Chronic pain and fatigue

What is chronic fatigue syndrome?

Chronic fatigue syndrome (also known as immune dysfunction syndrome or myalgic encephalomyelitis) is a chronic, debilitating disorder characterized by fatigue, pain, and cognitive disorders. It is the often severe cognitive complaints that distinguish the syndrome from other, similar disorders. The fatigue and depression associated with chronic fatigue syndrome differ from the normal ups and down we experience in everyday life. Early signs of chronic fatigue syndrome include a strong and noticeable fatigue that comes on suddenly. This fatigue often comes and goes or in some cases, never really seems to cease. It often lasts for more than six months and cannot be attributed to any identifiable medical or psychological problems.¹ Profound weakness, often associated with chronic fatigue syndrome, does not diminish with a few nights of good sleep, but rather, it silently robs energy and vitality over the course of months and sometimes years.²

Although the cause of chronic fatigue syndrome remains a mystery, for many people the disease begins after a bout with a minor illness such as a cold or flu. It first appears as a viral infection affecting the upper respiratory tract and is often marked by fever, headache, muscle aches, sore throat, earache, congestion, runny nose, cough, diarrhea, and fatigue.³

Symptoms of chronic fatigue syndrome

Unlike the symptoms of flu which usually subside in a few days or weeks, the symptoms of chronic fatigue syndrome linger or come and go for periods in excess of six months. Symptoms of chronic fatigue syndrome may include:⁴

• headache
• tenderness of the lymph nodes
• fatigue and weakness
• muscle aches and joint pain
• inability to concentrate

Symptoms of chronic fatigue may be further characterized as being either chronic fatigue syndrome or idiopathic chronic fatigue.

Chronic fatigue syndrome

In order to be classed as chronic fatigue syndrome, a patient's symptoms must meet the following criteria:⁵

1. Four or more of the following symptoms must have been present for longer than six months:
   • short-term memory loss or a severe inability to concentrate that affects work, school, or other normal activities
   • sore throat
   • swollen lymph nodes in the neck or armpits
   • muscle pain
   • pain without redness or swelling in a number of joints
   • intense or changing patterns of headaches
   • unrefreshing sleep
   • after any exertion, weariness that lasts for more than a day
2. In addition, fatigue must be severe, meaning that:
   • sleep or rest does not help
   • fatigue is not the result of excessive work or exercise
   • the fatigue substantially impairs a person's ability to function normally
   • even mild exercise often aggravates the symptoms, especially fatigue
3. Fatigue must be new, with a definite time of onset.
4. Symptoms must persist. Unlike the symptoms of flu which usually subside in a few days or weeks, fatigue and other symptoms recur or continue for months or years. Many patients with chronic fatigue syndrome report recurring bouts of flu-like illness, with episodes lasting from hours to weeks.

Idiopathic chronic fatigue

If a patient's symptoms do not meet the criteria for chronic fatigue syndrome as outlined above, his or her doctor may make a diagnosis of idiopathic chronic fatigue. Idiopathic means that the cause of the disease is not known.

Who gets chronic fatigue syndrome?

Many people complain of long-term fatigue, but the vast majority of these cases are explained by other medical or psychological problems. Chronic fatigue syndrome itself affects only about 0.4 percent of the population. It is most common in adults between the ages of 40 and 50 and is least common in those under 29 or over 60. Nevertheless, chronic fatigue syndrome is experienced by men and women of all ages, in all racial and ethnic groups. Studies also suggest that chronic fatigue syndrome is more common in girls than in boys. Children and adolescents suffering from chronic fatigue syndrome also suffer other psychiatric disorders such as anxiety or depression.⁶

Although more common in women in their 30s and 40s, chronic fatigue syndrome may affect both men and women of all ages and socioeconomic classes. Because no specific tests exist to detect and diagnose chronic fatigue syndrome, it's unclear just how many people are affected by the disease. The Centers for Disease Control estimate that as many as half a million people in the United States are affected by chronic fatigue syndrome.⁷

What causes chronic fatigue syndrome?

At present, some members of the medical community and many members of the general public do not know about or are skeptical of chronic fatigue syndrome, believing instead that it is part of a psychological disorder or a symptom of other problems such as anemia. Those who do believe in the existence of chronic fatigue syndrome, however, are still unsure what causes it, but suggest that it may be caused by several factors, including:⁸

• genetic factors
• abnormalities in the brain
• a hyper-reactive immune system
• viral or other infectious agents
• psychiatric or emotional conditions

In the mid 1980s, health experts found laboratory clues which led them to believe the Epstein-Barr virus—one of the causes of infectious mononucleosis—may also be linked to chronic fatigue syndrome. Since then, however, new evidence has cast doubt on this theory.⁹

Diagnosis

Because chronic fatigue syndrome has symptoms consistent with many other diseases, diagnosis is often arrived at through exclusion. This means that through discussions with you, your doctor or health care provider must first rule out diseases whose symptoms are similar to those of chronic fatigue syndrome. Your doctor will take a careful personal and family medical history, which may include a psychological profile. As a patient, you should be prepared to tell your doctor:¹⁰

• when your fatigue first began
• whether anything improves or aggravates it
• whether it improves at certain times of the day
• whether it is aggravated by physical activity
• whether anyone else in your family has ever experienced fatigue
• whether your personal or professional life is stressful

Your doctor may also ask you about any changes in your weight, and he or she may also require you to monitor your temperature in the mornings and in the afternoons. Be sure to tell your doctor about any vitamins, dietary supplements, or over-the-counter medications you may be taking. You may also be sent for thyroid and liver function tests, and other tests such as blood count and sedimentation rate. Such tests are typically recommended to rule out other diseases.¹¹

In subsequent visits, you and your doctor need to watch for new signs that may indicate you suffer from a condition other than chronic fatigue syndrome. Once your doctor has ruled out other diseases, he or she can then diagnose you as having chronic fatigue syndrome.¹²

Managing chronic fatigue syndrome

Learning to manage fatigue, in spite of the many symptoms of chronic fatigue syndrome, can help improve overall quality of life and the level at which patients function. A rehabilitation specialist or occupational therapist can work with you to develop a treatment program of activities to take advantage of times when you feel better.¹³

Lack of proven effective treatment is frustrating to both patients and health care professionals. Some patients experience improved sleep and relief of mild, general pain through the use of anti-depressants. Other patients have benefited from medications commonly prescribed to treat acute anxiety and other neurological problems such as dizziness. Current studies are exploring the effectiveness of such treatments as cognitive-behavioral therapy and exercise therapy. Although preliminary results look promising, it should be noted that these approaches do not work for everyone.¹⁴

Although the progression of chronic fatigue syndrome varies from one person to another, there are things all patients can do to improve well-being and quality of life. If you have chronic fatigue syndrome, it's recommended that you eat a balanced diet and get adequate rest, exercise regularly without causing additional fatigue, and pace yourself emotionally, physicaly and intellectually in order to avoid unnecessary stress. Stress may aggravate your symptoms.¹⁵

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