Chronic fatigue syndrome
John M. Saxton in Exercise and Chronic Disease, 2011
Chronic fatigue syndrome (CFS) describes a disorder that consists of chronic debilitating fatigue that cannot be explained by any known chronic medical or psychological condition (Holmes et al., 1988). The most commonly used diagnostic criteria and definition of CFS for research and clinical purposes was published by the United States Centers for Disease Control and Prevention (Fukuda et al., 1994). The core feature of a CFS diagnosis is the exclusion of any active medical condition which may explain the presence of the symptoms (e.g. primary sleep disorders, severe obesity, cancer hypothyroidism, Hepatitis B or C, major depressive disorders with psychotic or melancholic features, bipolar affective disorders, schizophrenia, dementia, alcohol abuse, etc.). In addition, the presence of a new onset (not lifelong), unexplained, persistent fatigue is required. The fatigue should be unrelated to exertion, is not substantially relieved by rest and should be severely disabling (i.e. causing substantial reductions in activity levels). Finally, four or more of the following symptoms should be present for six months or longer: impaired memory or concentration; post-exertional malaise, ‘extreme, prolonged exhaustion and sickness’ as a result of physical or mental exertion; unrefreshing sleep; muscle pain; pain in multiple joints; headaches of a new kind or greater severity; sore throat and tender lymph nodes (cervical or axillary). A large increase in pain and fatigue following too vigorous physical (or mental) activity is called post-exertional malaise, which is considered a key feature of the illness CFS. It remains a challenge for clinicians to deal with post-exertional malaise. This will be addressed in more detail below. Over the years, attempts to develop an effective treatment therapy for CFS have been confounded by the evolution of various case definitions, lack of consensus regarding aetiology, as well as difficulty in defining and measuring the symptom of fatigue, the principal complaint in CFS. To date, no reliable laboratory markers have been identified, nor has a cure been discovered.
Role of Naturopathy in Pain Management
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Despite a poor rate of patient compliance, NDs recommend exercise to patients with pain. In one study, general practitioners gave written advice on physical activity during usual consultations. For every 10 written prescriptions for exercise, at 12 months only 1 person achieved and sustained 150 minutes of moderate or vigorous leisure activity per week. In these compliant patients, measures of self-rated general health, vitality, and pain improved significantly (Elley et al., 2003). Fibromyalgia and chronic fatigue syndrome fall under the spectrum of chronic multisymptom illnesses. This constellation of syndromes is often defined by chronic pain, unremitting fatigue, cognitive difficulties, and various other symptoms. In treating these illnesses, a prescription for exercise is often overlooked by health care practitioners. Research has shown that exercise is quite beneficial in reducing pain and fatigue in this population and should be included as part of a multimodal therapy regimen (Ambrose, Lyden, & Clauw, 2003; King et al., 2002; Valim et al., 2003). Beyond its use in treatment of pain syndromes, physical activity also effectively decreases the risk of many chronic disorders. Numerous studies have convincingly demonstrated that moderate levels of physical activity greatly reduce the incidence of many chronic health conditions, most notably type II diabetes mellitus, obesity, cardiovascular disease, depression, and many types of cancers (Chakravarthy, Joyner, & Booth, 2002). Also, strength training in elderly people has been shown to have beneficial effects on risk factors for age-related diseases and pain. In addition to improved strength, function, endurance, muscle mass, and power, strength training has been shown to reduce insulin resistance, decrease both total and intra-abdominal fat, increase resting metabolic rate, prevent the loss of bone mass density, reduce risk factors for falls, and reduce pain (Hurley & Roth, 2000).
The management of common mental health concerns in primary care
Julie M Schirmer MSW, Alain J Montegut MD, Stephen J Spann MD, Gabriel Ivbijaro MD, Alfred Loh MD in Behavioral Medicine in Primary Care, 2017
Chronic tiredness is a condition that occurs worldwide. Patients commonly present noting that, despite getting enough rest, they are easily and constantly tired, especially compared with their previous levels of energy. The prevalence of the condition varies markedly, from approximately 2% to 15%. A higher proportion of patients in high-income countries report having symptoms of fatigue when asked directly by practitioners, compared with patients in lower-income countries. Interestingly, however, patients in lower-income countries are more likely to present in primary care centers with fatigue as their chief complaint. A variety of triggers precipitate tiredness. Physical causes can be found in 30% of patients with chronic fatigue by obtaining a detailed history, completing a physical examination, and assessing basic laboratory analyses. Psychiatric diagnoses, including depression, anxiety, and dysthymia, are the source of tiredness in more than 50% of all primary care patients. However, approximately 20% of patients who present with tiredness have no identifiable etiology. A very small number of these patients have chronic fatigue syndrome, diagnosed when the functionally disabling fatigue lasts for more than 6 months and is accompanied by at least four other associated symptoms, such as sore throat, unrefreshing sleep, and muscle pain, among others. The remaining patients have either transient or prolonged fatigue, depending on whether their tiredness lasts for less than or more than one month. Although there is considerable variation in the treatment of chronic unexplained tiredness and fatigue, the principles of management are similar and are especially conducive to care in primary care settings. These principles involve a biopsycho-social approach, and consist of the following:1 offering multiple consultations over time in order to establish a therapeutic relationship and provide ongoing supportjudicious ordering of laboratory tests if availablerecommending lifestyle changes if appropriatepromoting behavioral strategies such as relaxation exercises (see Chapter 8) and exercise.Medications such as tricyclic antidepressants, selective serotonin reuptake inhibitors, or other atypical antidepressants may be effective in certain patients. They are worth trying, although individual responses vary, and there is no conclusive evidence to support their use.
The Effect of Fatigue and Fibromyalgia on Sexual Dysfunction in Women With Chronic Fatigue Syndrome
Published in Journal of Sex & Marital Therapy, 2015
Alicia Blazquez, Eva Ruiz, Luisa Aliste, Ana García-Quintana, José Alegre
Sexual dysfunction in patients with chronic fatigue syndrome is attracting growing interest but, to date, few studies have analyzed it. For this reason, the authors evaluated sexual dysfunction in women with chronic fatigue syndrome (using the Golombok Rust Inventory of Sexual Satisfaction) and explore correlations with fatigue and other symptoms. Sexual dysfunction was greater in patients with chronic fatigue syndrome (n = 615) with a higher number of cognitive, neurological, and neurovegetative symptoms, concomitant fibromyalgia, Sjögren's syndrome, or myofascial pain syndrome, and more intense fatigue (p
Development and Properties of the Dutch Neurophysiology of Pain Test in Patients with Chronic Fatigue Syndrome
Published in Journal of Musculoskeletal Pain, 2010
Mira Meeus, Jo Nijs, Kim Soon Elsemans, Steven Truijen, Kenny De Meirleir
Objectives: This investigation aimed at determining the validity and reliability of the Dutch neurophysiology of pain test in chronic fatigue syndrome [CFS] patients with chronic widespread pain. Methods: The Dutch neurophysiology of pain test was completed by 61 CFS patients with chronic pain and 31 health care professionals. Patients repeated the test 24 hours later. Results: Performance on the test was better [p < 0.001] for professionals [10.71 ± 3.08] than for patients [5.95 ± 2.99], supporting the validity of the test. Test–retest reliability [ICC = 0.756] and internal consistency [Cronbach's α = 0.769] were fair for CFS patients. Conclusion: The Dutch neurophysiology of pain test appears valid and reliable in CFS patients with chronic pain.
Chronic fatigue syndrome – an update
Published in Acta Clinica Belgica, 2016
Steven Rimbaut, Céline Van Gutte, Lina Van Brabander, Luc Vanden Bossche
Background: Chronic fatigue syndrome is a widespread condition with a huge impact not only on a patient’s life, but also on society as evidenced by substantial losses of productivity, informal costs, and medical expenses. The high prevalence rates (0.2–6.4%) and the low employment rates (27–41%) are responsible for the enormous burden imposed on society, with loss of productivity representing the highest cost. The objective of this review is to systematically review the recent literature on chronic fatigue syndrome/myalgic encephalomyelitis. Methods: The published literature between 1 January 1990 and 1 April 2015 was searched using the MEDLINE, Cochrane Library, and Web of Sciences databases. The reference lists of the selected articles were screened for other relevant articles. Results and conclusions: Despite extensive research, none of the proposed etiological factors have shown strong, reproducible scientific evidence. Over the years, the biopsychosocial model integrating many of the proposed hypotheses has been gaining popularity over the biomedical model, where the focus is on one physical cause. Since the etiological mechanism underlying chronic fatigue syndrome is currently unknown, disease-specific treatments do not exist. Various treatments have been investigated but only cognitive behavior therapy (CBT) and graded exercise therapy (GET) have shown moderate effectiveness.
Related Knowledge Centers
- Atrophy
- Muscle Hypertonia
- Muscle Weakness
- Spinal Cord
- Spasm
- Neuromuscular Diseases
- Fibromyalgia