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Chronic fatigue syndrome (CFS) is a condition that causes extreme tiredness (fatigue). This condition is also known as myalgic encephalomyelitis (ME). The fatigue in CFS does not improve with rest, and it gets worse with physical or mental activity. Several other symptoms may occur along with fatigue.

Symptoms may come and go, but they generally last for months. Sometimes, CFS gets better over time. In other cases, it can be a lifelong condition. There is no cure, but there are many possible treatments. You will need to work with your healthcare providers to find a treatment plan that works best for you.

What are the causes?

The cause of this condition is not known. CFS may be caused by a combination of things. Possible causes include:

• An infection.
• An abnormal body defence system (abnormal immune system).
• Low blood pressure.
• Poor diet.
• Living with a lot of physical or emotional stress.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Being female.
• Being 40–50 years old.
• Having a family history of CFS.

What are the signs or symptoms?

The main symptom of this condition is fatigue that is severe enough to interfere with day-to-day activities. This fatigue does not get better with rest, and it gets worse with physical or mental activity. There are eight other major symptoms of CFS:

• Discomfort and lack of energy (malaise) that lasts more than 24 hours after physical activity.
• Sleep that does not relieve fatigue (un-refreshing sleep).
• Short-term memory loss or confusion.
• Joint pain without redness or swelling.
• Muscle aches.
• Headaches
• Painful and swollen glands (lymph nodes) in the neck or under the arms.
• Sore throat.

Other symptoms can include:

• Cramps in the abdomen, constipation, or diarrhoea (irritable bowel syndrome).
• Chills and night sweats.
• Vision changes.
• Dizziness and mental confusion (brain fog).
• Clumsiness
• Sensitivity to food, noise, or odours.
• Mood swings, depression, or anxiety attacks.

How is this diagnosed?

There are no tests that can diagnose this condition. Your healthcare provider will make the diagnosis based on:

• Your symptoms and medical history.
• A physical exam and a mental health exam.
• Tests to rule out other conditions. It is important to make sure that your symptoms are not caused by another medical condition. Tests may include lab tests or X-rays.

For your healthcare provider to diagnose CFS:

• You must have had fatigue for at least six straight months.
• Fatigue must be your first symptom, and it must be severe enough to interfere with day-to-day activities.
• You must also have at least four of the eight other major symptoms of CFS.
• There must be no other cause found for the fatigue.

How is this treated?

There is no cure for CFS. The condition affects everyone differently. You will need to work with your team of healthcare providers to find the best treatments for your symptoms. Your team may include your primary care provider, physical and exercise therapists, and mental health therapists. Treatment may include:

• Having a regular bedtime routine to help improve your sleep.
• Avoiding caffeine, alcohol, and tobacco or nicotine products.
• Doing light exercise and stretching during the day. You may also want to try movement exercises, such as yoga or tai chi.
• Taking medicines to help you sleep or to relieve joint or muscle pain.
• Learning and practicing relaxation techniques, such as deep breathing and muscle relaxation.
• Using memory aids or doing brainteasers to improve memory and concentration.
• Getting care for your body and mental well-being, such as:
  • Seeing a mental health therapist to evaluate and treat depression, if necessary.
  • Cognitive behavioral therapy (CBT). This therapy changes the way you think or act in response to the fatigue. This may help improve how you feel.
  • Trying massage therapy and acupuncture.

Follow these instructions at home:

Eating and drinking

• Avoid caffeine and alcohol.
• Avoid heavy meals in the evening.
• Eat a healthy diet that includes foods such as vegetables, fruits, fish, and lean meats.

Activity

• Rest as told by your healthcare provider.
• Avoid fatigue by pacing yourself during the day and getting enough sleep at night.
• Exercise regularly, as told by your healthcare provider.
• Go to bed and get up at the same time every day.

Lifestyle

• Ask your healthcare provider whether you should keep a diary. Your healthcare provider will tell you what information to write in the diary. This may include when you have fatigue and how medicines and other behaviours or treatments help to reduce the fatigue.
• Consider joining a CFS support group.
• Avoid stress and use stress-reducing techniques that you learn in therapy.

General instructions

• Take over-the-counter and prescription medicines only as told by your healthcare provider.
• Do not use herbal or dietary supplements unless they are approved by your healthcare provider.
• Maintain a healthy weight.
• Do not use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your healthcare provider. This is important.

Contact a healthcare provider if:

• Your symptoms do not get better or they get worse.
• You feel angry, guilty, anxious, or depressed.

Get help right away if:

• You have thoughts of self-harm.

If you ever feel like you may hurt yourself or others, or have thoughts about taking your own life, get help right away. Go to your nearest emergency department or:

• Call your local emergency services.

Summary

• Chronic fatigue syndrome (CFS) is a condition that causes extreme tiredness (fatigue). This fatigue does not improve with rest, and it gets worse with physical or mental activity.
• There is no cure for CFS. The condition affects everyone differently. You will need to work with your team of healthcare providers to find the best treatments for your symptoms.
• Exercise regularly, as told by your healthcare provider. Avoid stress and use stress-reducing techniques that you learn in therapy.
• Contact a healthcare provider if your symptoms do not get better or they get worse.

This information is not intended to replace advice given to you by your healthcare provider. Make sure you discuss any questions you have with your healthcare provider.

References:

Aili K., Andersson M., Bremander A., Haglund E., Larsson I., Bergman S.: Sleep problems and fatigue as predictors for the onset of chronic widespread pain over a 5- and 18-year perspective. BMC Musculoskelet. Disord. 2018; 19: pp. 390.

Brown P.J., Badreddine D., Roose S.P., Rutherford B., Ayonayon H.N., Yaffe K., Simonsick E.M., Goodpaster B., Health A.B.C.S.: Muscle fatigability and depressive symptoms in later life. Int. J. Geriatr. Psychiatry 2017; 32: pp. e166-e172.

Hirshkowitz M., Whiton K., Albert S.M., et. al.: National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep Health 2015; 1: pp. 233-243.

Wright J., O’Connor K.M.: Fatigue. Med Clin North Am 2014; 98: pp. 597-608.

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