends to deteriorate drastically after intense physical or mental activity (usually, in these situations, the consequences are paid one or two days later).

WHEN TO REFER TO THE DOCTOR?

Due to the characteristics of the symptomatology, the chronic fatigue syndrome could recall much more serious (and potentially even more dangerous) morbid conditions, such as:

Lyme disease
Some sleep disorders
Major depression
Alcohol addiction
Diabetes
hypothyroidism
Mononucleosis
Multiple sclerosis
Systemic lupus erythematosus
Chronic hepatitis

In light of this, if the sense of fatigue is prolonged and, above all, does not seem to resolve itself, even after a period of absolute rest, it is advisable to contact your doctor immediately.

COMPLICATIONS

When fatigue and a sense of fatigue become excessive, the patient feels completely powerless: he is unable to perform the simplest tasks, he is struggling to move, he finds it difficult to get out of bed and, indeed, he is unable to leave his home .

All this could isolate it from the social context, lead it to depression or induce it to absent from the workplace chronically.

Diagnosis

There is currently no specific diagnostic test for chronic fatigue syndrome.

Therefore, to determine whether a person is affected by myalgic encephalomyelitis, the doctor proceeds first by excluding the diseases that cause a very similar sense of fatigue (differential diagnosis) and then by analyzing the symptoms described directly by the patient's voice.

Fundamental to this last step is the help of what has been published by the US Center for Disease Prevention and Control (CDC) regarding chronic fatigue syndrome.

NB: in the United States, the CDC is the national public health institute. This organization makes use of doctors, biologists, pharmacologists and other experts to outline the main characteristics (from the causes to the symptoms, up to the criteria of diagnosis and prevention) of the various diseases.

DIFFERENTIAL DIAGNOSIS

A doctor, before taking chronic fatigue syndrome into consideration, must make sure that the sense of persistent fatigue is not due to:

Sleep disorders, such as obstructive sleep apnea syndrome, restless leg syndrome or insomnia .
Serious and chronic health problems, such as anemia, diabetes and hypothyroidism
In this case, laboratory tests on the patient's blood are of fundamental importance.
Psychological and mental illnesses, such as depression, anxiety, bipolar disorder and schizophrenia . In this case, it is useful to request the consultation of a specialist in the sector.

DIAGNOSIS CRITERIA

According to the US CDC, the sense of persistent fatigue may be related to chronic fatigue syndrome (in an adult) if:

It has been in existence for at least 6 months, it is not caused directly by intense physical exercise and is not linked to any particular morbid condition
Significantly reduces any type of activity performed by a person
It is associated with at least 4 of the eight points reported in the chapter dedicated to symptoms.

NB: in patients of young age, it is sufficient that the sense of fatigue has been in place for 3 months.

Treatment

Currently, there is no specific cure to cure chronic fatigue syndrome. However, there are remedies and therapeutic strategies aimed at alleviating symptoms.

There has been much debate (and is still debating) about the effective effectiveness of these remedies and strategies, as not all patients derive equal benefits; in some cases, there is also a worsening of symptoms.

COGNITIVE-BEHAVIORAL THERAPY

The purpose of cognitive-behavioral therapy is to teach the patient to understand the disease from which he suffers and to recognize the symptoms, so that he can dominate them in some way. Generally, the implementation of this therapy is reserved for mental illnesses, but doctors have noted that it is also effective against chronic fatigue syndrome. Some patients with myalgic encephalomyelitis, treated with a cognitive-behavioral therapy, have in fact shown that they know how to "accept" their situation and know how to "react" well to symptoms, without letting themselves be conditioned by them.

However, readers should be reminded that there have also been cases in which the symptoms, instead of improving, have worsened.

THERAPY BASED ON GRADUAL EXERCISE

The therapy based on gradual exercise (in English Graded Exercise Therapy, GET) consists in making the patient practice physical activity at increasing intensity and duration. This means that initially the exercise will be short and not very intense; then, as the weeks go by, it will gradually get longer and stronger.

It is important that duration and intensity increase in small doses; if this were not the case, the therapeutic approach based on gradual exercise could have completely adverse effects.

The most recommended activities by therapists are: swimming, walking and jogging.

ANTIDEPRESSIVE DRUGS

Suffering from chronic fatigue syndrome could lead to social isolation and depression. If this occurs, it is possible that the doctor will prescribe antidepressant drugs, such as amitriptyline (tricyclic antidepressant).

Attention: the treatment based exclusively on the use of antidepressant drugs is not very effective and not recommended. It is necessary, especially in the case of depression, to rely on an experienced psychotherapist.

NB: amitriptyline is contraindicated in case of heart problems.

ANTIDOLORIFYING DRUGS

Patients with severe muscle and joint pain may take pain medication, but only on prescription.

To learn more: Chronic Fatigue Syndrome - Drugs and Care »

Advice and other remedies

In carrying out the various physical activities, a good strategy to avoid adverse effects is to proceed step by step, patiently and perhaps recording your feelings on a diary.

Moreover, it is very useful to alternate a few days of exercise with a few days of rest, diligently respecting this alternation, without ever exceeding, even in moments when the sense of tiredness seems to have faded.

SOME RECOMMENDATIONS

For patients with chronic fatigue syndrome, doctors usually recommend:

Avoid particularly stressful situations
Avoid alcoholic beverages and coffee
Don't overdo the sugars and artificial sweeteners
Avoid any food or drink to which there is intolerance
Eat light, but several times throughout the day
Set aside time during the day to relax
Always go to bed at the same time and avoid, if possible, taking long naps during the day