review – Page 48 – American ME and CFS Society

Chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome is a controversial disease entity. Opinions range from non-disease via psychiatric disorder to a somatic disturbance. Somatic pathogenetic hypotheses include persisting infections, intoxications, metabolic or immunologic disturbances, nervous system diseases and endocrine pathology. None of these hypotheses has been substantiated as yet. Psychological factors are important in the course of the disorder and can be used in the therapeutic approach of patients with chronic fatigue syndrome.

Source: van der Meer JW. Chronic fatigue syndrome. Ned Tijdschr Geneeskd. 1997 Aug 2;141(31):1507-9. [Article in Dutch] http://www.ncbi.nlm.nih.gov/pubmed/9543735

Neuropsychology of chronic fatigue syndrome: a critical review

Abstract:

This article provides a comprehensive and critical review of the neuropsychological and related literature on chronic fatigue syndrome (CFS). Despite the methodological limitations observed in several studies, some consistent findings are noted.

The most consistently documented neuropsychological impairments are in the areas of complex information processing speed and efficiency. General intellectual abilities and higher order cognitive skills are intact. Emotional factors influence subjective report of cognitive difficulty, whereas their effect on objective performance remains uncertain.

Although the neuropathological processes underlying cognitive dysfunction in CFS are not yet known, preliminary evidence suggests the involvement of cerebral white matter. Directions for future research are outlined.

Source: Tiersky LA, Johnson SK, Lange G, Natelson BH, DeLuca J. Neuropsychology of chronic fatigue syndrome: a critical review. J Clin Exp Neuropsychol. 1997 Aug;19(4):560-86. http://www.ncbi.nlm.nih.gov/pubmed/9342690

Managing patients suffering from acute and chronic fatigue

Abstract:

The subjective experience of fatigue is common and debilitating, and affects many individuals in various healthcare settings. The condition requires adequate assessment, innovative planning and interventions, and patient-centred evaluations by the nursing profession. Fatigue, whether acute or chronic, needs to be recognized as a true and valid condition in order for treatment to be successful. There are many considerations to be taken into account when working with the fatigued, and this article suggests how the areas needing most attention may be tackled. Chronic fatigue and acute fatigue can be quite different conditions, requiring different approaches, of which nurses need to be aware. In order to reduce the effects of fatigue on the client, nurses need to fully understand the factors surrounding the phenomenon of fatigue to provide expert care, to help educate the patient, and improve the quality of life.

Source: Cook NF, Boore JR. Managing patients suffering from acute and chronic fatigue. Br J Nurs. 1997 Jul 24-Aug 13;6(14):811-5. http://www.ncbi.nlm.nih.gov/pubmed/9283306

Chronic fatigue syndrome: an update for clinicians in primary care

Abstract:

Cases of long-standing (6 months or longer) fatigue that are not explained by an existing medical or psychiatric diagnosis are referred to as chronic fatigue syndrome (CFS). CFS is a condition of unknown etiology that presents with a complex array of symptoms in patients with diverse health histories. A diagnosis of CFS is largely dependent upon ruling out other organic and psychologic causes of fatigue. CFS can present the clinician with a unique set of challenges in terms of diagnosis and treatment. A review of recent research suggests that the management of CFS requires an individualized approach for each patient. An historic overview of the condition is presented along with current theories of causation, diagnosis considerations, symptom management, and health promotion strategies.

Source: Houde SC, Kampfe-Leacher R. Chronic fatigue syndrome: an update for clinicians in primary care. Nurse Pract. 1997 Jul;22(7):30, 35-6, 39-40 passim. http://www.ncbi.nlm.nih.gov/pubmed/9253014

Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms

Abstract:

Patients with unexplained chronic pain and/or fatigue have been described for centuries in the medical literature, although the terms used to describe these symptom complexes have changed frequently. The currently preferred terms for these syndromes are fibromyalgia and chronic fatigue syndrome, names which describe the prominent clinical features of the illness without any attempt to identify the cause.

This review delineates the definitions of these syndromes, and the overlapping clinical features. A hypothesis is presented to demonstrate how genetic and environmental factors may interact to cause the development of these syndromes, which we postulate are caused by central nervous system dysfunction. Various components of the central nervous system appear to be involved, including the hypothalamic pituitary axes, pain-processing pathways, and autonomic nervous system. These central nervous system changes lead to corresponding changes in immune function, which we postulate are epiphenomena rather than the cause of the illnesses.

Source: Clauw DJ, Chrousos GP. Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms. Neuroimmunomodulation. 1997 May-Jun;4(3):134-53. http://www.ncbi.nlm.nih.gov/pubmed/9500148

Chronic fatigue syndrome and occupational health

Abstract:

Chronic fatigue syndrome (CFS) is a controversial condition that many occupational physicians find difficult to advise on. In this article we review the nature and definition of CFS, the principal aetiologic hypotheses and the evidence concerning prognosis. We also outline a practical approach to patient assessment, diagnosis and management. The conclusions of this review are then applied to the disability discrimination field. The implications of the new UK occupational health legislation are also examined. Despite continuing controversy about the status, aetiology and optimum management of CFS, we argue that much can be done to improve the outcome for patients with this condition. The most urgent needs are for improved education and rehabilitation, especially in regard to employment. Occupational physicians are well placed to play an important and unique role in meeting these needs.

Source: Mounstephen A, Sharpe M. Chronic fatigue syndrome and occupational health. Occup Med (Lond). 1997 May;47(4):217-27. http://occmed.oxfordjournals.org/content/47/4/217.long (Full article)

Chronic fatigue syndrome–aetiological aspects

Abstract:

The chronic fatigue syndrome (CFS) has been intensively studied over the last 40 years, but no conclusions have yet been agreed as to its cause. Most cases nowadays are sporadic. In the established chronic condition there are no consistently abnormal physical signs or abnormalities on laboratory investigation.

Many physicians remain convinced that the symptoms are psychological rather than physical in origin. This view is reinforced by the emotional way in which many patients present themselves. The overlap of symptoms between CFS and depression remains a source of confusion and difficulty. But even if all CFS patients were rediagnosed as depressives, this would not negate the possibility of an underlying organic cause for the condition, in view of the growing evidence that depression itself has a physical cause and responds best to physical treatments.

There is some evidence both for active viral infection and for an immunological disorder in the CFS. Many observations suggest that the syndrome could derive from residual damage to the reticular activating system (RAS) of the upper brain stem and/or to its cortical projections. Such damage could be produced by a previous viral infection, leaving functional defects unaccompanied by any gross histological changes.

In animal experiments activation of the RAS can change sleep state and activate or stimulate cortical functions. RAS lesions can produce somnolence and apathy. Studies by modern imaging techniques have not been entirely consistent, but many magnetic resonance imaging (MRI) studies already suggest that small discrete patchy brain stem and subcortical lesions can often be seen in CFS.

Regional blood flow studies by single photon-emission computerized tomography (SPECT) have been more consistent. They have revealed blood flow reductions in many regions, especially in the hind brain. Similar lesions have been reported after poliomyelitis and in multiple sclerosis–in both of which conditions chronic fatigue is characteristically present. In the well-known post-polio fatigue syndrome, lesions predominate in the RAS of the brain stem. If similar underlying lesions in the RAS can eventually be identified in CFS, the therapeutic target for CFS would be better defined than it is at present. A number of logical approaches to treatment can already be envisaged.

Comment in:

Chronic fatigue syndrome. [Eur J Clin Invest. 1997]

Source: Dickinson CJ. Chronic fatigue syndrome–aetiological aspects. Eur J Clin Invest. 1997 Apr;27(4):257-67. http://www.ncbi.nlm.nih.gov/pubmed/9134372

Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome

Abstract:

The diagnosis of fibromyalgia continues to generate heated debate. The presence of multiple lifetime psychiatric diagnoses was not intrinsically related to fibromyalgia but rather to the decision of patients to seek specialty medical care. Better outcome measures in fibromyalgia were tested. Neurally mediated hypotension may be associated with chronic fatigue syndrome (CFS). Treatment of patients with fibromyalgia and CFS continues to be of limited success, although the role of multidisciplinary group intervention appears promising. Two position papers focused on the adverse aspects of the medicolegal issues in fibromyalgia and CFS.

Source: Goldenberg DL. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1997 Mar;9(2):135-43. http://www.ncbi.nlm.nih.gov/pubmed/9135918

The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review

Abstract:

The prognosis of chronic fatigue syndrome and chronic fatigue has been studied in numerous small case series. We performed a systematic review of all studies to determine the proportion of individuals with the conditions who recovered at follow-up, the risk of developing alternative physical diagnoses, and the risk factors for poor prognosis.

A literature search of all published studies which included a follow-up of patients with chronic fatigue syndrome or chronic fatigue were performed. Of 26 studies identified, four studied fatigue in children, and found that 54-94% of children recovered over the periods of follow-up. Another five studies operationally defined chronic fatigue syndrome in adults and found that < 10% of subjects return to pre-morbid levels of functioning, and the majority remain significantly impaired. The remaining studies used less stringent criteria to define their cohorts. Among patients in primary care with fatigue lasting < 6 months, at least 40% of patients improved.

As the definition becomes more stringent the prognosis appears to worsen. Consistently reported risk factors for poor prognosis are older age, more chronic illness, having a comorbid psychiatric disorder and holding a belief that the illness is due to physical causes.

Comment in:

Chronic fatigue syndrome. [QJM. 1997]

Source: Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. QJM. 1997 Mar;90(3):223-33. http://qjmed.oxfordjournals.org/content/90/3/223.long (Full article)

Chronic fatigue syndrome: a 20th century illness?

Abstract:

The chronic fatigue syndrome has become the fin de siècle illness, now getting similar attention to that of neurasthenia, which dominated medical thinking at the turn of the century.

Myalgic encephalomyelitis was an early term introduced in the United Kingdom in 1957 for this state, but it had little or no public or professional prominence. Until then “chronic fatigue had become invisible”, with “no name, no known etiology, no case illustrations or clinical accounts in the medical textbook, no ongoing research activity–nothing to relate it to current medical knowledge”.

The reconstruction of chronic fatigue began in the mid-1980s, with the emergence of “chronic Epstein-Barr virus syndrome”, which was later converted to chronic fatigue syndrome. The former term, which first emerged in the mid-1980s, is now regarded as a misnomer and should be abandoned.

In the popular American literature the term “chronic fatigue and immune deficiency syndrome” is preferred by the most active of the patient lobbies, while myalgic encephalomyelitis continues to be the usual label in the United Kingdom.

The relevant research linking chronic fatigue syndrome with somatization is reviewed in this article. Understanding the nature of somatization can still shed some light on the meaning of chronic fatigue at the end of the 20th century.

Source: Wessely S. Chronic fatigue syndrome: a 20th century illness? Scand J Work Environ Health. 1997;23 Suppl 3:17-34. http://www.sjweh.fi/show_abstract.php?abstract_id=239 (Full article)