Chronic Fatigue Syndrome (CFS): Tests, Causes, Treatments

Chronic fatigue syndrome goes by many names, including CFS, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and chronic fatigue immune dysfunction syndrome (CFIDS). CFS is a chronic disorder characterized by several debilitating conditions, including severe fatigue. Other symptoms include weakness, impaired memory or concentration, insomnia, muscle pain, and fatigue following exertion that lasts more than 24 hours. The causes of CFS are unknown, and there is no specific test to diagnose the condition. It is diagnosed through exclusion, that is, ruling out other illnesses with similar symptoms.

Chronic fatigue syndrome can be difficult to diagnose, and also hard to define. A diagnosis of CFS is made when a patient meets at least two of the criteria described on the following slides.

In order to be diagnosed with chronic fatigue syndrome, a person must have severe and chronic fatigue that lasts six months or more, and other medical conditions that could cause the fatigue must be excluded. The fatigue must significantly interfere with work or daily activities.

In addition to prolonged fatigue, a person must have four or more of the following symptoms to be diagnosed with chronic fatigue syndrome:

• impairment in short-term memory or concentration
• sore throat
• tender lymph nodes
• muscle pain
• joint pain without swelling or redness
• headaches of a new type, pattern, or severity
• unrefreshing sleep
• post-exertional malaise lasting more than 24 hours.

Fatigue is a symptom that is often associated with many other medical conditions. Before being diagnosed with chronic fatigue syndrome a doctor will often try to rule out:

• fibromyalgia syndrome
• myalgic encephalomyelitis (ME)
• neurasthenia
• multiple chemical sensitivities
• chronic mononucleosis

There are many other illnesses that are treatable that need to be ruled out to arrive at a diagnosis of chronic fatigue syndrome. It is possible to have these other conditions and also have CFS; if the conditions are treated and someone still has chronic fatigue, then CFS may be considered as a diagnosis. Conditions that can be treated that may have similar symptoms include:

• hypothyroidism
• sleep apnea or narcolepsy
• major depressive disorders, bipolar affective disorders, schizophrenia
• eating disorders
• cancer
• autoimmune disease
• hormonal disorders
• subacute infections
• obesity
• alcohol or substance abuse
• vitamin D deficiency
• reactions to medications.

There are a number of secondary symptoms that are also associated with chronic fatigue syndrome. Up to half of people with CFS may experience symptoms including abdominal pain, alcohol intolerance, bloating, chest pain, chronic cough, diarrhea, dizziness, dry eyes or mouth, earaches, irregular heartbeat, jaw pain, morning stiffness, nausea, night sweats, psychological problems (depression, irritability, anxiety, panic attacks), shortness of breath, skin sensations, tingling sensations, and weight loss.

Somewhere between 800,000 and 2.5 million Americans are affected by chronic fatigue syndrome. Most are not diagnosed, however, making the exact prevalence unknown.

People of all ethnicities and ages can develop CFS. Risk factors for developing chronic fatigue syndrome include:

• Female gender – women are four times more likely to develop CFS
• Age 40s and 50s
• There may be a genetic link

There are no specific tests that will diagnose chronic fatigue syndrome. To complicate matters, people often may not appear ill, and the disease may go into remission and then relapse. To make a diagnosis, a doctor will first rule out other conditions that have similar symptoms that can be tested for, including

• mononucleosis,
• Lyme disease,
• thyroid conditions,
• diabetes,
• multiple sclerosis,
• various cancers,
• depression,
• vitamin D deficiency, and
• bipolar disorder.

The Centers for Disease Control (CDC) estimates fewer than 20% of people who have CFS are actually diagnosed.

There is no cure for chronic fatigue syndrome, so treatment is aimed at managing symptoms. Treatment usually involves a combination of medication and lifestyle changes such as

• preventing overexertion,
• reducing stress,
• managing diet, and
• nutritional supplements.

Physical therapy may also be recommended. It is believed that the earlier the diagnosis is made, and the sooner treatment starts, the better the outcome will be.

Chronic fatigue syndrome symptoms vary from person to person. Some people are severely disabled and unable to work or carry out daily activities. Others may be able to work while still experiencing symptoms. Some people cycle through periods of relative wellness and periods of illness. The number of people who recover from CFS is unknown, but management of symptoms early on seems to be associated with better outcomes.

The causes of chronic fatigue syndrome are unknown. Causes may be infectious, physical, psychological, genetic, or environmental – or a combination of these factors.