Chronic Fatigue Syndrome

What is chronic fatigue syndrome?

Chronic fatigue syndrome, also known as myalgic encephalomyelitis (ME) is an illness that affects the muscles, brain and nervous tissue. While there is some debate about whether chronic fatigue syndrome is a condition in itself, there is no dispute that it is a relatively common, severely disabling and, on occasion, life-threatening problem.

How long have we known about chronic fatigue syndrome?

Chronic fatigue syndrome is not a modern-day condition. It has probably been around for centuries and has been written about in the medical literature since the 1860s.

What causes chronic fatigue syndrome and who is at risk?

The true cause of chronic fatigue syndrome isn’t known, although there are many theories. Ongoing viral infections, an immune system that isn’t working properly, injury or stressful life events have all been named as possible triggers of chronic fatigue syndrome. Three times more women than men suffer from the condition, and the peak incidence is between the ages of 30 and 40, but it can strike people of any age.

What are the common symptoms of chronic fatigue syndrome?

The most common symptom of chronic fatigue syndrome is ongoing and severe tiredness or fatigue. This can come on gradually or suddenly and last for several months or longer. Other symptoms can be present, although they vary from person to person. They include:

• feeling generally unwell
• aches and pains affecting the entire body, most commonly the muscles
• headaches of a new type, pattern or severity
• mood swings
• persistent sore throat or tender lymph nodes
• difficulties with digestion
• problems with short- term memory or concentration
• weight loss
• weakness of the legs, which may make walking difficult
• problems sleeping or a greatly increased need for sleep

How does chronic fatigue syndrome affect people’s lives?

Often, a person who suffers from chronic fatigue syndrome can’t work or perform any normal daily living activities. Many sufferers must live their lives at a lower than normal level of activity and some must even use a walking stick or wheelchair to get around. In its most severe but rare form, a person may be bed-bound, unable to eat and will spend most of the day sleeping. Sadly, it can cause a huge disruption to peoples’ lives, careers, and relationships.

How can doctors recognise chronic fatigue syndrome?

There is no single test that can help doctors recognise and confirm chronic fatigue syndrome. The only method available to your doctor is to study the range and pattern of your symptoms.

To make matters more difficult, the symptoms of chronic fatigue syndrome, especially extreme tiredness, are also associated with a number of other conditions such as depression, hormonal disorders and autoimmune diseases (eg myasthenia gravis, a condition in which the muscles become weak and tire quickly), and even cancer. That’s why it’s important that your doctor rules out other causes of fatigue before he / she can consider that you have chronic fatigue syndrome. This may involve having blood tests, urine tests, X-rays, brain scans, lumbar puncture (examining the fluid around your spine), electrical recordings of the brain, and electrical recordings of the nerves and muscles. Occasionally, a biopsy of muscle (taking a sample of muscle to examine under the microscope) may be required.

What is the treatment for chronic fatigue syndrome?

Self-care action plan

If symptoms are not too severe, a planned and graded exercise programme at home may be helpful. It is thought that the tiredness in chronic fatigue syndrome is related to activity level. So try to pace your activities with enough rest in between. Remember to increase your activity level gradually and avoid the urge to complete tasks in one sitting. Preserving your energy is all-important.

Eat a healthy, balanced diet, cutting down on sugary snacks and processed foods. It’s best to choose a wide variety of foods from the four food groups:

1. bread, other cereal and potatoes;
2. fruits and vegetables;
3. milk and dairy foods;
4. meat, fish and alternatives (such as beans and lentils).

Sometimes people with chronic fatigue syndrome may develop reactions to some foods. Be sure to discuss this with your doctor before making any changes to your eating habits.

Medicines

Presently, there is no cure for chronic fatigue syndrome, although medications can be used to treat some of the symptoms. Small doses of antidepressants, including the newer selective serotonin reuptake inhibitors such as Prozac, may help. You might also be admitted to a specialised unit, where a treatment called ‘cognitive psychotherapy’ may be used. This therapy is aimed at changing negative attitudes and teaching you to think in more constructive ways. At the same time, a pre- planned, tailored exercise programme is often started, in which you and your doctor will set goals for gradually increasing your ability to do exercise.

Complementary therapy

Relaxation therapy, the Alexander technique, reflexology, yoga and tai chi may promote a sense of well- being, reduce stress levels and help you to take part in the healing process.

What is the outcome of chronic fatigue syndrome?

It’s very difficult to predict the outcome for someone with chronic fatigue syndrome. Recovery can often take a long time. It is thought that about 20 percent of people make a full recovery, while many others can improve to a point where, with care, they can lead a more normal life. Periods of relapse may be triggered by stress in some of these people. A small group of people may not improve at all and may become severely disabled.

There are local and national self-help groups devoted to helping people with chronic fatigue syndrome and their carers. These groups offer a range of services – such as telephone contact lines, meetings and newsletters – to help people better understand their illness and obtain informed medical advice about it. These groups also provide mutual support and understanding – a vital lifeline for the sufferers of this lingering, little understood illness. You can find out about self-help groups on the Internet or through your local library, community centre or GP.

May 2001

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