© Sweet Livin, Inc. 2011
Chronic Fatigue and Fibro Living
Causes of CFS
Diagnosis of CFS
Treatment of CFS
Chronic fatigue syndrome (CFS) is a debilitating and complex disorder characterized by intense fatigue that is not
improved by bed rest and that may be worsened by physical or mental activity. People with CFS most often function at a
substantially lower level of activity than they were capable of before the onset of illness. The cause or causes of CFS
have not been identified and no specific diagnostic tests are available. Therefore, in order to be diagnosed with chronic
fatigue syndrome, a patient must satisfy two criteria:
Have severe chronic fatigue for at least six months or longer with other known medical conditions (whose
manifestation includes fatigue) excluded by clinical diagnosis; and
Concurrently have four or more of the following symptoms:
impaired memory or concentration
multi-joint pain without redness or swelling
tender cervical or axillary lymph nodes
The symptoms must have persisted or recurred during six or more consecutive months of illness and must not have
predated the fatigue.
Definition [back to the top]
Chronic fatigue syndrome (CFS) is a characterized by extreme fatigue that doesn’t improve with bed rest and may
worsen with physical or mental activity.
Chronic fatigue syndrome may occur after an infection, such as a cold or viral illness. The onset can be during or shortly
after a time of great stress, or chronic fatigue syndrome come on gradually without a clear starting point or obvious
Women are diagnosed with chronic fatigue syndrome far more often than men are. However, it’s unclear whether chronic
fatigue syndrome affects women more frequently or if women report it more often than men do.
The Fact Sheet for CFS published by the National Institutes of Allergy and Infectious Diseases of the National Institutes
of Health states that “Today, CFS is also known as myalgic encephalomyelitis (ME), post viral fatigue syndrome (PVFS),
and chronic fatigue and immune dysfunction syndrome (CFIDS).” ME/CFS is now recognized as part of a range of
illnesses that have fatigue as a major symptom.
Causes of CFS [back to the top]
Of all chronic illnesses, chronic fatigue syndrome is one of the most mysterious. Unlike definite infections, it has no clear
cause. Several possible causes have been proposed, including:
Iron deficiency anemia
Low blood sugar (hypoglycemia)
History of allergies
Virus infection, such as Epstein-Barr virus or human herpes virus 6
Dysfunction in the immune system
Changes in the levels of hormones produced in the hypothalamus, pituitary glands
Mild, chronic low blood pressure hypotension
The cause of chronic fatigue syndrome may be an inflammation of the pathways of the nervous system as a response to
an autoimmune process, but with nothing measurable in the blood as in other autoimmune diseases, such as rheumatoid
arthritis and lupus.
Chronic fatigue syndrome may also occur when a viral illness is complicated by a dysfunctional immune system. Some
people with CFS may have a low blood pressure disorder that triggers the fainting reflex.
In many cases, however, no serious underlying infection or disease is proved to specifically cause chronic fatigue
syndrome. Lack of medical knowledge and understanding of CFS has made determining and describing the
characteristics of the condition difficult.
Other Commonly Observed Symptoms in CFS
dry eyes or mouth
psychological problems (depression, irritability, anxiety, panic attacks)
shortness of breath
skin sensations, such as tingling
These symptoms do not contribute to the diagnosis of CFS.
Diagnosis of CFS [back to the top]
A diagnosis of chronic fatigue syndrome is based on exclusion. This means that before arriving at a diagnosis, a doctor
has ruled out any other disease or condition that may be causing your fatigue and related symptoms.
Doctors find it difficult to diagnose chronic fatigue syndrome because it has some of the same signs and
symptoms as many other diseases. There’s no diagnostic or laboratory procedure to confirm the presence of
chronic fatigue syndrome.
Doctors exclude certain conditions before considering a diagnosis of chronic fatigue syndrome. These include:
Having an active, identifiable medical condition that often results in fatigue, such as Lupus, low levels of
thyroid hormones (hypothyroidism) or sleep apnea
Using medicines that may cause fatigue
Having a relapse of a previously treated illness that can result in fatigue, such as cancer
Having had a past or current diagnosis of a major depressive disorder or other psychiatric illness, such as
schizophrenia or an eating disorder
Abusing alcohol or another substance
Being severely obese, as defined by a body mass index (BMI) of 45 or greater
Over time, be alert to any new cues that might indicate that the problem is caused by something other than chronic
fatigue syndrome. When other diseases or conditions are excluded, your doctor may then determine if your illness meets
the CFS-specific criteria.
Treatment of CFS [back to the top]
There’s no specific chronic fatigue syndrome treatment. In general, doctors aim to relieve signs and symptoms by using a
combination of treatments, which may include:
Moderating daily activity. Your doctor may encourage you to slow down and to avoid excessive physical and
psychological stress. However, too much rest can make you weaker, worsening your long-term symptoms. Your goal
should be to maintain a moderate level of daily activity and gently increase your stamina over time
Gradual but steady exercise. Often with the help of a physical therapist, you may be advised to begin an exercise
program that slowly becomes more challenging. Research has proved that gradually increasing exercise can improve the
symptoms of chronic fatigue syndrome. In one study, 70 percent of participants with CFS reported feeling better after
completing a supervised program of graduated exercise.
Cognitive behavior therapy. This treatment, often used in combination with graduated exercise, also has been found to
improve the symptoms of chronic fatigue syndrome. In cognitive behavior therapy, you work with a mental health
professional to identify negative beliefs and behaviors that might be delaying your recovery and replace them with
healthy, positive ones.
Treatment of depression. If you’re depressed, medications, such as tricyclic antidepressants and selective serotonin
reuptake inhibitors (SSRIs), may help. Antidepressants may also help improve sleep and relieve pain. Tricyclic
antidepressants include amitriptyline (Limbitrol, a multi-ingredient drug that contains amitriptyline), desipramine
(Norpramin) and nortriptyline (Aventyl, Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil),
sertraline (Zoloft) and bupropion (Wellbutrin).
Treatment of existing pain. Acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs), such
as aspirin and ibuprofen (Advil, Motrin, others), may be helpful to reduce pain and fever.
Treatment of allergy-like symptoms. Antihistamines, such as fexofenadine (Allegra) and cetirizine (Zyrtec), and
decongestants that contain pseudoephedrine (Sudafed) may relieve allergy-like symptoms such as runny nose.
Treatment of low blood pressure (hypotension). The drugs fludrocortisone (Florinef), atenolol (Tenormin) and
midodrine (ProAmatine, Orvaten) may be useful for certain people with chronic fatigue syndrome.
Treatment for problems of the nervous system. Symptoms such as dizziness and extreme skin tenderness can
sometimes be relieved by clonazepam (Klonopin). Your doctor may prescribe medications such as lorazepam (Ativan)
and alprazolam (Xanax) to relieve symptoms of anxiety.
Research aimed at finding new treatments for chronic fatigue syndrome has included studies of the following
Methylphenidate (Ritalin, Concerta). This psychostimulant appears to boost and balance levels of the brain chemicals
called neurotransmitters. It’s commonly used to treat attention-deficit/hyperactivity disorder (ADHD). One study found
that methylphenidate improved fatigue and concentration in some people with chronic fatigue syndrome.
D-ribose. Also called ribose, this form of sugar is an essential energy source for your cells. Scientists believe that
impaired cellular metabolism — some kind of disorder in the way your cells do their work — may play a role in chronic
fatigue syndrome. Some research has found that natural D-ribose supplements may significantly improve the symptoms
of chronic fatigue syndrome, with particular benefit in study participants’ energy level and overall well-being.
Acupuncture. Acupuncture has been studied as a treatment for the symptoms of fibromyalgia, a disease that is
considered similar to CFS and is also characterized by fatigue and muscle soreness. In one clinical trial, half the
participants received acupuncture, while the other half received a placebo treatment. Those treated with acupuncture
experienced a significant improvement in their symptoms — especially fatigue and anxiety — compared with the
Corticosteroids. Some studies have found that oral hydrocortisone may improve symptoms of chronic fatigue syndrome,
while other studies have found no benefit.
Immune globulins and interferons. These medications are used to boost your immune system’s ability to fight
infection. Studies have not found them to be consistently effective in treating chronic fatigue syndrome, and participants
have experienced severe side effects.
Antiviral drugs, such as acyclovir. The possible connection between chronic fatigue syndrome and Epstein-Barr virus
led researchers to test whether powerful antiviral medications could improve the symptoms of chronic fatigue syndrome.
This approach has not been found effective, and the connection between Epstein-Barr virus and chronic fatigue syndrome
has since been disproved.
Cholinesterase (ko-lin-ES-tur-ase) inhibitors, such as galantamine. These drugs improve the effectiveness of
acetylcholine, a chemical messenger that is believed to be important for memory, thought and judgment. Galantamine is
used in the treatment of Alzheimer’s disease, but has not been found beneficial for chronic fatigue syndrome.
Risk Factors [back to the top]
Women are diagnosed with chronic fatigue syndrome two to four times as often as men, but sex isn’t a proven risk factor
for this condition. It may be that women are simply more likely than men are to report their symptoms to their doctor.
The condition is most common in people in their 40s and 50s, but it can affect people of all ages. Because the cause of
the condition is unknown, doctors have yet to determine and confirm definite risk factors for the disease.
Complications [back to the top]
There are a number of complications arising from CFS, including:
Social isolation caused by fatigue
Lifestyle restrictions (some people are so fatigued that they are essentially disabled during the course of the
Depression (related both to symptoms and lack of diagnosis)
Side effects and adverse reactions related to medication treatments
Call for an appointment with your health care provider if you experience persistent, severe fatigue, with or without other
symptoms of this disorder. Other more serious disorders can cause similar symptoms and should be excluded. More
information on C.F.S. is available from the Centers for Disease Control and Prevention and the CFIDS Association of