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Chronic fatigue syndrome

What is chronic fatigue?

Onset / triggers / causes of chronic fatigue

Symptoms of chronic fatigue

The central governor hypothesis for chronic fatigue

Remedies / treatment for chronic fatigue

References

What is chronic fatigue?

Fatigue is a common symptom in many illnesses. Chronic fatigue syndrome (CFS) is persistent fatigue that disrupts life for at least six months in adults, or three months in children or adolescents. CFS is not relieved by rest or caused by other medical conditions.

Many CFS symptoms are similar to fibromyalgia, and the two may be linked to each other.

CFS is also known as myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS) when it arises following a flu-like illness, or chronic fatigue immune dysfunction syndrome (CFIDS).

Medical researchers do not agree on the cause of CFS. It may have multiple causes. (1,2) There is no diagnostic laboratory test or biomarker for CFS.

CFS is a severely disrupting illness, affecting for an extended period the patient's ability to function normally.

National health bodies estimate more than 1 million people in the USA and a quarter of a million in the UK have CFS. (2,3) It occurs more often in women than men, most often in people in their 40s and 50s, and is less prevalent among children and adolescents. (3)

Onset / triggers / causes of chronic fatigue

Many cases start suddenly, usually accompanied by a "flu-like illness". (1,4)

CFS often starts after an assault by several but not all of the following:

Symptoms of chronic fatigue

CFS symptoms vary between different people. The most common symptoms are:

Less common symptoms include:

The central governor hypothesis for chronic fatigue

Tim Noakes, a sports physiologist at the University of Cape Town, suggests that there is a "central governor" in the brain that deliberately causes the body to feel tired during exertion, stress or illness. It causes this fatigue so that you slow down and protect the body from any serious damage. This is why we can go much further and faster during a dire emergency. There are many stories of people running further or faster than ever before, or lifting unbelievably heavy weights when their or other's lives are at stake.

When you get sick, your central governor makes you feel tired so you'll take the rest that your body needs to heal. With nutritious food, rest, sleep and a low stress non-toxic environment, your immune system is able to clear the infection and your body repairs itself.

If you continue to stress your body while ill, the central governor gets confused and makes you continue to feel tired even after the original infection is healed.

The central governor is at least partly psychological. Many studies have shown that when CFS sufferers are convinced that physical activity will be harmful, they are likely to stay fatigued. It is first and primarily the brain that determines when we feel exhausted.

This suggests that re-training the brain could cure chronic fatigue. There are several doctors and researchers testing this idea with significant success. They are using cognitive behavioural therapy (CBT) and introducing graded exercises to their patients. Their primary objective is to reduce the patient's deep-seated fear that they will remain fatigued, while re-assuring them and re-introducing activities in graded steps. A five year study published in 2011 found that 22% of patients recovered after a year of CBT, compared to 7-8% in other test groups. (9)

It seems that both physical and psychological factors are involved in chronic fatigue syndrome, and that successful treatment needs to address both.

Remedies / treatment for chronic fatigue

Most people recover from the depths of their CFS, though it can take months or even years. Many report that they have to be gentler on their bodies after the experience, and have not fully recovered their previous physical and mental resilience. (5)

Children tend to recover better than adults, with a study showing 54-94% of children having recovered to pre-illness levels of functioning compared to less than 10% of adults. The majority of adults remain significantly impaired, according to a number of studies. (7)

References

1. Afari N, Buchwald D. Chronic fatigue syndrome: a review. 2003, Am J Psychiatr 160 (2): 221-36. doi:10.1176/appi.ajp.160.2.221. PMID 12562565.

2. Chronic Fatigue Syndrome Causes. Centers for Disease Control and Prevention. Retrieved 10 December 2012.

3. Gallagher AM, Thomas JM, Hamilton WT, White PD. Incidence of fatigue symptoms and diagnoses presenting in UK primary care from 1990 to 2001. 2004, J R Soc Med 97 (12): 571-5.

4. Salit IE. Precipitating factors for the chronic fatigue syndrome. J Psychiatr Res. 1997 Jan-Feb;31(1):59-65.

5. Rimes KA, Chalder T. Treatments for chronic fatigue syndrome. Occup Med (Lond). 2005 Jan;55(1):32-9.

6. Wolfe F; Chalmers A; Littlejohn GO & Salit I. Fibromyalgia, Chronic Fatigue Syndrome, and Repetitive Strain Injury: Current Concepts in Diagnosis, Management, Disability, and Health Economics. 1995, New York: Haworth Medical Press. p. 142. ISBN 1-56024-744-4.

7. Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. QJM. 1997 Mar;90(3):223-33.

8. P D White, J M Thomas, J Amess, D H Crawford, S A Grover, H O Kangro, A W Clare. Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. The British Journal of Psychiatry Dec 1998, 173 (6) 475-481; DOI: 10.1192/bjp.173.6.475

9. Peter D. White et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. The Lancet. Volume 377, No. 9768, p8239-836, 5 March 2011.