CHRONIC FATIGUE SYNDROME: LATEST TREATMENTS AND LIVING WITH IT

Medically Reviewed by Dr. Sony Sherpa, (MBBS) - September 30, 2024

What is Chronic Fatigue Syndrome?

Chronic Fatigue Syndrome (CFS), or Myalgic Encephalomyelitis (ME), is a real condition with severely debilitating fatigue and other symptoms that affect millions of people worldwide. While exhaustion is a common symptom in many illnesses, the fatigue experienced in CFS is distinct due to its persistence and the fact that rest does not alleviate it. Despite its prevalence, CFS remains a complex, poorly understood condition, and many individuals struggle with its physical and emotional toll.

This article highlights the symptoms, causes, triggers, and treatment options currently available for those with CFS/ME, as well as debunks some myths surrounding the condition. Valuable lifestyle tips and tools for managing this challenging condition are also provided to help navigate life with greater ease.

Chronic Fatigue Syndrome Symptoms

Overwhelming, unexplained fatigue that does not improve with rest and persists for at least six months is one of the main symptoms of Chronic Fatigue Syndrome. The fatigue felt can be debilitating, and those with the condition may be bedridden for long periods of time and struggle with their ordinary daily activities.

The following are other typical signs of Chronic Fatigue Syndrome:

• Pain and muscle aches
• Post-exertional malaise (PEM), often described as a crash, collapse, or relapse
• Chronic insomnia or sleeping sickness (hypersomnia)
• Being unable to think clearly or brain fog
• Reduced attention span and concentration ability
• Depression, anxiety, or similar emotional concerns
• Lower immune function and increased vulnerability to infections
• Feeling dizzy when shifting positions from sitting or lying down to standing (orthostatic intolerance)

CFS symptoms are known to intensify after physical activity, mental exertion, and other triggers such as stress. They can have a profound impact on daily life, making it difficult to work, maintain relationships, and participate in social activities.

The severity of chronic fatigue syndrome differs from person to person, with some being unable to move at all and others capable of being active for short periods throughout the day before feeling exceedingly exhausted. Some individuals may experience episodes where exhaustion is worse, with a slow, gradual progression of symptoms or sudden onset of symptoms with no relief in between.

If suffering from similar symptoms, it is vital to get help as soon as possible.

How Long Does Chronic Fatigue Syndrome Last?

Chronic Fatigue Syndrome is not commonly known to go away on its own, and there is no cure for the condition. Physical function may improve on its own after a decade. Some individuals experience a quicker turnaround through proper symptom management and CFS therapies, while others experience a worsening of symptoms^[1]. The effectiveness of these interventions varies based on the individual's condition, and improvements may not become apparent for 12 to 18 months. There are a number of studies revealing that a few with CFS (<9%) manage to find complete remission after several years.^[2]

Is Chronic Fatigue Syndrome Real?

Despite being acknowledged since the 60s and symptoms being formally characterized as early as 1988, CFS is still not accepted as an official condition by many healthcare professionals.^[3]

The name ‘Chronic Fatigue Syndrome’ is often debated amongst those with the disease, as it promotes stigma among both uninformed physicians and the general public. As fatigue is a natural daily occurrence for many people, the word does not accurately describe the condition, downplays its severity, and can be perceived as offensive. It can also contribute towards perpetuating symptoms in sensitive individuals who would prefer not to refer to fatigue or tiredness when explaining their symptoms.

Myalgic Encephalomyelitis is currently the preferred term for the condition, as it refers to the components of the disease that more accurately reflect its severity, such as muscle pain and inflammation of the brain and spinal cord.

Differentiating CFS from Other Similar Conditions

As symptoms of CFS overlap with psychiatric and other neurological diseases, diagnosis can be difficult, even with an experienced specialist. Conditions that mimic CFS include fibromyalgia, Lyme disease, multiple sclerosis, and depression. Thorough medical evaluation and testing are necessary to rule out these conditions and arrive at an accurate diagnosis.

Chronic Fatigue Syndrome vs. Fibromyalgia

Fibromyalgia and Chronic Fatigue Syndrome are very similar conditions that share a great degree of overlap. Patients with one are known to develop the other, and they are often seen as comorbidities^[4]. Fibromyalgia is a chronic pain condition due to unknown causes that lasts for six months or longer without going away on its own and frequently does not improve with treatment. In this condition, pain can be exaggerated or caused by any stimulation of the nerves (allodynia), and these patients often experience physical pain connected to emotional problems as well.

While those with CFS experience muscle pain and aches, allodynia is uncommon, and extreme fatigue is the main complaint, especially after activity. Those with fibromyalgia may be susceptible to periods of weakness and exhaustion, yet the cause is typically debilitating pain.

Is Chronic Fatigue Syndrome an Autoimmune Disease?

CFS/ME is not an autoimmune disease, although, like many inflammatory conditions, it can present with similar features such as joint and muscle pain and gastrointestinal issues or sensitivities. PEM is also known to trigger worse symptoms in some, resembling autoimmune episodes where symptoms can rise and fall.

Triggers and Causes of CFS

So, what causes Chronic Fatigue Syndrome? The exact causes of Chronic Fatigue Syndrome remain elusive, but researchers have explored various factors that may contribute to its development.^[5]

While the condition is likely multifactorial, some key areas of interest include:

1. Infections: Previous viral or bacterial infections have been linked to the onset of CFS in some individuals. Of these, Epstein-Barr virus is the most well-known infection associated with CFS/ME.
2. Immune System Dysfunction: Immune system abnormalities have been observed in CFS patients, pointing to an autoimmune component.^[6]
3. Gut Dysbiosis: Genetic studies have revealed that imbalances in the gut microbiome may contribute to CFS symptoms and progression.^[7]
4. Stress: Physical or emotional stress can trigger or exacerbate CFS symptoms, highlighting the importance of stress management.
5. Energy Deficits: Mitochondrial dysfunction and deficits in energy production are theorized to play a role in CFS/ME, linking inflammation, extreme fatigue, pain, and other symptoms.

Understanding triggers is crucial for tailoring treatment and management strategies. Those who manage to identify and work with potential causes have a better prognosis.

Can Covid Cause Chronic Fatigue Syndrome?

The relationship between long covid and Chronic Fatigue Syndrome has been the focus of multiple studies. The two appear to have many of the same symptoms^[8], pointing to SARS-COV-2 as another virus that could contribute to CFS/ME. More research is required to confirm these findings.

Chronic Fatigue Syndrome Diagnosis and When to Seek Medical Help

One common question is how is Chronic Fatigue Syndrome diagnosed? There is no single test or clear marker for CFS, and hence, it can be difficult to diagnose. Instead, medical professionals rely on various clinical factors, including the presence of severe fatigue for at least six months, the exclusion of other medical conditions, and the presence of additional CFS-specific symptoms.

If you suspect you have CFS, it is essential to seek medical help. Better management and an improved quality of life are possible with early diagnosis. Keep a record of your symptoms and their severity, as this can help your healthcare provider make an accurate diagnosis.

What Kind of Doctor Treats Chronic Fatigue Syndrome?

Doctors able to diagnose and treat CFS/ME include rheumatologists, psychiatrists and neurologists who specialize in treating such patients. It is important not to self-diagnose and to opt for a doctor who has treated those with CFS before.

Chronic Fatigue Syndrome Treatment Options

Due to the mysterious nature of the condition, treating Chronic Fatigue Syndrome can be challenging, with therapies still being investigated. The treatment of Chronic Fatigue Syndrome involves a tailored management program that requires a multifaceted approach for the best results.^[9]

Chronic Fatigue Syndrome treatments may include:

• Medication For Chronic Fatigue Syndrome: Medication can help alleviate specific symptoms, such as pain, sleep disturbances, and cognitive dysfunction. Those with CFS/ME often benefit from painkillers and may respond to antidepressants to cope with other symptoms. Speak to your doctor about appropriate medication for CFS symptom management.
• Antimicrobial Treatment: A course of antibiotics or antivirals followed by probiotics may be beneficial as a treatment for Chronic Fatigue Syndrome for handling infections known to increase symptoms. Some patients with CFS/ME respond very well to antibiotics, even seeing short periods of relief^[10].
• Pacing Daily Activities: Learning to balance activity and rest is crucial for managing CFS. Pacing involves breaking tasks into manageable segments and avoiding overexertion. This may also be referred to as ‘energy management.’
• Cognitive Behavioral Therapy (CBT): CBT can be effective in helping individuals cope with CFS-related challenges, improve their mental health, and set realistic goals.
• Graded Exercise Therapy (GET): This refers to a supervised exercise program that helps patients gradually increase physical activity levels, regulate energy deficits, improve muscle strength and overall fitness, and reduce symptom severity.
• Alternative Therapies: Chronic Fatigue Syndrome therapies involving alternative medicine such as acupuncture, massage, or mindfulness meditation can be helpful for some CFS patients. These are especially great for lowering stress, which may trigger symptoms.

What is the Latest Treatment for Chronic Fatigue Syndrome?

Ongoing research into CFS has led to promising developments in treatment. Researchers are exploring potential medications that target specific aspects of the condition, as well as innovative approaches like immunomodulation therapies.

Some of the latest advancements include:

• New Blood Test with 91% Accuracy: A team at Stanford University may have found a way to diagnose CFS/ME by assessing metabolic differences in peripheral blood mononuclear cells (PBMCs).^[11]
• Nerve Stimulation Devices: Patients with ME/CFS have been shown to benefit from neurofeedback therapy, which uses electrodes to track and train brain waves and increase sleep quality while lowering anxiety and depression. Those with CFS may also respond to the Hummingbird, a small device for the calf that stimulates nerves in the legs. This has been shown to improve blood flow to the brain and muscles.
• Antioxidant Therapy: Various antioxidant supplements have shown promise in preliminary studies, including CoQ10, zinc, and selenium. These may be able to lower fatigue and improve overall life quality in CFS patients.^[12]

While no definitive cure exists, these advances offer hope for improved management of CFS in the future.

Tips for Living with CFS

Living with Chronic Fatigue Syndrome can be challenging. In addition to adopting a tailored treatment plan, lifestyle changes, social support, and one’s attitude can all help improve upon symptoms.

Practical tips for Chronic Fatigue Syndrome self-care include:

Dietary Considerations: A balanced diet rich in nutrients and prebiotic foods can help support overall health in those with CFS. Probiotics may also be helpful in restoring the balance of good gut bacteria and improving upon symptoms. Intermittent fasting, avoiding sugar, reducing carb intake, and consuming plenty of healthy dietary fats have also been suggested due to the way in which they support the metabolism.

Stress Management Techniques: To lower stress levels, try relaxing exercises like yoga, meditation, or deep breathing. This is especially helpful if anxiety worsens the symptoms.

Sleep Hygiene: To enhance the quality of rest, establish a regular sleep schedule and a sleep-conducive environment. This involves ensuring your bedroom is cool and dark, dimming light and stimulation in the hour before sleep, and getting to sleep at a set time every night that allows for 7-9 hours of rest.

Prioritize Mental and Emotional Well-being: Your attitude and approach to CFS/ME can make all the difference in managing the condition, especially when taking into account how thoughts and feelings can contribute towards pain, motivation, and immune function. It is important to accept that CFS is a part of your life, yet it does not define who you are. If required, counseling or support groups can help to address the emotional impact of CFS and improve outcomes.

Track Symptoms and Progress: Keeping a journal of your symptoms can help identify patterns and triggers that worsen exhaustion. Use these observations to enhance your treatment plan and allow you to acknowledge the progress you have made.

Conclusion

Chronic Fatigue Syndrome is a challenging condition that affects millions of individuals globally. While there is no definitive cure, understanding its symptoms, causes, and management options can significantly improve one's quality of life. With ongoing research and advances in treatment, there is hope for a brighter future for those living with CFS. By embracing a holistic approach to managing the condition, individuals can find ways to mitigate symptoms, cope with their emotional toll, and live fulfilling lives despite the challenges.

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