Chronic Fatigue Syndrome

Chronic fatigue syndrome, also called CFS, is a disorder marked by intense exhaustion.

"It Just Hit Me Like Lightning"

In November 1996, the enormously popular American jazz pianist Keith Jarrett found himself completely drained of energy in the middle of a concert tour in Italy. The only way he could get through his performances was to stay in bed most of the day and get up just for the concert at night. Too tired even to cross the street, Jarrett would not play in public again for 2 years. The illness was so severe that he said he felt as though aliens had entered his body. He was eventually diagnosed with chronic fatigue syndrome.

What Is Chronic Fatigue Syndrome?

Chronic fatigue syndrome (CFS) is a condition of severe fatigue and other symptoms of weakness. For many years, patients with CFS were told that their illness was probably psychological or mental in origin. Since the 1980s, however, most doctors have come to recognize CFS as a physical condition. Still, efforts to find an easily identifiable cause, such as a bacterium or a virus, have so far been unsuccessful, and CFS is diagnosed and defined primarily by how it makes people feel.

The precise number of people with CFS is difficult to know, but one study by the U.S. Centers for Disease Control and Prevention (CDC), a major public health agency in the United States, suggested that 200 out of every 100,000 Americans between the ages of 18 and 69 have the condition. CFS is more common among women than among men, but it affects all racial and ethnic groups. Although adolescents can have CFS, their cases have been less well studied.

Because there are no specific tests for the disorder, in 1988 the CDC drew up a list of symptoms that define it. This set of symptoms provides a standard to guide doctors in diagnosing and treating the condition.

CFS is defined as fatigue that begins very suddenly and continues or recurs over a period of 6 months. In addition to fatigue, cases of CFS must include four or more of the following symptoms:

• Forgetfulness or difficulty concentrating
• Sore throat
• Tender lymph (LIMF) nodes ^* in the neck or armpit
• Muscle pain
• Pain in the joints without joint swelling or redness
• Unusual headaches
• Unrefreshing sleep
• A vague feeling of illness or depression that lasts more than 24 hours following exercise.

What Causes CFS?

There are many different opinions about what causes CFS. There is no evidence that CFS is contagious. Some doctors believe that CFS is caused by a virus. In fact, symptoms of CFS may begin after a viral infection, but this does not mean that a viral infection explains the persisting symptoms and long-term effects of the condition. It is possible that CFS may be caused by a malfunction in the immune system, that is, the body's defenses against disease. Other doctors think that some imbalance of chemicals in the brain might cause CFS. Many people with CFS also suffer from depression. Consequently, some doctors argue that CFS is a psychiatric condition, and the physical symptoms follow from that.

Diagnosing CFS Is Hard

It is very difficult for doctors to diagnose CFS. Although they take a medical history, examine the patient, and request routine laboratory tests of blood and other bodily substances, there are no specific findings that define CFS or laboratory tests that indicate a clear diagnosis. Instead, the diagnosis of CFS is made when other causes of the characteristic symptoms cannot be found. A wide number of medical conditions have many of the same symptoms: viral infections, depression, kidney disease, heart disease, and many others. Before diagnosing CFS, these other possible causes must be ruled out.

What Are the Symptoms of CFS?

The hallmark of CFS is intense fatigue that comes on very suddenly. Other symptoms vary from person to person, and they may come and go. For example, patients may have trouble concentrating or remembering things such as a story they have just read in the newspaper. Eye problems such as blurry vision are common, as are chills, night sweats, and diarrhea. Patients may complain that their weight has changed even though they have not changed their diet. Some people with CFS say they feel as though they are in a fog. The symptoms that the CDC lists for CFS are the ones most commonly seen among the long list of those which have been reported.

Can CFS Be Treated?

CFS has no known specific cause, so there is no specific treatment for it, but usually people do not get worse. Most get better over time, and some will eventually become completely well again.

Although CFS itself is not treatable, some of the symptoms can be helped—for example, headache and pain. Antidepressants may be prescribed to relieve anxiety and depression. Patients with CFS should avoid heavy meals, alcoholic drinks, and caffeine. Although they may not feel like moving around very much, moderate exercise may bring benefits.

In their quest for a cure, patients may be tempted to try unproven treatments. Such treatments are often expensive, however, and they may be of little value or even harmful.

What Is It Like to Live with CFS?

CFS profoundly alters the ability of patients to work, study, and enjoy themselves. Patients may feel driven to seek consultations from many different kinds of doctors and practitioners of alternative medicine to find an answer. Most people are able to keep on with their lives, but some are unable to work, and others need help with day-today activities. Many of the symptoms of CFS are hard for others, including employers, to understand, and patients may feel isolated and frustrated when family and friends make jokes about being tired. They may become angry at their physicians, too, for not understanding or being able to help them. Periods of relative good health may alternate with times when patients do not feel very well at all. Research efforts are continuing with the goals of identifying the cause of the condition and finding ways to prevent, cure, or lessen the symptoms and disability caused by this disorder.