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Chronic Fatigue Syndrome Definitions and Treatments

Depression, General | August 24, 2014 | Author: The Super Pharmacist

depression

Chronic Fatigue Syndrome Definitions and Treatments

Chronic fatigue syndrome (CFS) is a name routinely applied to a condition that is associated with the consistent, debilitating experience of lethargy, in addition to other hallmark symptoms.

This fatigue is often considered idiopathic, i.e. it is not caused by a medical condition, or by other discernable factors. CFS is also known as myalgic encephalomyelitis (ME), a term often preferred by patients who find the 'chronic fatigue' label dismissive of a condition that significantly affects their ability to function, as well as their quality of life. However, ME and CFS are regarded as separate conditions by some researchers and CFS is regarded as a subjective or somatic syndrome by some others.

CFS is classified as a syndrome as a discrete causative disorder, infection or other medical condition has yet to be conclusively linked to the appearance of symptoms.

Symptoms

Along with chronic unexplained energy reduction the following symptoms of chronic fatigue syndrome may include:

  • Disproportional lack of energy following exertion (i.e. post-exertional malaise)
  • Sleep without restorative or beneficial effects
  • Muscle pain
  • Muscle weakness
  • Joint pain (this may migrate from joint to joint over time)
  • Recurrent sore throat
  • New-onset headache, or headache of a type not usual experienced
  • Cognitive 'fog'
  • Significant and persistent physical and mental exhaustion
  • Increased sonophobia, photophobia or osmophobia
  • Orthostatic intolerance
  • Digestive disturbances
  • Depressive symptoms
  • Painful and/or mildly swollen lymph nodes

Fatigue from an unknown origin

Fatigue is a symptom that presents in many conditions, but it does not usually persist following treatment, and cases of idiopathic persistent fatigue are rare. 

CFS is more likely to occur in women in comparison to men, and in adults rather than children or adolescents.

This condition has many symptoms and characteristics in common with some other conditions. There is no definitive evidence that these may cause CFS, although there is a possibility they may occur simultaneously (i.e. be comorbid). These conditions include:

  • Fibromyalgia
  • Irritable bowel syndrome
  • Depression
  • Cancer
  • Chronic headache
  • Other types of myalgia (i.e. muscle pain)
  • Recovery from poliomyelitis
  • Multiple chemical sensitivity

As mentioned above, there is debate concerning the definition of CFS as opposed to ME and other similar conditions, or even if there is a distinction between them. Some even distinguish between chronic fatigue and CFS, intimating that the two are comorbid conditions, or that persistent fatigue is caused by a discrete factor which is also present in CFS. Some contend that the symptom of post-exertional malaise is specific to ME only.

CFS and ME are associated with abnormal levels of certain immune system proteins, indicating that both are conditions known as neuro-immune disorders. However, ME is associated with significantly higher levels of these molecules, which include TNF-alpha, neopterin and interleukin-18. This is a further barrier to the definition of CFS as something other than a subjective complaint.

ME and CFS share other biological or molecular anomalies, including:

  • Dysfunction in the mechanisms controlling immune system activation and inflammation
  • Immunosuppression
  • Intestinal abnormalities
  • Increased oxidative and nitrosative stress, which may promote cell damage
  • Dysfunction and damage to mitochondria (the 'energy factory' of the cell)
  • Diminished heart muscle activity and deficits in the blood and oxygen supply to the brain and muscles, which may explain extertional malaise and orthostatic intolerance
  • Deficiencies in cortisol, a hormone that controls the body's stress response and resilience
  • Reduced activity in the hypothalamic-pituitary-adrenal (HPA) axis of the brain, which plays a role in activity levels, sleep and hormonal control

Treatments

A number of treatments are recommended to address CFS such as medical care for symptoms, cognitive behavioral therapy, graded exercise therapy and pacing. 

Medical care

This is mainly based on referral to certain medical practices or professionals to treat symptoms of CFS. 

For example, a patient may be referred to a counsellor to address psychological issues associated with the condition (e.g. depressive symptoms). Antidepressants are also often recommended for CFS. However, the evidence of any efficacy of these medications is inconclusive. 

Trials indicate medical treatments do not improve energy.

Medical care may be combined with other treatments, as listed below, but some researchers conclude that even this approach has benefits in the short-term only.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a type of therapy that educates patients on their symptoms, and their perceptions of these, which may impair recovery or the motivation to recover. CBT also helps the patient practice behavioural modifications which may promote functional improvement and the reduction of symptoms. A recent review of CBT as applied to fatigue found the therapy had a positive impact on patients. A number of trials have reported a significant reduction in fatigue associated with CBT. Another trial found that CBT also reduced muscle pain in comparison with standard medical treatment.

Cognitive behavioral therapy is associated with a high probability of recovery from Chonic fatigue syndrome

Graded exercise therapy (GET)

This is a variation on physical therapy often associated with treatment of CFS. As the name suggests, it is a system of exercises increased slowly over time, with the possible addition of education on symptoms and the benefits of maintaining the programme at home.

GET has been associated with recovery equal to that achieved by CBT in a multi-centre trial of CFS treatments.

The results of the same trial indicated that the rate of physical deterioration as a result of GET was lower compared to other treatments. Some research indicates that the efficacy of GET will vary on a person-to-person basis.

Graded exercise therapy has been associated with recovery equal to that achieved by congnitive behavioral therapy

Pacing

This therapy is based on the observation that exertion is associated with an exacerbation of CFS symptoms. Pacing is an adaptation of the rate of activity in response to the onset of symptoms, and/or by designing a schedule of activity to avoid onset. It has been shown to have positive effects on the exertion phenomenon in CFS. However, a trial of CFS therapies including 641 patients found there was a greater number of adverse events (in the form of physical deterioration) caused by pacing compared to CBT, GET or medical treatment.

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