The Negative Effects Of Chronic Fatigue Syndrome (CFS)

Chronic Fatigue Syndrome(CFS) is an emerging illness characterized by debilitating fatigue (experienced as exhaustion and extremely poor stamina), neurological problems, and a variety of flu-like symptoms. The illness is also known as chronic fatigue immune dysfunction syndrome (CFIDS), and outside of the USA is usually known as myalgic encephalomyelitis (ME). In the past the syndrome has been known as chronic Epstein-Barr virus (CEBV).

Some patients are bedridden; others consider themselves fortunate if they can work or attend school at least part time, since any exertion typically worsens their symptoms. Many are denied disability insurance benefits because doctors and employers believe they are lazy or have a mental illness rather than a serious physical condition.

Symptoms include fatigue, substantial impairment of short-term memory or concentration, sore throat, tender lymph nodes, muscle and joint pain, headaches, unrefreshing sleep, and fatigue lasting more than 24 hours following exertion.

CFS is diagnosed when these symptoms persist for more than six months and cannot be explained by any other medical or psychological condition.

Many veterans of the Persian Gulf war have a symptom complex that has been determined by scientists to be virtually identical to CFS.

Research is being done on many fronts, from cardiology to immunology to endocrinology, but the disease remains a mystery. Even the most promising treatments seem to work only for some patients and improve their lives by only small degrees.

It is not improved by bed rest and may be worsened by physical or mental activity. Persons with CFS must 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. The cause or causes of CFS have not been identified and no specific diagnostic tests are available. Moreover, since many illnesses have incapacitating fatigue as a symptom, care must be taken to exclude other known and often treatable conditions before a diagnosis of CFS is made.

A number of illnesses have been described that have a similar spectrum of symptoms to CFS. These include fibromyalgia syndrome, myalgic encephalomyelitis, neurasthenia, multiple chemical sensitivities, and chronic mononucleosis. Although these illnesses may present with a primary symptom other than fatigue, chronic fatigue is commonly associated with all of them.

People diagnosed with CFS often describe its onset as sudden but not alarming because many of the syndrome's symptoms--headache, tender lymph nodes, fatigue and weakness, muscle and joint aches, inability to concentrate--mimic those of the flu. But whereas flu symptoms usually go away in a few weeks, CFS symptoms either persist or recur frequently for more than six months.

For many people, CFS begins after an acute infection such as a cold, bronchitis, hepatitis, or an intestinal bug. For some, it follows a bout of mononucleosis, the "kissing disease" that temporarily saps the energy of teenagers and young adults. In others, CFS develops more gradually, with no clear triggering event. Often a patient reports that the illness emerged during a period of high stress.

Contrary to the popular stereotype, CFS is not a new "yuppie flu." Similar syndromes, known by different names, date back to the late 1800s. The modern stereotype arose because those who sought help for and stimulated scientific interest in CFS in the early 1980s were mainly well-educated, affluent women in their thirties and forties. Since then, physicians have seen the syndrome in people of all ages, races, and socioeconomic classes from several countries around the world.

Still, CFS is diagnosed two to four times more often in females than in males, which may be the result of biological, psychological, and social influences. For example, a real gender difference may exist in CFS, similar to diseases such as lupus and multiple sclerosis that affect more women than men. Or, women may be more likely than men to consult doctors about CFS-like symptoms. Also, some members of the medical community and the public remain unaware or skeptical of the syndrome. An increasingly diverse patient population will likely emerge as more physicians recognize CFS as a legitimate disorder.

There is not yet any consensus on a treatment protocol for CFS. The following appear to be typical prescriptions:

  • Teaching the patient energy management and recognition of limits
  • Low dose tricyclic anti-depressants such as doxepin and amitriptyline, for sleep disorder, and muscle and joint pain
  • NSAIDs such as ibuprofen and naproxen for headache, and muscle and joint pain.

Other treatments often prescribed are Klonopin, intra-muscular gamma globulin (IMgG), nutritional supplements (particularly anti-oxidants, B-vitamins generally and B-12 specifically), herbs, and acupuncture.

A variety of vitamin supplements, medications, and other substances have been described as having potential therapeutic benefits for CFS patients. Many of the treatments recommended for CFS patients are intended to provide relief for symptoms of this condition. However, some proposed treatments are unproven and potentially dangerous. As a service to CFS patients and other interested persons, this section provides some basic information about different therapies that have been used for the treatment of CFS patients. These descriptions are intended to be used only for general informational purposes. Decisions regading the use of these or other treatments should be made only in consultation with a physician. If you have doubts about a particular treatment, contact your local medical society, university medical school, or another physician for additional information.

Pharmacologic therapy is directed toward the relief of specific symptoms experienced by the individual patient. Patients with CFS appear particularly sensitive to drugs, especially those that affect the central nervous system. Thus, the usual treatment strategy is to begin with very low doses and to escalate the dosage gradually as necessary.

Prescription medications

Low-dose Tricyclic Agents: Tricyclic agents are sometimes prescribed for CFS patients to improve sleep and to relieve mild, generalized pain.

Antidepressants: Antidepressants have been used to treat depression in CFS patients, although non-depressed CFS patients receiving treatment with serotonin reuptake inhibitors have been found by some physicians to benefit from this treatment as well or better than depressed patients.

Anxiolytic agents: Anxiolytic agents are used to treat panic disorder in CFS patients.

Nonsteroidal Anti-inflammatory Drugs: These drugs may be used to relieve pain and fever in CFS patients. Some are available as over-the-counter medications.

Dietary Supplements and Herbal Preparations

General Comments: A variety of dietary supplements and herbal preparations are claimed to have potential benefits for CFS patients. With few exceptions, the effectiveness of these remedies for treating CFS patients has not been evaluated in controlled trials. Contrary to common belief, the "natural" origin of a product does not ensure safety. Dietary supplements and herbal preparations can have potential side reactions and some can interfere or interact with prescription medications. CFS patients should seek the advice of their physician before using any unprescribed remedy.

Vitamins, Coenzymes, Minerals: Preparations that have been claimed to have benefit for CFS patients include adenosine monophosphate, coenzyme Q-10, germanium, glutathione, iron, magnesium sulfate, melatonin, NADH, selenium, l-tryptophan, vitamins B12, C, and A, and zinc. An early CFS study found reduced red blood cell magnesium sulfate in CFS patients, but two subsequent studies have found no difference between patients and healthy controls. The therapeutic value of all these preparations has not been validated.

Herbal Preparations: Plants are known sources of pharmacological materials. However, unrefined plant preparations contain variable levels of the active compound as well as many irrelevant, potentially harmful substances. Preparations that have been claimed to have benefit to CFS patients include astragalus, borage seed oil, bromelain, comfrey, echinacea, garlic">garlic, Ginkgo biloba, ginseng, primrose oil, quercetin, St. Johns Wort, and Shiitake mushroom extract. Only primrose oil was evaluated in a controlled study, and the beneficial effects noted in CFS patients have not been independently confirmed. Some herbal preparations, notably comfrey and high-dose ginseng, have recognized harmful effects.

The nutrients mentioned above reflect the major nutritional supplements that may help the condition. Please do remember however that nutritional supplementation is an adjunct to medical treatment and in no way replaces medical treatment.

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