Category: Overview

Chronic fatigue syndrome: probable pathogenesis and possible treatments

Abstract:

Chronic fatigue syndrome (CFS) belongs in the medically unexplained illnesses. It affects approximately 0.2-0.7% of the population in Western countries. It is characterised by unexplained fatigue, lasting 6 months or more, impairment of neurocognitive functions and quality of sleep, and of somatic symptoms, such as recurrent sore throat, muscle aches, arthralgias, headache and postexertional malaise. No link between infections and CFS has been clearly established but the immune system is activated, there are aberrations in several hypothalamic-pituitary axes and involvement of other parts of the central nervous system. No specific treatment has been found. Cognitive behavioural therapy is established to be of value to improve quality of life. More effective treatment should result, as advances in biomedical as well as psychological research continue.

 

Source: Evengård B, Klimas N. Chronic fatigue syndrome: probable pathogenesis and possible treatments. Drugs. 2002;62(17):2433-46. http://www.ncbi.nlm.nih.gov/pubmed/12421101

 

Chronic fatigue syndrome: evaluation and treatment

Abstract:

Severe fatigue is a common complaint among patients. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome (CFS) should be considered. CFS is characterized by debilitating fatigue with associated myalgias, tender lymph nodes, arthralgias, chills, feverish feelings, and postexertional malaise. Diagnosis of CFS is primarily by exclusion with no definitive laboratory test or physical findings. Medical research continues to examine the many possible etiologic agents for CFS (infectious, immunologic, neurologic, and psychiatric), but the answer remains elusive. It is known that CFS is a heterogeneous disorder possibly involving an interaction of biologic systems. Similarities with fibromyalgia exist and concomitant illnesses include irritable bowel syndrome, depression, and headaches. Therefore, treatment of CFS may be variable and should be tailored to each patient. Therapy should include exercise, diet, good sleep hygiene, antidepressants, and other medications, depending on the patient’s presentation.

Comment in:

Differential diagnosis for chronic fatigue syndrome. [Am Fam Physician. 2003]

Chronic fatigue syndrome and depression. [Am Fam Physician. 2002]

 

Source: Craig T, Kakumanu S. Chronic fatigue syndrome: evaluation and treatment. Am Fam Physician. 2002 Mar 15;65(6):1083-90. http://www.aafp.org/afp/2002/0315/p1083.html (Full article)

 

Defining and managing chronic fatigue syndrome

Abstract:

Objectives: Objectives of this evidence report are to summarize research evidence regarding the case definitions, prevalence, natural history and therapy of chronic fatigue syndrome (CFS).

Search Strategy: English and non-English citations were identified through July 2000 from four electronic bibliographic databases (MEDLINE, The Cochrane Library, PsycINFO, EMBASE), CFS Internet sites, the Journal of Chronic Fatigue Syndrome, references of pertinent articles, textbooks, and experts. The electronic search was updated through October 2000 using PubMed; experts identified relevant citations up to January 2001.

Selection Criteria: Published and unpublished studies that were conducted after 1980 and that involved adults with CFS were reviewed.

Data Collection and Analysis: Two reviewers (physician, psychometrician, research methodologist, and/or nurse) independently abstracted data from the selected studies. Data were synthesized descriptively, emphasizing the quality and methodologic design of studies. Meta-analyses were not done because of marked heterogeneity of study designs.

Main Results: There are four well-recognized case definitions of CFS, and the Centers for Disease Control and Prevention (CDC) is spearheading the development of a fifth. Definitions, developed primarily by expert knowledge and consensus, have evolved over time. A few comparative research studies support the concept of a condition, characterized by prolonged fatigue and impaired ability to function, which is captured by the case definitions. The superiority of one case definition over another is not well established. The validity of any definition is difficult to establish because there are no clear biologic markers for CFS, and no effective treatments specific only to CFS have been identified.

Findings from surveys show that the prevalence of CFS in community populations is probably less than 1% and in primary care populations less than 3%. The reliability of these estimates is limited, because surveys used different case definitions and varied assessment and reporting methods, and sometimes had poor response rates.

Precise estimates of recovery, improvement, and/or relapse from CFS are not possible because there are few natural history studies and those that are available have involved selected referral populations or have used varying case definitions and followup methods.

 

Source: Mulrow CD, Ramirez G, Cornell JE, Allsup K. Defining and managing chronic fatigue syndrome. Evid Rep Technol Assess (Summ). 2001 Sep;(42):1-4. http://www.ncbi.nlm.nih.gov/books/NBK33797/ (Full article)

 

Chronic fatigue

The possibility that fatigue may be an early manifestation of a serious medical illness not elicited through blood testing has been investigated by monitoring fatigued patients prospectively over time for the development of new diagnoses. At 1 year of follow-up, one study 3 showed no significant differences in new diagnoses, the incidences of diagnosed cancers, number of physician visits, or number of hospital admissions or hospital days.

This gives more weight to the conclusion that patients with chronic fatigue who otherwise have normal histories and no abnormalities on physical examination do not require extensive workups for occult medical illnesses.

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071607/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071607/

 

Source: Stevens DL. Chronic fatigue. West J Med. 2001 Nov;175(5):315-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071607/ (Full article)

 

Chronic fatigue syndrome and fibromyalgia resources on the world wide web: a descriptive journey

Abstract:

A wealth of information on chronic fatigue syndrome (CFS) and fibromyalgia is available on the World Wide Web for health care providers and patients. These illnesses have overlapping features, and their etiologies remain unknown. Multiple Web sites were reviewed, and selected sites providing useful information were identified. Sites were classified according to their content and target audience and were judged according to suggested standards of Internet publishing. Fifty-eight sites were classified into groups as follows: comprehensive and research Web sites for CFS and fibromyalgia, meetings, clinical trials, literature search services, bibliographies, journal, and CFS and fibromyalgia Web sites for the patient.

 

Source: Gantz NM, Coldsmith EE. Chronic fatigue syndrome and fibromyalgia resources on the world wide web: a descriptive journey. Clin Infect Dis. 2001 Mar 15;32(6):938-48. Epub 2001 Mar 9. http://cid.oxfordjournals.org/content/32/6/938.long (Full article)

 

Aspects of occupational disability in psychosomatic disorders

Abstract:

In 1997, 30% of the persons going into early retirement because of occupational disability and received pensions were psychosomatically ill. An additional large number of retirees suffered from untreatable pain such as chronic low back pain, some of them might as well have a chronic somatoform pain disorder. The article describes frequent psychosomatic diseases like somatization disorder, fibromyalgia and chronic fatigue syndrome with respect to their pathophysiology and psychological aspects as well as therapeutic advancements. It is postulated that an interdisciplinary access to these patients early in the course of their illness involving both somatic medical and psychiatric competence is the most promising means to tackle this enormous medical and health protection problem.

 

Source: Huber M. Aspects of occupational disability in psychosomatic disorders. Versicherungsmedizin. 2000 Jun 1;52(2):66-75. [Article in German] http://www.ncbi.nlm.nih.gov/pubmed/10853374

 

Chronic fatigue syndrome

Definition: Chronic fatigue syndrome is characterised by severe, disabling fatigue and other symptoms, including musculoskeletal pain, sleep disturbance, impaired concentration, and headaches. Two widely used definitions of chronic fatigue syndrome (from the US Centers for Disease Control and Prevention 1 and from Oxford 2—see table) were developed as operational criteria for research. There are two important differences between these definitions. The British criteria insist on the presence of mental fatigue; the American criteria include a requirement for several physical symptoms, reflecting the belief that chronic fatigue syndrome has an underlying immunological or infective pathology.

Incidence/prevalence: Community and primary care based studies have reported the prevalence of chronic fatigue syndrome to be 0.2-2.6%, depending on the criteria used.3 4 Systematic population surveys have found similar rates of the syndrome in people of different socioeconomic status, and in all ethnic groups.4 5 Female sex is the only demographic risk factor (relative risk 1.3 to 1.7 depending on diagnostic criteria used).6

Aetiology: The cause of chronic fatigue syndrome is poorly understood.

Prognosis: Studies of prognosis in chronic fatigue syndrome have focused on people attending specialist clinics, who are likely to have had the condition for longer and to have a poorer outlook. Children with the syndrome seem to have a notably better outcome: 54-94% of children show definite improvement (after up to six years’ follow up); 20-50% of adults show some improvement in the medium term and only 6% return to premorbid levels of functioning.7 Despite the considerable burden of morbidity associated with chronic fatigue syndrome, there is no evidence of increased mortality. Outcome is influenced by the presence of psychiatric disorders and beliefs about causation and treatment.7

Aims: To reduce levels of fatigue and associated symptoms; to increase levels of activity; to improve quality of life.

Outcomes: Severity of symptoms; effects on physical function and quality of life measured in several different ways by: the medical outcomes survey short form general health survey (SF-36), a rating scale measuring limitation of physical functioning caused by ill health 8; the Karnofsky scale, a modified questionnaire originally developed for the rating of quality of life in people undergoing chemotherapy for malignancy 9; the Beck depression inventory 10; the sickness impact profile, a measure of the influence of symptoms on social and physical functioning 11; and self reported severity of symptoms and levels of activity.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117488/

 

Source: Reid S, Chalder T, Cleare A, Hotopf M, Wessely S. Chronic fatigue syndrome. BMJ : British Medical Journal. 2000;320(7230):292-296. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117488/ (Full article)

 

Chronic fatigue syndrome

Abstract:

The chronic fatigue syndrome is an illness of unknown etiology characterized by severe fatigue, myalgias, lymphadenopathy, arthralgias, chills, fevers, and postexertional malaise. Recognizing chronic fatigue syndrome is primarily a method of exclusion with no definitive diagnostic test or physical findings. As research continues to delve into the many possible etiologic agents for chronic fatigue syndrome–infectious, immunologic, neurologic, or psychiatric alone or in combination–the answer remains elusive. What is known is that chronic fatigue syndrome is a heterogeneous disorder very possibly involving an interaction of biological systems. Therefore, chronic fatigue syndrome may describe a large subset of patients, each exhibiting unique symptoms and serologic profiles dependent on the nature of the onset of illness and the genetic profile of individual patients.

 

Source: Kakumanu S, Yeager M, Craig TJ. Chronic fatigue syndrome. J Am Osteopath Assoc. 1999 Oct;99(10 Su Pt 1):S1-5. http://www.ncbi.nlm.nih.gov/pubmed/10624375

 

Chronic fatigue syndrome: new insights and old ignorance

Abstract:

Chronic fatigue syndrome (CFS) is a condition characterized by impairment of neurocognitive functions and quality of sleep and of somatic symptoms such as recurrent sore throat, muscle aches, arthralgias, headache, and postexertional malaise. A majority of patients describe an infectious onset but the link between infections and CFS remains uncertain. Findings show an activation of the immune system, abberations in several hypothalamic-pituitary axes and involvement of other parts of the central nervous system. The origin is bound to be complex and it may well be that the solution will come together with a more generally altered view about mind-body dualism, and the concept of illness and disease.

 

Source: Evengård B, Schacterle RS, Komaroff AL. Chronic fatigue syndrome: new insights and old ignorance. J Intern Med. 1999 Nov;246(5):455-69. http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2796.1999.00513.x/full (Full article)

 

Chronic fatigue syndrome

Abstract:

The chronic fatigue syndrome is an illness of unknown etiology characterized by severe fatigue, myalgias, lymphadenopathy, arthralgias, chills, fevers, and postexertional malaise. Recognizing chronic fatigue syndrome is primarily a method of exclusion with no definitive diagnostic test or physical findings. As research continues to delve into the many possible etiologic agents for chronic fatigue syndrome-infectious, immunologic, neurologic, or psychiatric alone or in combination- the answer remains elusive. What is known is that chronic fatigue syndrome is a heterogeneous disorder very possibly involving an interaction of biological systems. Therefore, chronic fatigue syndrome may describe a large subset of patients, each exhibiting unique symptoms and serologic profiles dependent on the nature of the onset of illness and the genetic profile of individual patients.

 

Source: Craig TJ, Kakumanu S, Yeager M. Chronic fatigue syndrome. J Am Osteopath Assoc. 1999 Oct 1;99(10_suppl):S1-S5. doi: 10.7556/jaoa.1999.99.10.S1. http://www.ncbi.nlm.nih.gov/pubmed/26983059