Chronic fatigue syndrome: symptoms, causes and treatment

Chronic fatigue syndrome is a complex disease, with multiple symptoms and manifestations, and of which very little is known about its origin and treatment. Hence, it still constitutes a very great mystery within the scientific community.

Interestingly, in the 70s and 80s it was called the yuppie flu, since it mainly affected young people workers who lived in the city and were exhausted by stress and the fast pace of life intense.

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What is chronic fatigue?

Chronic fatigue syndrome (CFS) is an alteration that causes the person a feeling of extreme tiredness or fatigue, which can prevent the person from being able to perform any usual activity or task.

To distinguish chronic fatigue from severe tiredness, the person must have symptoms for more than six months. In addition, if it tries to alleviate them through rest, or physical or mental tasks, it is very likely that it will even get worse.

This disease is constituted as a chronic condition, extremely complex and of which they are still its causes are clear, interfering in the cardiovascular, endocrine, neurological system and in the system immune.

Today, It is speculated that this condition affects about 0.5% of the world's demography, with women being the most affected in 90% of cases. What's more. usually appears together with other diseases such as fibromyalgia or irritable bowel syndrome.

Other names for chronic fatigue (CFS) are myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS) or systemic exercise intolerance disease (ESIE).

Symptoms

As noted above, to consider this fatigue as an extreme fatigue syndrome, they must last for a minimum of six months. The patient affected by chronic fatigue syndrome presents, among many others, the following symptoms:

• Intense fatigue
• Hyperthermia or fever
• Photophobia
• Hyperacusis
• Non-restorative sleep
• Headache
• Muscle pain
• Intolerance to changes in temperature
• Concentration deficits
• Short-term memory loss
• Spatial orientation deficit

Thus, the symptoms of chronic fatigue syndrome can be noticed in many aspects of life and affect both the way in which the person functions relates to others as to their way of interacting with elements of the environment in which they live, which affects their achievement of objectives, in their self-image, etc.

Causes

Long ago, chronic fatigue was considered a psychosomatic disorderHowever, at present it has been accepted that it cannot be considered as a psychiatric disorder, but rather as a disease with an organic basis but whose causes are not yet fully known.

Despite the large amount of research around chronic fatigue syndrome worldwide, the origin of this phenomenon is still a long way from being discovered. Even so, some investigations have obtained reliable conclusions in which it is pointed out that stress oxidative is an important element of the disease, despite not knowing if this is a cause or a consequence of the SFC.

A study carried out in 2001 concluded that an increase in both nitrous oxide (NO) and peroxynitrites would be linked to origin of various diseases, including chronic fatigue syndrome, post-traumatic stress disorder, and chemical sensitivity multiple.

With the passage of time and the advancement of science, it was hypothesized about the possibility that an accelerated rhythm of life and a bad diet, among other causes, will cause an abnormal development of the yeast fungus, thus triggering fatigue syndrome chronic. However, this theory has been widely criticized and condemned.

On the other hand, some studies conjecture that toxic substances found in the environment and chemical elements present in some foods also contribute to weakening the person and cause CFS.

Finally, the influence of sleep quality, recurrent physical and psychological stress, or some disorders such as post traumatic stress disorder.

Diagnosis

Chronic fatigue syndrome is distinguished by its difficult diagnosis. For a better assessment of the patient's condition, the clinician should begin by preparing a clinical history and physical examination, in order to rule out any hidden disease behind these symptom.

Taking into account that between 39% and 47% of CFS patients also suffer from depression, it is necessary that an assessment of the patient's mental state is also carried out. As well as ruling out a possible influence of some drugs through blood and urine tests.

Despite the difficulties involved in diagnosing CFS, there are eight criteria developed over time, and Although there is no consensus opinion on which of all is more effective, there are two methods that stand out above the rest. These are the diagnostic criteria of Fukuda (1994) and other more recent ones elaborated by the National Academy of Medicine of the United States (2015).

Fukuda's diagnostic criteria (1994)

In order to diagnose CFS according to these criteria, the patient must present:

1. Intense tiredness

Chronic and severe fatigue for at least six months and for no apparent reason. In addition, this fatigue does not subside with rest.

2. Rule out other conditions that could cause fatigue

Exclude any illness that is a potential cause of feeling tired.

3. Present at least four of the following signs for six or more months:

• Memory and concentration deficits
• Sore throat when swallowing
• Muscle pain
• Non-inflammatory joint pain
• Headaches
• Non-restorative sleep
• Tiredness after making an effort with a course of more than 24 hours

Diagnostic criteria from the United States National Academy of Medicine (2015)

These guidelines, much more current, were the first to highlight the possible organic features of the disease.

According to this organization, to make a valid diagnosis of chronic fatigue syndrome, the patient must present the following symptoms:

• Significant decrease in energy to carry out any activity, for at least six months and without apparent causes.
• Feelings of unease after exercising.
• Non-restorative rest
• Presenting one of these two symptoms: cognitive jam or orthostatic intolerance.

Other aspects to be taken into account in the diagnosis are the frequency and degree to which these occur, having to occur, at least in half of the cases, mainly or severely.

Treatment

Since it is a chronic disease, there is no remedy for it. However, drug therapy to manage symptoms such as muscle pain, sleep disturbance, anxiety, or depression, has proven to be effective, with symptoms improving over time.

That is, the health intervention is palliative, to cushion the impact that the disease has on the quality of life and avoid creating additional problems that do not have to exist with effective management of symptoms and interaction with the environment.

Likewise, cognitive-behavioral intervention to work on emotional aspects, and food reeducation, can also be successful as a complement to pharmacological treatment.

Bibliographic references:

• Bested, A. C.; Marshall, L. M. (2015). Review of Myalgic Encephalomyelitis / Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians. Rev Environ Health, 30 (4): 223-49.
• Haney, E., Smith, M.E., McDonagh, M., Pappas, M., Daeges, M., Wasson, N., Nelson, H.D. (2015). Diagnostic Methods for Myalgic Encephalomyelitis / Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med, 162 (12): 834-40.
• Reeves, W.C., Lloyd, A., Vernon, S.D., Klimas, N., Jason, L.A., Bleijenberg, G., Evengard, B., White, P.D., Nisenbaum, R., Unger, E.R. et. to the. (2003). Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution. BMC Health Serv Res. 3 (1): 25.