Chronic Fatigue Syndrome

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Introduction

What is chronic fatigue syndrome?

Chronic fatigue syndrome (CFS) is a medical condition that produces a long-lasting tiredness, achiness, and general lack of energy. The cause of chronic fatigue syndrome is not known. Many scientific studies have linked chronic fatigue syndrome to viral infections, such as infections with the Epstein-Barr virus, but a definitive association has not been established.

People with chronic fatigue syndrome often find that they become exhausted after minor exertion. Activities that they once considered to be normal activities of daily life may become impossible or extremely difficult. Along with these symptoms of easy fatigability, many people experience other symptoms, such as a generalized achiness, low-grade fevers, and in some cases, night sweats.

Chronic fatigue syndrome is a clinical diagnosis. That is, there are no specific laboratory tests that can diagnose it. The diagnosis is established through a doctor’s clinical judgment. While treatments are available, none of them can cure the condition. The foundation of treatment is what doctors refer to as supportive care. Supportive care consists of good nutrition and hydration, treatment of pain with nonsteroidal anti-inflammatory drugs (NSAIDs), and most importantly, rest.

Chronic fatigue syndrome is a clinical diagnosis. This means that there are no specific laboratory tests that can diagnose it. The diagnosis is established through a doctor’s clinical judgment after excluding the possibility of other treatable conditions. 

While symptom treatments are available, none of them can cure the condition. The foundation of treatment is what doctors refer to as supportive care. Supportive care consists of good nutrition and hydration, treatment of pain with nonsteroidal anti-inflammatory drugs (NSAIDs), and most importantly, rest.

Seek prompt medical care if you experience severe fatigue that is new for you, does not go away, and seems to have no obvious cause; if you are experiencing fatigue that is far more severe than you’ve ever experienced or that interferes with your other activities; or if you are being treated for chronic fatigue syndrome, but symptoms recur or are persistent. Seek immediate medical care (call 911) if you, or someone you are with, experience serious symptoms, such as depression that is severe enough to give you suicidal thoughts.

Symptoms

What are the symptoms of chronic fatigue syndrome?

Symptoms of chronic fatigue syndrome include various unusual forms of exhaustion that are fairly specific and help to rule out other disorders that can cause fatigue.

Common symptoms of chronic fatigue syndrome

The symptoms of chronic fatigue syndrome tend to be daily and ongoing. As a rule, you must have at least four of the other symptoms (besides fatigue) to be diagnosed with chronic fatigue syndrome. At times, any of these symptoms can be severe:

  • Fatigue more severe than any you’ve experienced before
  • Fatigue that arises after less than half your typical exertion
  • Fatigue that comes on within a few hours or days and lasts at least 6 months
  • Fatigue that is not relieved by bed rest or a solid night’s sleep
  • Fatigue that lasts more than 24 hours after exercise you usually think of as easy to moderate
  • Fatigue that restricts daily activities
  • Headache that is unlike previous headaches
  • Lymph node tenderness, especially in the neck or armpit
  • Migratory joint pain (moves from joint to joint without swelling or redness)
  • Mild fever (101 degrees Fahrenheit or less)
  • Muscle pain or weakness
  • Sore throat

Symptoms that might indicate a serious condition

In some cases, chronic fatigue syndrome can be a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have depression severe enough to result in suicidal thoughts.

Causes

What causes chronic fatigue syndrome?

It is not known what causes chronic fatigue syndrome. Certain theories suggest it may be caused by a virus, but no specific virus has been linked to the disorder. Some studies theorize that it may be caused by a nervous system inflammation or immune response, or that previous illnesses, stress, environment, or genetics may have an influence on its development.

What are the risk factors for chronic fatigue syndrome?

Because no cause has been discovered for chronic fatigue syndrome, no factors have been identified that positively increase your risk of developing this disorder. However, the syndrome seems to occur most frequently in women between the ages of 30 and 50, and some researchers speculate that stress, prior illnesses, environmental factors, or genetics may play a role.

Treatments

How is chronic fatigue syndrome treated?

There is not yet a cure for chronic fatigue syndrome, but its symptoms are treatable. Depression and other psychological problems that are associated with the debilitation and isolation which chronic fatigue syndrome can cause can also be treated. However, there are no drug treatments specifically for chronic fatigue syndrome.

Clinical treatments

Clinical or rehabilitation treatments provide therapies that can effectively treat some symptoms of chronic fatigue syndrome. These therapies include:

  • Cognitive-behavioral therapy for certain patients

  • Graded exercise programs

  • Sleep clinic participation for sleep management techniques

Pain relief agents

Several kinds of drugs seem to be particularly helpful for treating the pain associated with chronic fatigue syndrome. These drugs are useful at very different stages of pain relief; you and your medical practitioner should plan together which pain-relief agents are most appropriate for your current pain levels. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first choice in pain control in chronic fatigue syndrome, followed by muscle relaxants, antimalarial drugs, or antiepileptics. Opiates are usually a late-stage, last resort for advanced stages of pain, and they are used when other pain relievers no longer work. Pain-relief agents used in chronic fatigue syndrome include:

  • Antiepileptics, such as gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), and topiramate (Topamax)

  • Antimalarial agent hydroxychloroquine (Plaquenil) to help raise pain thresholds

  • Local anesthetics such as lidocaine transdermal patch (Lidoderm)

  • Muscle relaxant tizanidine (Zanaflex)

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or celecoxib (Celebrex)

  • Opiate narcotic analgesics or opiate agonists, which change the way the body senses pain, such as tramadol (Rybix, Ryzolt, Ultram), methadone (Dolophine, Methadose), or morphine (MS Contin)

Sleep aids/tricyclic antidepressants

Tricyclic antidepressant agents can be effective for both sleep disturbance and depression. They are effective sleep aids at much lower doses than are needed for depression. The most commonly used drug in this class for chronic fatigue syndrome is duloxetine (Cymbalta).

What you can do to improve your chronic fatigue syndrome

In addition to following your health care provider’s prescriptions for medical and clinical management of symptoms of chronic fatigue syndrome, you may also limit some of your discomfort by:

  • Distributing challenging tasks throughout the week or month (avoiding tackling all timely projects at once)

  • Finding ways to balance activity and rest

  • Getting enough sleep

  • Maintaining a healthy diet

  • Practicing the division of big tasks into small manageable steps

Complementary treatments

Some complementary treatments may help some people to better deal with chronic fatigue syndrome and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture

  • Massage therapy

  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

What are the potential complications of chronic fatigue syndrome?

Complications of untreated or poorly controlled chronic fatigue syndrome are not life threatening, but they can be debilitating. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of chronic fatigue syndrome include:

  • Depression from the effects of chronic fatigue syndrome or misunderstanding from family, friends, and associates

  • Eventual debilitation or lifestyle restrictions

  • Medication side effects and adverse reactions

  • Social isolation caused by the effects of severe fatigue

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 12
  1. Chronic fatigue syndrome. MedlinePlus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/001244.htm
  2. Chronic fatigue syndrome. Centers for Disease Control and Prevention. http://www.cdc.gov/cfs/
  3. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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