Chronic Fatigue Syndrome:Understanding and Managing Symptoms, Causes, Diagnosis, and Treatment

Chronic Fatigue Syndrome:
Understanding and Managing Symptoms, Causes, Diagnosis, and Treatment 

​Chronic fatigue syndrome, formally known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is a debilitating multi-system disease associated with considerable morbidity, functional disability, and healthcare expenditure.  It is characterized by severe fatigue, cognitive dysfunction and the presence of a multitude of other symptoms.  ME/CFS is not understood well at this time, and the effect of this chronic illness on individuals can have an immense impact on their quality of life.  
Chronic fatigue syndrome is not the same as temporary fatigue after a heavy weekend of partying or a draining week at work. Despite this background information, the exact cause of ME/CFS remains unclear.  Chronic fatigue syndrome Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating illness that has a substantial impact on the well-being of those affected.  It is defined as a persistent or relapsing multi-system disorder that features fatigue lasting for more than six months and a myriad of other symptoms.  Unlike simple fatigue, which is common and usually episodic, the fatigue experienced in CFS is debilitating and can hamper an individual’s ability to perform basic functions such as rising out of bed, walking to the grocery store, working a full day and carrying out household chores.  It is estimated that 17%-20% of people diagnosed with CFS are either unemployed or incapacitated.  
The symptoms of CFS are diverse and can impact functional capacity, psychosocial well-being, employment status, autonomic functioning, neurocognitive processes, immune function and quality of life.  Furthermore, the spectrum of CFS symptoms fluctuates over time and is unique to individual patients.  Understanding chronic fatigue syndrome Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterized by fatigue, typically lasting for at least six months, sometimes exacerbated by physical or mental activity; unrestful sleep; cognitive dysfunction; muscle and joint pain; or prolonged fatigue that can impact the ability to perform basic tasks, continue working or engaging in social activities.  ME/CFS symptoms are diverse, persistent and intrusive, potentially affecting every aspect of an individual’s life.  
Symptoms of chronic fatigue syndrome 
Chronic fatigue syndrome (CFS) manifests with fatigue, individuals with CFS can experience cognitive difficulties such as problems with memory and concentration, also referred to as Brain fog which can significantly impair their ability to engage in work tasks and social interactions.  CFS is often an isolating illness as other individuals experience fatigue after a long day of work or an intense week of work, but for patients with CFS, their fatigue can last for days, weeks or even months following physical or mental exertion.  
CFS is also associated with various physical symptoms such as muscle and joint pain, which can severely affect their daily function.  For example, a person experiencing CFS may not be able to complete a simple task like dusting or carrying groceries into the house due to the persistent pain in their muscles or joints.  Additionally, symptoms such as dizziness and mood swings can also impact one’s ability to perform daily activities or engage in social interactions, further contributing to the diversity of symptoms associated with CFS.

Causes and risk factors 
The exact causes of chronic fatigue syndrome (CFS) remain elusive as numerous factors might contribute to the development of the condition, and determining the exact cause or causes could prove challenging.  Among the potential risk factors are genetic predispositions, where individuals may have an intrinsic risk of developing CFS due to underlying genetic susceptibilities.  For example, one observational study found that CFS is associated with genetic factors, suggesting a potential role of genetics in CFS risk.  In addition to genetics, infections such as the Epstein-Barr virus are thought to trigger CFS in some cases.  Epstein-Barr virus is a herpes virus that causes mononucleosis, and there is evidence that a prior Epstein-Barr viral infection may increase the risk of developing CFS symptoms.  For example, a prevalent case series suggests that a prior Epstein-Barr infection may lead to the development of a persistent form of CFS, exemplifying the potential infectious triggers of CFS.  

Alterations in immune function and neuroinflammation are also thought to play a role in the development of CFS because dysregulations in immune response and neuroinflammation can contribute to CFS symptomatology.  By elucidating immune dysfunction and neuroinflammatory mechanisms, it may be possible to identify novel targets and therapies that can help to manage CFS.  

Diagnosing chronic fatigue syndrome 
Despite the wide array of symptoms associated with chronic fatigue syndrome (CFS), the absence of a definitive diagnostic test for confirming the condition poses a challenge in its diagnosis.  Thus, a healthcare provider must conduct a detailed examination of the patient’s symptoms and medical history to make the diagnosis of CFS.  For instance, a patient presenting with fatigue lasting for more than six months along with a coexistence of unrefreshing sleep, pain, cognitive dysfunction and mood swings might be at risk for CFS.  When diagnosing CFS, a physician must rule out alternative medical conditions that could produce similar symptom profiles.  For example, assessing a patient for related conditions such as fibromyalgia, hypothyroidism and depression is critical because their symptoms overlap with those of CFS.  Diagnosing CFS thus requires a detailed history and evaluation of symptoms by the healthcare provider to differentiate CFS from similar-appearing illnesses.  Misdiagnosis is a significant concern when dealing with CFS because delayed diagnosis can impair the management and treatment strategies of the condition.  


Treatment options for chronic fatigue syndrome 
The primary treatment target for chronic fatigue syndrome (CFS) is the management of its symptoms to improve quality of life.  In addition, to administering antidepressants for depression and mood swings, other therapeutic interventions are used to manage most of the symptoms associated with CFS.  For example, cognitive-behavioral therapy has proven to be beneficial as a treatment for CFS since it helps patients identify and modify negative thoughts and behaviors that may exacerbate their condition.  Grade exercise therapy is another important treatment modality recommended for individuals with CFS.  Graded exercise therapy typically involves prescribed physical activity programs, usually under the supervision of a trained professional, to improve physical function, lessen fatigue and enhance physical well-being.  The therapy involves a gradual increase in physical activity levels to enable the CFS patient to enhance their endurance, thereby reducing the impact of CFS on their quality of life.  These are some of the diverse treatment options for CFS, further highlighting the chronic nature and multidimensional challenges of managing CFS.  

The experience of living with chronic fatigue syndrome 
Diagnosing chronic fatigue syndrome (CFS) can be challenging because no single biochemical marker or test allows healthcare providers to make the diagnosis.  Thus, healthcare providers must determine the diagnosis based on a patient’s symptoms, medical history and duration of the illness.  For instance, a patient who presents to a physician with fatigue lasting for more than six months and accompanying sleep, muscle and joint pain, combined with cognitive dysfunction and mood swings might be at risk for a diagnosis of CFS.  In addition, when diagnosing CFS, the physician needs to rule out alternative medical conditions that could produce similar patterns of symptoms.  For example, patients could present with similar symptoms of CFS arising from fibromyalgia, thyroid disorders like hypothyroidism and depression to ensure that their conditions are differentiated.  and rule out other medical causes.