Chronic fatigue syndrome Introduction

Chronic fatigue syndrome Introduction

Chronic Fatigue Syndrome (CFS) is long-term tiredness (fatigue) that does not go away with sleep, or rest, and affects everyday life.

CFS is also known as ME (myalgic encephalomyelitis). Myalgia is muscle pain, and encephalomyelitis is inflammation of the brain and spinal cord. ME is a commonly used term, although it can be thought to be too specific to cover all the symptoms.

CFS is the term that is often used to describe long-term tiredness by GPs and medical professionals. This is because in the majority of cases, the main symptom is chronic fatigue. This is usually the preferred term, rather than ME, as in CFS, there is little evidence that inflammation of the brain and spinal cord occurs.

ME is often the preferred term of people who have CFS. This is due to the fact that they feel fatigue is too general and does not reflect the severity, and different types of fatigue. Also, it is felt that even though fatigue may occur in most cases, it is not the main, or only, symptom people experience.

It is estimated that 150,000 people in the UK have CFS. Anyone can get CFS, although it is more common in women than in men. It usually develops in the early twenties to mid-forties. Children can also be affected, most commonly between the ages of 1315.

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Chronic fatigue syndrome Symptoms

The main symptom of CFS is persistent fatigue (tiredness) and exhaustion. This does not go away with sleep or rest, and limits the activities you were once capable of. Fatigue is mental as well as physical, and some people describe it as overwhelming. You may also begin to feel that:

it is a different type of tiredness than what you have experienced before,
after sleep you do not feel refreshed,
it is not due to exhaustion, or
it is not simply experiencing a loss of motivation, for example like people with depression tend to go through.
Exercising, or being physically active, can make symptoms of CFS worse. This is called post-exertional malaise. The effect of this is sometimes delayed. For example, if you were to play a game of sport, the resulting fatigue may not develop for a few hours afterwards, or it might even develop the next day.

In addition to fatigue, other symptoms are also common, although most people do not have all of them. They include:

Muscular pain, joint pain, and severe headaches.


Poor short-term memory and concentration.


Difficulty organising your thoughts and finding the right words.


Painful lymph nodes this is often felt as tender, glandular swelling around your throat.


Stomach pain and other problems similar to irritable bowel syndrome for example bloating, constipation, diarrhoea and nausea.


Sore throat.


Sleeping problems, such as insomnia and disturbed sleep.


Sensitivity or intolerance to light, loud noise, alcohol and certain foods.


Additional, less common symptoms, such as dizziness, excess sweating, balance problems and difficulty controlling body temperature.


Psychological difficulties, such as depression, irritability and panic attacks may also occur.
Depending on your symptoms, CFS is often categorised into four categorises, mild, moderate, severe or very severe:

Mild CFS you are able to care for yourself, but may need to take days off work to rest.


Moderate CFS you may have reduced mobility and your symptoms can vary from time to time. You may also have disturbed sleep patterns and commonly sleep in the afternoon.


Severe CFS you are able to carry out minimal daily tasks, for example brushing your teeth, but occasionally you may need to use a wheelchair. You may also have difficulty concentrating.


Very severe CFS you are unable to carry out any daily tasks for yourself and rely on bed rest for the majority of your day. Often, in severe cases, you may experience an intolerance to noise, and become very sensitive to bright lights.
Most cases of CFS are mild or moderate, but up to 1 in 4 people have severe or very severe symptoms.

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Chronic fatigue syndrome Causes

The exact cause of CFS is unknown, although there are several theories. Some people think that a viral infection, such as glandular fever, can trigger the condition. Tiredness is normal after a viral infection, but this does not explain why symptoms continue and get worse.

It is more likely that CFS is caused by a combination of physical and psychological factors, which also affect how severe the condition is and how long it lasts.

The main factors that contribute to CFS are thought to be:

inherited genetic susceptibility (it is more common in some families),
viral infections such as glandular fever, which weaken the immune system,
exhaustion and mental stress,
depression, or
a traumatic event such as a bereavement, divorce or redundancy.
The following factors tend to make CFS worse:

recurring viral or bacterial infections,
not being active enough, or being too active,
stress,
poor diet,
being socially isolated and/or feeling frustrated and depressed, and
environmental pollution.

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Chronic fatigue syndrome Diagnosis

There is no test to diagnose CFS. Many people consult their GP thinking they have CFS, but only a small minority are diagnosed with the condition. CFS is not diagnosed in people who simply feel tired all the time it is the presence of other symptoms as well that helps to confirm the diagnosis.

Your GP is likely to ask you about your medical history, carry out a physical examination, and possibly organise blood tests and scans to rule out other causes of prolonged fatigue. For example, anaemia (low red cells in your blood), an underactive thyroid gland (the gland does not produce enough thyroid hormone) or liver and kidney problems.

CFS is usually suspected if serious fatigue and other symptoms persist for six months or more without any other identifiable cause.

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Chronic fatigue syndrome Treatment

There is no specific treatment for CFS. Sometimes, simply diagnosing CFS and giving advice about how to deal with it can help. CFS tends to last for months, if not years, but most people do recover, or adjust their lifestyle to improve their symptoms.

There is no cure for CFS, so treatment tends to focus on easing the symptoms. The effectiveness of treatments depends on how CFS affects you. Early diagnosis, balancing rest with activity, medication to control certain symptoms, and self-help measures can all help to varrying degrees.

Common treatments include:

Adjusting your daily routine so that you have regular sleep patterns.


Cognitive behavioural therapy (CBT) may identify the thoughts and feelings causing certain behaviour, and help you develop new ways of coping. It is one of the most effective treatments for CFS.


Graded exercise is the gradual increase in aerobic exercise, such as swimming or walking. It is based on a theory that not doing anything can make illness worse, and can be helpful to people with CFS. Make sure you discuss any new exercise programme with your GP before getting started.


Pacing is an important way of controlling symptoms. It involves finding a balance between activity and rest, and avoiding large bursts of exercise that may set you back. Learning how to make the most of your energy can help to increase the amount you can do.


Antidepressants can be useful for people who have depression with CFS.


Over-the-counter painkillers can help to ease muscle and joint pain and headaches. Stronger painkillers can also be prescribed by your GP, although they should only be for short-term use.


Complementary therapies, such as osteopathy, nutritional therapy, and homeopathy may help.
Self-help measures for managing CFS include:

avoiding stressful situations,
moderate, graded exercise,
avoiding alcohol, caffeine, sugar and sweeteners,
avoiding any other food and drinks that you are sensitive to, and eating small, regular meals,
regular rest and pacing,
relaxation, and
staying aware of how your energy levels change, and resting, or being active, accordingly.
If you have CFS, there will be times when your symptoms do not cause too much of a problem and you are able to carry out many normal, everyday activities. However, at other times, your symptoms can flare up and get worse, affecting your daily life.

Lots of people with CFS start to show improvement over time sometimes recovering within as little as two years. However, health and activity levels may not return to what they once were before the illness. People who have been affected for many years are less likely to recover. However, with the appropriate advice and treatment the condition can be successfully managed.

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