Trivia: Chronic Fatigue Syndrome (CFS)

What is chronic fatigue syndrome?

The CDC defines chronic fatigue syndrome (CFS) as "a debilitating and complex disorder characterized by profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity. Persons with CFS most often function at a substantially lower level of activity than they were capable of before the onset of illness. In addition to these key defining characteristics, patients report various nonspecific symptoms, including weakness, muscle pain, impaired memory and/or mental concentration, insomnia, and post-exertional fatigue lasting more than 24 hours. In some cases, CFS can persist for years."

How is CFS diagnosed?

To date, no cause or causes of CFS have been identified and no specific diagnostic tests are available.

There are treatable conditions that have symptoms similar to CFS, so conditions such as mononucleosis, Lyme disease, thyroid disorders, diabetes, multiple sclerosis, some cancers, depression, and bipolar disorder must be ruled out. To receive a diagnosis of CFS, a patient must:

1. Have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis; and
2. Concurrently have four or more of the following symptoms: substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern or severity; unrefreshing sleep; and post-exertional malaise lasting more than 24 hours.

Interestingly, regarding the issue of sleep, an article published on December 5, 2007 in BMC Neurology concluded that while people with CFS report sleep problems significantly more than control subjects, there were no significant differences in sleep pathology or architecture between subjects with CFS and control subjects, so "… CFS subjects may have an increased appreciation of sleep behaviour that may contribute to their perceived sleep problems."

How many people have CFS?

The CDC reports that 1+ million Americans have CFS, but they also note that their own research indicates that less than 20% of CFS patients in the USA have been diagnosed. In a 2003 Statistics Canada study of Canadians with medically unexplained physical symptoms, it was reported that 1.3% of Canadians over age 12, or approximately 341,000 people, had been diagnosed with CFS. An article in the November 2006 Journal of Clinical Virology says that the worldwide prevalence of CFS is thought to be .4% to 1%.

Who gets CFS?

People of every age, sex, and ethnicity can develop CFS. The Mayo Clinic's page on CFS says that women are diagnosed two to four times as often as men, but that it is unknown whether more women have the condition or whether women are more likely to report the condition. CFS is most common in people in their 40s and 50s. The CDC says that there is some evidence that CFS is more common in lower-income households. CFS is also sometimes seen in members of the same family, but there is no indication that it is contagious, so instead there may be a genetic predisposition.

How long does CFS last?

Individual symptoms vary in number, type, and severity, but even those least affected are functionally impaired to some degree. The CDC says, "CFS often follows a cyclical course, alternating between periods of illness and relative well-being. Some patients experience partial or complete remission of symptoms during the course of the illness, but symptoms often reoccur. This pattern of remission and relapse makes CFS especially hard for patients and their health care professionals to manage. … The percentage of CFS patients who recover is unknown, but there is some evidence to indicate that the sooner symptom management begins, the better the chance of a positive therapeutic outcome."

How is CFS treated?

Treatment may involve pharmaceutical therapy for symptom relief (e.g., meds to help with sleep or pain), complementary/alternative therapies (e.g., massage, acupuncture), cognitive behavioral therapy (a November 2007 meta-analysis of the use of CBT for CFS reported that it "tends to be moderately efficacious"), counseling (e.g., to help with coping skills), and/or support groups.

Recent Research into Possible Causes of CFS

An article in the November 2006 Journal of Clinical Virology summarized: "Studies of pathogenesis have revealed immune system abnormalities and chronic immune activation, dysfunction of the hypothalamic–pituitary–adrenal (HPA) axis, brain abnormalities, evidence of emotional stress (comprising host aspects) and evidence of exogenous insults, for example, various microbial infections (Epstein-Barr virus, enteroviruses, parvovirus B19, Coxiella burnetii and Chlamydia pneumoniae), vaccinations and exposure to organophosphate chemicals and other toxins (comprising environmental aspects)."

An article published in the January 2008 issue of the Journal of Clinical Pathology reports that, in studies on 165 patients with CFS, that 82% of the samples contained the enterovirus protein VPI, which can cause acute respiratory and GI infections, and affect the heart, nervous system, and muscles.

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