Chronic Fatigue Syndrome

Unusual fatigue or exhaustion is a very common medical complaint. It can be caused by a very large number of illnesses. But there is also a specific condition called "chronic fatigue syndrome" (CFS). This is sometimes also known as chronic fatigue and immune dysfunction syndrome (CFIDS). Other common symptoms are widespread pain, difficulties with memory and concentration, and sometimes, features suggesting a viral illness like fever, or sore throat.

Many of the symptoms of chronic fatigue syndrome overlap with those of fibromyalgia. For instance, in both conditions there is often widespread pain, poor sleep, an unusual degree of exhaustion after minor exertion, and difficulty with memory and concentration. So it is hardly surprising that many experts believe these disorders are related. Some even believe that they are essentially the same disease. However, there are also some ways in which these two conditions seem very different. For instance, FM is much commoner in women, CFS less so; FM seems to be increasing in the USA, whereas CFS is decreasing; whereas CFS very often starts suddenly with something like an acute viral illness, such an onset is rare with FM; and certain lab tests are different in the two conditions.

The underlying cause of CFS is still unsure. It is quite likely to consist of several separate diseases that we cannot yet distinguish, that may have very different mechanisms but which all end up causing the same set of symptoms. As with fibromyalgia, many doctors have viewed it as a variety of depression or some other psychiatric illness. This is not surprising: over the years, doctors have quite commonly labelled patients as mentally ill if their problems were resistant to the usual diagnostic tests. This was true of conditions like tuberculosis, or stomach ulcers, or Lyme disease, before tests became available to establish their true physical basis. We believe that the medical profession will eventually come round to seeing CFS (and FM) as disorders of (mainly) the nervous system, like Parkinson’s disease or epilepsy, but with effects outside the nervous system as well.

It does sometimes get completely better without treatment. More often it waxes and wanes in severity over months and years. A wide variety of treatments have been tried, and some of them clearly help a few people. But none of them helps more than a fraction of the people with CFS. It follows that all treatments for this condition are essentially "trial and error." The same principles apply as for those on the Pain Treatment page: start with treatments that, if they help at all, are rapid, powerful, safe, inexpensive and convenient, and be much more cautious about trying anything that will take a long time to work, and therefore is likely to be inconvenient, expensive and perhaps even risky.

This condition has sadly attracted a lot of quackery: much of it well-meaning but none the less misguided. We try to steer patients among the various approaches they may be attracted to, and help them distinguish the scams from those that may actually be helpful. Meanwhile, it’s important for the doctor to stay abreast of the research on CFS, so that when better treatments become available, they can be promptly offered to the people they may help.

Alan Spanos, MD, MA