Chronic fatigue syndrome

Overview

Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is a complex and debilitating disorder characterized by extreme fatigue that does not improve with rest and cannot be explained by any underlying medical condition. The condition affects both physical and mental functioning and can severely impact a person’s daily life. CFS/ME is often misunderstood and misdiagnosed due to its wide range of symptoms and the absence of specific diagnostic tests.

Causes

The exact cause of Chronic Fatigue Syndrome is unknown, but several factors may contribute to its development. These include:

• Viral infections: Some people report the onset of CFS after a viral illness such as Epstein-Barr virus or human herpesvirus 6

• Immune system dysfunction: Abnormal immune responses may play a role in symptom development

• Hormonal imbalances: Changes in hormones produced by the hypothalamus, pituitary glands, or adrenal glands may contribute

• Physical or emotional trauma: Stressful events or psychological stress can trigger or worsen symptoms

• Genetics: Some evidence suggests a hereditary component, though no specific genes have been confirmed

CFS is likely a multifactorial condition resulting from a combination of these triggers in susceptible individuals.

Symptoms

The primary symptom of Chronic Fatigue Syndrome is persistent, unexplained fatigue lasting six months or more. Other common symptoms include:

• Post-exertional malaise (PEM): Worsening of symptoms after physical or mental activity

• Sleep disturbances: Unrefreshing sleep or insomnia

• Cognitive issues: Often referred to as “brain fog,” including problems with memory, focus, and information processing

• Muscle and joint pain: Without obvious inflammation

• Headaches of a new or unusual type

• Dizziness or lightheadedness: Especially when standing (orthostatic intolerance)

• Sore throat and swollen lymph nodes: Common during flare-ups

Symptoms can range from mild to severe and may fluctuate over time. In severe cases, individuals may become housebound or bedridden.

Diagnosis

There is no single test to diagnose Chronic Fatigue Syndrome. Diagnosis is made by ruling out other medical and psychiatric conditions and confirming symptom criteria. The diagnostic process includes:

• Medical history and symptom review: Including duration and severity of fatigue and associated symptoms

• Physical examination: To check for signs of other illnesses

• Laboratory tests: Such as blood tests or thyroid function tests to rule out anemia, hypothyroidism, autoimmune disease, or infections

• Functional assessments: Evaluating cognitive function and response to exertion

The CDC and Institute of Medicine define CFS based on key symptoms like persistent fatigue, PEM, and sleep disruption, with cognitive impairment or orthostatic intolerance being supportive features.

Treatment

There is no cure for Chronic Fatigue Syndrome, and treatment focuses on symptom management and improving quality of life. A personalized, multidisciplinary approach is often most effective. Common treatment strategies include:

• Energy management (pacing): Balancing activity and rest to avoid overexertion and post-exertional crashes

• Cognitive behavioral therapy (CBT): May help some patients manage coping strategies, though its use is debated

• Medications:

  • Pain relievers for muscle or joint pain

  • Sleep aids or low-dose antidepressants to improve sleep quality

  • Medications for associated symptoms like orthostatic intolerance or depression

• Diet and nutrition: Healthy eating, hydration, and supplementation as needed

• Support groups and counseling: Emotional and peer support can be helpful in managing the psychological burden

Prognosis

The prognosis for Chronic Fatigue Syndrome varies significantly. Some individuals experience gradual improvement, while others have persistent or worsening symptoms. Complete recovery is rare but possible in mild cases. Early diagnosis, symptom tracking, and individualized management plans can improve function and quality of life. Because the course of the illness is unpredictable, ongoing medical care and patient support are essential for long-term management.