CFS

CFS is the acronym for chronic fatigue syndrome.

• It is a condition that lasts for more than 6 months in which a person feels tired most of the time.
• They may also have trouble concentrating and carrying out daily activities.
• Other symptoms include sore throat, fever, muscle weakness, headache, and joint pain.
• Other names include myalgic encephalomyelitis/chronic fatigue syndrome.

What are the symptoms of CFS?

Symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may appear similar to many other illnesses and there is no test to confirm ME/CFS which makes ME/CFS difficult to diagnose.

What are the core symptoms of CFS or ME/CFS?

Also called “core” symptoms, three primary symptoms are required for diagnosis:

1. Greatly lowered ability to do activities that were usual before the illness.
2. Worsening of ME/CFS symptoms after physical or mental activity that would not have caused a problem before illness known as post-exertional malaise (PEM).
3. Sleep problems.
4. Problems with thinking and memory.
5. Worsening of symptoms while standing or sitting upright called orthostatic intolerance.

Other Common Symptoms include: Many but not all people with ME/CFS have other symptoms.

• Pain is very common in people with ME/CFS.
• Muscle pain and aches
• Joint pain without swelling or redness
• Headaches, either new or worsening
• Some people with ME/CFS may also have:
• Tender lymph nodes in the neck or armpits
• A sore throat that happens often
• Digestive issues, like irritable bowel syndrome
• Chills and night sweats
• Allergies and sensitivities to foods, odors, chemicals, light, or noise
• Muscle weakness
• Shortness of breath
• Irregular heartbeat

How is ME/CFS diagnosed?

• No confirmatory test to diagnose ME/CFS is currently available.
• While many biological abnormalities have been reported in patients with the illness, none of these “biomarkers” have a sufficiently low false negative and false positive rate to constitute a diagnostic test.
• A healthcare provider can make the diagnosis of ME/CFS based on a thorough medical history and physical examination, laboratory test results, and evaluating for other fatiguing illnesses with a targeted work-up.
• Comorbid conditions are often present and may include: sleep disorders, irritable bowel syndrome, fibromyalgia, depression or anxiety. The presence of these conditions does not exclude the diagnosis of ME/CFS.

How is ME/CFS treated?

• There is no cure or approved treatment for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
• Most symptoms can be treated or managed.
• Treating these symptoms might provide relief for some patients with ME/CFS but not others.
• Other strategies, like learning new ways to manage activity, can also be helpful.

What is the clinical course of CFS?

• The illness can be unpredictable.
• Symptoms may come and go, or there may be changes in how bad they are over time.

What is the 1994 International Research Case Definition?

Overview of Inclusions from the 1994 International Research Case Definition include:

• Fatigue + 4 out of 8 case-defining symptoms:
• PEM lasting more than 24 hours
• Unrefreshing sleep
• Significant impairment of short-term memory or concentration
• Muscle pain
• Pain in the joints without swelling or redness
• Headaches of a new type, pattern, or severity
• Tender lymph nodes in the neck or armpit
• A sore throat that is frequent or recurring

What is the duration of these symptoms?

≥ 6 months (clinical evaluation starts at one month – prolonged fatigue)

Fatigue

• ≥ 6 months new onset severe persistent or relapsing fatigue
• Unexplained after clinical evaluation
• Not explained by ongoing exertion
• Not substantially relieved by rest
• Results in substantial reduction in occupational, educational, social, or personal activities
• Post-exertional malaise

The minimum number of symptoms is 5

Exclusions

• Active medical condition that explains chronic fatigue – untreated hypothyroidism, sleep apnea, narcolepsy, medication side effects
• Previous diagnosis not unequivocally resolved – chronic hepatitis, malignancy
• Past or current major depressive disorder with psychotic or melancholic features, bipolar disorder, schizophrenia, delusional disorders, dementias, anorexia nervosa, bulimia nervosa
• Alcohol or substance abuse within 2 years of illness onset or anytime after
• Severe obesity (BMI > 45)

Comorbidities Accepted co-morbidities include: Fibromyalgia, anxiety disorders, somatoform disorders, nonpsychotic or melancholic depression, neurasthenia, multiple chemical sensitivity disorder, treated Lyme disease or syphilis before chronic sequelae, isolated unexplained lab or physical abnormality insufficient to suggest exclusionary diagnosis

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