Chronic fatigue syndrome, sometimes called CFS, is a condition that makes you feel so tired that you can't do all of your normal, daily activities. There are other symptoms too, but being very tired for at least 6 months is the main one.
Many people improve in a year or two and do not have a relapse. Some people continue to have severe fatigue and other symptoms for many years.
The disease is not well understood. Most experts now believe that it is a separate illness with its own set of symptoms. But some doctors do not believe this.
There are no tests for CFS. Because of this, many people have trouble accepting their disease or getting their friends and family to do so. Having people who believe your diagnosis and support you is very important. Having a doctor you can trust is critical.
Your tiredness is real. It's not "in your head." It is your body's reaction to a combination of emotional and physical factors.
Doctors don't know what causes CFS. Sometimes it begins after an illness like the flu, but there is no proof of any connection. It's likely that a number of factors or triggers come together to cause CFS.
Extreme tiredness, or fatigue, is the main symptom. If you have CFS:
Depression is common with CFS, and it can make your other symptoms worse. Antidepressant medicines can help you feel better.
There are no tests for CFS. Doctors can diagnose it only by ruling out other possible causes of your fatigue. Many other health problems can cause fatigue, and most people with fatigue have something other than chronic fatigue syndrome.
There is no treatment for CFS itself, but many of its symptoms can be treated. A good relationship with your doctor is important, because the two of you will need to work together to find a combination of medicines and behavior changes that will help you get better. Some trial and error may be needed, because no single combination of treatments works for everyone.
Home treatment is very important. You may need to change your daily schedule, learn better sleep habits, and start getting regular gentle exercise.
Counseling and a gradual increase in exercise help people who have CFS get better.
Even though it may not be easy, keeping a good attitude really helps. Try not to get caught in a cycle of frustration, anger, and depression. Learning to cope with your symptoms and talking to others who have the same illness can help you keep a good attitude.
Learning about chronic fatigue syndrome (CFS):
Living with chronic fatigue syndrome (CFS):
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Doctors do not know what causes chronic fatigue syndrome (CFS). Some people develop it after having a viral or bacterial infection, such as the flu, but there is no evidence to prove this link. Other theories point to the immune system, the nervous system, glands and hormones, and family history. But again, there's not enough evidence to prove any connection.
The main symptom of chronic fatigue syndrome (CFS) is a devastating tiredness or exhaustion that has lasted at least 6 months and does not improve much with rest. This fatigue also is so severe that it interferes with your work, your play, and your social activities. The fatigue and other symptoms described below may begin suddenly or they may develop gradually over weeks or months.
Other long-term symptoms include:
Because CFS is not easily diagnosed, health experts have established some rules to help them recognize the disease. To be diagnosed with CFS, you must have fatigue and at least four of the symptoms listed above. At least four of your symptoms must have started at the same time as or after your fatigue began, and they must have lasted for at least 6 months.
But if you have symptoms of CFS, such as often feeling very tired for no clear reason, you may still get treatment even if you don't quite meet these criteria. For instance, your doctor may decide you need treatment even if you have had symptoms for less than 6 months.
Some people with CFS develop a condition in which their heart rate increases and their blood pressure drops when they stand or sit up from a reclining position. This is often described as feeling "lightheaded" or feeling faint or dizzy. This condition is called orthostatic hypotension.
Depression is common and can make your other symptoms worse. Antidepressant medicines can help you feel better.
CFS causes symptoms that are the same as many other diseases, especially early on. For this reason, it can be diagnosed only after a thorough evaluation has ruled out other conditions with similar symptoms.
In some cases, chronic fatigue syndrome (CFS) develops after an illness such as mononucleosis (mono) or the flu, or after a period of unusual stress. But it may also develop without warning, even if you have not been sick.
The fatigue may come upon you gradually or quite suddenly. Because fatigue can be vague and can be caused by many things, you might not pay attention to the problem for several weeks or months. It is hard to say what is normal with CFS because the diagnosis often is not clear for some time.
Some people find the fatigue, pain, and thinking problems caused by CFS greatly hamper their lives, but other people are not nearly as affected.
People who have chronic fatigue syndrome (CFS) are generally 25 to 45 years of age. Women are more likely to have CFS.
CFS is rare in children. It may occur in teenagers, especially young teenage girls. Unlike adults, teenagers are more likely to develop CFS after having an illness such as mononucleosis or the flu.
It's important to talk to your doctor about any symptoms you may have.
Call your doctor if you have:
Watchful waiting refers to a period of time in which you are being watched by your doctor but are not receiving treatment. It is also called observation or surveillance. A month or two of paying close attention to your sleep habits, getting regular moderate exercise, trying to control stress, and eating a balanced diet will take care of most cases of fatigue not caused by CFS or another medical problem. But if your fatigue has not improved after 1 to 2 months of self-care, or if fatigue is persistent and limits your usual activities, call your doctor.
If you have been diagnosed with CFS, pay attention to any new symptoms and report them to your doctor. Although CFS can cause a variety of symptoms, new symptoms could be caused by another illness or medical condition that may need to be evaluated and treated.
The following health professionals can evaluate fatigue and other symptoms:
There are doctors who specialize in the treatment of CFS. Get a recommendation from your family doctor or a local CFS support group before making an appointment with a specialist. It is always wise to start with your family doctor. You may also be referred to a physiatrist, psychologist, or psychiatrist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Chronic fatigue syndrome (CFS) is hard to diagnose. Fatigue is an extremely common problem, and it can have many other causes. CFS can be diagnosed only by ruling out other conditions.
First, your doctor will take your medical history and do a physical exam. Experts have come up with a specific list of symptoms to decide whether a person has CFS. Doctors use a variety of tests to rule out other conditions. These tests usually include:
These are routine lab tests. Other tests may be done if your symptoms, history, and physical exam suggest other possible problems. Additional tests may include:
Some doctors may order tests that check your immune system. These can be expensive and generally are done only in research settings. Also, it's hard to know what the findings of these tests mean, because so little is known about the immune system's connection to chronic fatigue syndrome.
Treatment for chronic fatigue syndrome (CFS) focuses on making you feel better so that you can resume a normal life. Simple measures you can take at home—such as improving your sleep habits and getting gentle exercise—are important parts of treatment. Talking with a counselor or psychologist has been shown to be helpful for people who have CFS.
Although there is no cure for CFS, many of its symptoms do respond to treatment.
Pain relievers that you can buy without a prescription, such as acetaminophen or ibuprofen, may help relieve headaches, muscle and joint pain, and other physical symptoms. Narcotic pain relievers, which require a prescription from a doctor, may become addictive if they are used frequently. So they are typically prescribed in the most severe cases on a short-term basis.
Taking antidepressants and getting counseling can help relieve your other symptoms, whether you have depression or not. Antidepressants are used to improve your mood, control your pain, and help you sleep. With CFS, treating both physical and psychological factors is important.
There are many unproven remedies, such as special diets or mineral supplements, that some people recommend for treating CFS. There is no evidence that any of these are effective.1
Home treatment is very important. Adjusting your daily schedule to take advantage of times when you have more energy, improving your sleep habits, and getting regular and gentle exercise can often help you feel better. Beginning a graded exercise program, in which the level of exercise starts out easy and gradually grows more challenging, should be part of your treatment. Studies have shown that a carefully planned exercise program can help people with CFS regain their strength and energy and feel better.1 Remember that if you have CFS, you will be able to do only light exercise. Doing too much or increasing your level of exercise too quickly can make your symptoms worse.
A type of counseling called cognitive-behavioral therapy has been shown to help people who have CFS feel less tired.1 It is counseling that teaches people how to change the way they think and behave to cope more successfully with their fatigue and other symptoms.
Even though it's not easy, keeping a good attitude is a great benefit for people with CFS. Your mind and body are connected and influence each other. Physical illnesses can be made worse—or better—by your feelings and attitudes, and vice versa. Learn as much as you can about your disease and work with your doctor to learn ways to cope with your symptoms. Get emotional support from your health professionals as well as from your family and friends. It's easy to get caught in a cycle of frustration, anger, and depression. Learning to cope with your symptoms will help you avoid that cycle.
Regular visits to your doctor every few months can help track your progress and evaluate any changes in your symptoms that might indicate that your fatigue is caused by something other than CFS.
The good news about CFS is that it rarely gets worse over time. In some people, it goes away in 1 or 2 years. Others have periods of relatively good health followed by periods of severe symptoms and great difficulty. Relapses are not unusual. Continue to see your doctor periodically to monitor changes in your condition.
Although the cause of chronic fatigue syndrome (CFS) is not well understood, the fatigue is real and can make day-to-day activities difficult. As you work toward regaining your strength and energy, don't go too fast. Aim for a gradual return to your previous level of activity.
Chronic fatigue syndrome (CFS) can be neither prevented nor cured. Home treatment and, when appropriate, certain medicines can help control or reduce symptoms.
Home treatment is the most important part of treating chronic fatigue syndrome (CFS). If you have CFS, you can take steps to control and sometimes relieve your symptoms:
Be patient, and keep in mind that consistent home treatment usually helps relieve or control CFS symptoms. Your doctor may suggest cognitive-behavioral therapy to help you with your home treatment.
Medicines do not cure chronic fatigue syndrome (CFS): they only help relieve symptoms. They may not greatly speed up your return to full activity. But when medicines are used properly, they can help you feel better.
Over-the-counter medicines include:
Prescription medicines include:
Some research has studied the use of corticosteroids (such as hydrocortisone and fludrocortisone) to treat chronic fatigue syndrome (CFS). Studies have shown that these medicines do not work very well to treat CFS. And the side effects can be serious. Unless corticosteroids can be shown to have a greater benefit for people with CFS over a longer period of time, the side effects associated with long-term corticosteroid therapy outweigh the benefits from their use in most cases.1
Depression often becomes a part of chronic fatigue syndrome and can make your symptoms worse. Like any medical illness, depression needs to be treated. If you have CFS and are depressed, tell your doctor how you feel. Antidepressants and counseling can help you keep a good attitude, which has been shown to be a great benefit to people who have CFS.
As with many conditions that have no clear cause and no effective medical treatment, there are many treatments outside of conventional medicine that some people recommend for chronic fatigue syndrome (CFS). None have been shown to be effective.
But there are safe nontraditional therapies—acupuncture, yoga, or massage therapy, for example—that can relieve pain and stress, ease muscle tension, help you feel better and healthier, and improve your outlook and quality of life.
Some popular complementary therapies include:
There are many unproven treatments for CFS. Some of the more popular ones include:
None of these complementary therapies have been proven effective in treating CFS, but some people have reported feeling better after using them. If you have CFS and are thinking about trying a complementary therapy, get the facts before you begin. Consider these questions with your doctor:
Avoid products that claim to have a "secret" ingredient or that claim to cure CFS. Currently, there is no cure for CFS. Any benefit reported as a result of using a product is most likely due to improved symptom management, chance, or, possibly, the illness running its course.
For more information, see the topic Complementary Medicine.
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The American College of Physicians (ACP) is a national organization of internists. Doctors of internal medicine focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases. The ACP provides information for patients and families on the organization's website, including information on diseases and conditions, end-of-life care, women's issues, and immunizations. The site also offers video news stories, health tips, special reports, and a link to the ACP diabetes webpage.
|Centers for Disease Control and Prevention (CDC) Chronic Fatigue Syndrome Page|
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|Atlanta, GA 30333|
This Web site provides information about the diagnosis and treatment of chronic fatigue syndrome. It also includes information to help you find a support group for people with CFS. The site is maintained by the National Center for Infectious Diseases of the Centers for Disease Control and Prevention (CDC).
|Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America|
|P.O. Box 220398|
|Charlotte, NC 28222-0398|
The CFIDS Association of America works to build support for people suffering from chronic fatigue and immune dysfunction syndrome (also known as chronic fatigue syndrome). The organization offers educational information and other resources to people with CFS, their family and friends, support groups, caregivers, the general public, and health professionals.
- Reid S, et al. (2011). Chronic fatigue syndrome, search date March 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Other Works Consulted
- Bleijenberg G, Van Der Meer JWM (2012). Chronic fatigue syndrome. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 3519–3521. New York: McGraw-Hill.
- Engleberg NC (2010). Chronic fatigue syndrome. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., pp. 1897–1904. Philadelphia: Churchill Livingstone Elsevier.
- Sadock BJ, Sadock VA (2007). Chronic fatigue syndrome. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 652–657. Philadelphia: Lippincott Williams and Wilkins.
- White PD, et al. (2011). Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): A randomised trial. Lancet, 377(9768): 823–826.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Nancy Greenwald, MD - Physical Medicine and Rehabilitation|
|Last Revised||January 18, 2013|
Last Revised: January 18, 2013
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