Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a complex and debilitating disorder characterized by extreme fatigue that does not improve with rest and can worsen with physical or mental activity. Therefore, it significantly affects the quality of life of those who suffer from it, limiting their ability to perform daily activities.
In this article, we'll explore in depth what CFS is, its causes, symptoms, diagnosis, available treatments, and some recommendations for preventing and managing it.
What is chronic fatigue syndrome?
Chronic fatigue syndrome (CFS) is a chronic illness that causes profound and unexplained exhaustion that persists for more than six months and is not relieved by rest. In addition to fatigue, it can be accompanied by other symptoms such as muscle pain, memory problems, unrefreshing sleep, and post-exertional malaise (PEM).
Although its exact cause is unknown, it is believed to be related to previous infections, immune system disorders, hormonal imbalances, or chronic stress.
Causes and risk factors
Chronic fatigue syndrome (CFS) is a multifactorial disease, meaning it doesn't have a single known cause but rather arises from a combination of factors. Although research is ongoing, several possible causes and triggers have been identified.
Viral and bacterial infections
Many patients develop chronic fatigue syndrome after a viral or bacterial infection. Some of the most commonly associated pathogens include Epstein-Barr virus (mononucleosis), persistent COVID-19 (Long COVID), cytomegalovirus (CMV), Lyme disease (Borrelia infection), and human herpesvirus 6 (HHV-6).
These infections can trigger an abnormal immune response, leading to chronic inflammation and persistent fatigue.
Immune system dysfunction
Some studies suggest that CFS may be related to an autoimmune response, where the immune system mistakenly attacks healthy tissues, with chronic low-grade inflammation due to elevated levels of inflammatory cytokines, or due to alterations in NK (Natural Killer) cells, which present a decrease in their function, affecting the defense against infections.
Hormonal imbalances
The hypothalamic-pituitary-adrenal (HPA) axis regulates stress and energy. In chronic fatigue syndrome, this system may be disrupted, causing low levels of the stress hormone cortisol, which makes it difficult to respond to physical and emotional stress, or imbalances in serotonin and dopamine, which affect mood and energy.
Prolonged physical and emotional stress
Chronic stress can deplete the body's energy reserves and contribute to the development of CFS. Factors include psychological trauma, such as abuse or the loss of a loved one, the constant physical exertion experienced by athletes or those with demanding jobs, and chronic insomnia or sleep deprivation.
Genetic factors and family predisposition
Some people may have an increased genetic susceptibility due to polymorphisms in genes related to immune response and energy metabolism, or a family history of CFS or autoimmune diseases.
Alterations in energy metabolism
Some research suggests that CFS patients have mitochondrial dysfunction (mitochondria are the “powerhouses” of cells) or a buildup of lactic acid after exertion, causing fatigue and muscle pain.
Symptom
CFS not only manifests itself with extreme fatigue, but with a set of symptoms that affect multiple body systems:
The main symptoms are profound fatigue that does not improve with rest and worsens with physical or mental exertion; unrefreshing sleep in which patients wake up exhausted even after long hours of sleep; and cognitive dysfunction or "brain fog" that causes difficulty concentrating, short-term memory loss, and mental slowness.
Physical symptoms include muscle and joint pain without visible inflammation, similar to Fibromyalgia, a frequent migraine or tension-type headache, tender lymph nodes especially in the neck and armpits, and dizziness or orthostatic intolerance, which worsens when standing, and is related to dysautonomia.
Immunological and neurological symptoms include heightened sensitivity to lights, sounds, and smells; flu-like symptoms such as sore throat or fever; and digestive problems such as irritable bowel syndrome or food intolerances.
These symptoms can fluctuate in intensity, with periods of improvement followed by relapses, known as “flares.”
Difference between common tiredness and chronic fatigue
- Common fatigue improves with rest, while chronic fatigue does not.
- Chronic fatigue persists for more than 6 months, while tiredness is temporary.
- Fatigue is related to physical exertion or specific stress, while chronic fatigue does not necessarily have a cause.
- Fatigue does not affect memory, but chronic fatigue can cause “brain fog.”
- Common tiredness does not cause persistent muscle pain, while chronic fatigue often includes muscle aches and pains. articulations pain.
How to detect chronic fatigue syndrome?
The diagnosis of CFS is clinical and based on exclusion, as there is no single test to confirm it. The steps include a thorough medical evaluation that considers the duration and pattern of fatigue and associated symptoms, as well as a physical examination to rule out other conditions such as anemia, hypothyroidism, or autoimmune diseases.
The most commonly used diagnostic criteria are the Institute of Medicine Criteria (IOM, 2015), which indicate severe chronic fatigue lasting more than 6 months, post-exertional malaise (PEM), unrefreshing sleep, and cognitive dysfunction or orthostatic intolerance; or the Fukuda Criteria (1994), which consider persistent fatigue plus at least 4 of the following symptoms: muscle pain, joint pain, headache, swollen glands, sore throat, memory problems.
Although there is no specific exam, complementary tests may be performed, such as blood tests (complete blood count, thyroid hormones, vitamin D, ferritin), immunological tests to measure antibodies and cytokine levels, sleep studies such as polysomnography, if apnea is suspected, and stress tests such as the exercise tolerance test.
Differential diagnosis should rule out autoimmune diseases such as lupus, multiple sclerosis, endocrine disorders such as hypothyroidism, Addison's disease, and psychiatric problems such as depression or chronic anxiety.
A rheumatologist, neurologist, or internist is usually the specialist indicated to confirm the diagnosis.
How to eliminate chronic fatigue?
Cognitive behavioral therapy (CBT)
It helps manage stress and adapt to the disease and reduces associated anxiety and depression.
Pacing
You must learn to avoid the “boom and bust” cycle (overexertion followed by collapse), and plan activities in short periods, with scheduled breaks.
Medications for specific symptoms
Pain relievers (paracetamol, nonsteroidal anti-inflammatory drugs), low-dose antidepressants such as amitriptyline for pain and sleep, and controlled stimulants such as modafinil for severe fatigue may be prescribed.
Nutritional supplements
Magnesium and CoQ10 improve cellular energy, vitamin B12 and folic acid support nerve function, and Omega-3 acts as a natural anti-inflammatory.
Adapted physiotherapy
Low-intensity exercises such as stretching, gentle yoga, and swimming are helpful. However, strenuous exercise should be avoided, as it can worsen symptoms (PEM).
Alternative therapies
Acupuncture relieves pain and fatigue, and mindfulness and meditation techniques help reduce stress.
Habits and recommendations to prevent it
Stress management
Relaxation techniques such as meditation or deep breathing can be used. Psychological therapy is recommended if you have anxiety or depression.
Restful sleep
Sleep hygiene should be maintained by maintaining a regular schedule and maintaining a dark, cool environment. Screens should also be avoided before bed.
Anti-inflammatory diet
It is recommended to follow the Mediterranean diet, rich in fish, fruits, vegetables, and healthy fats, and avoid processed foods, sugars, and gluten (in cases of sensitivity).
Moderate and progressive exercise
Short walks, yoga, or tai chi are helpful, but overexertion should always be avoided; pacing is recommended to regulate activity.
Prevent infections and strengthen the immune system
It's recommended to stay up-to-date on flu and COVID-19 vaccinations, and to take supplements like vitamin D and zinc if you have deficiencies.
Frequently Asked Questions (FAQs)
Who diagnoses chronic fatigue syndrome?
A rheumatologist, neurologist or internist, after ruling out other diseases.
Does diet influence chronic fatigue?
Yes, a balanced, anti-inflammatory diet can help reduce symptoms.
How long can Chronic Fatigue Syndrome last?
It varies. For some, it improves within months, while others have chronic symptoms for years.
Is there a cure for CFS?
There is no definitive cure, but proper management can improve quality of life.
Is it the same as burnout or fibromyalgia?
No, burnout is related to work-related stress, and fibromyalgia causes widespread pain, but not always with extreme fatigue.
Conclusion
Chronic fatigue syndrome is a complex condition that profoundly affects the lives of those who suffer from it. Although its exact cause is still unknown and there is no cure, a multidisciplinary approach can help manage symptoms and improve well-being.
If you suspect you have chronic fatigue syndrome, don't hesitate to consult a specialist for a proper diagnosis and a personalized treatment plan.
If you suffer from extreme fatigue, muscle pain, or difficulty performing your daily activities, don't let it go. FisioPou, our clinic physiotherapy in MadridWe help you improve your quality of life with personalized treatments and specific techniques for chronic fatigue syndrome. Book your appointment today and start regaining your energy and well-being.
