Health & Medicine General Medicine

Chronic Fatigue Syndrome: Causes, Symptoms, and Treatment

Chronic Fatigue

Everyone feels fatigued and tired, some have more physical tolerance than others while others have more mental strength to fight stress and exertion. Chronic fatigue or continuous tiredness is not the same, in particular the fatigue that is not relieved by rest and leads to more tiredness.

What is Chronic Fatigue Syndrome?

Chronic fatigue syndrome (CFS) is a set of symptoms related to excessive tiredness that affect body systems. It is an enduring and debilitating disease. The patient may be confined to bed, feel tired after minor activity, or feel fatigued even after rest. The quality of life can be severely affected, with loss of productivity and disturbed daily activities, lasting for more than six months. It makes it difficult to do the smallest of tasks like showering or prepping a meal.

CFS was previously called myalgic encephalomyelitis. But with the progress in understanding over time it is now called systemic exertion intolerance disease or 

SEID. The terms previously used describe it as a skeletal muscle disorder, but in reality, the disease is a characteristic exercise or activity-induced malaise.

How common is it?

CFS is an organic disease, not a psychiatric illness but it is not life-threatening. The diagnosis of CFS is much less than the actual number of cases prevailing in the populations. This is in part due to a lack of understanding by the healthcare provider, limited means, or mistaken for other problems. The average age at which it presents is 33 years and it is more common in women compared to men.

Why does it happen?

The exact mechanism by which the disease acts is unknown. Researchers suggest that it may be multifactorial. Abnormalities in the immune system, hormonal balance, metabolism, and stress, all are thought to play roles in the disease manifestation. Allergies, stress, genetic and environmental factors also raise the risk for CSF.

Presenting features:

Chronic fatigue syndrome may start with a viral-like illness, after which the stamina and endurance go down and down. The National Academy of Medicine describes the five types of symptoms found in CFS. The two characteristic symptoms are;

  • unrelieved fatigue
  • and post-exertional malaise (PEM).

Along with these, the three other symptoms are:

  • sleep problems- reduced sleep, disturbed sleep, difficulty staying asleep, feeling tired after adequate sleep
  • cognitive/intellectual issues- difficulty concentrating and thinking, short term memory defects, loss of words, dizziness
  • and orthostatic intolerance- reduced capacity to stand and sit for some time.

Some people also report generalized body aches, joint pains, headaches, irritable bowel syndrome-like picture, sore throat, swollen neck nodes, chills and night sweats.

Symptoms are worsened by activity, typically after 12- 48 hours and last for days and weeks. There is a continuous feeling of tiredness, even after sleeping and resting. This may push the patient to become house- or bed-bound. There are usually no physical indicators in the patient.

Diagnosing CFS:

CFS is a clinical disease diagnosed on history and examinations. The doctor may advise tests to exclude other causes of fatigue, such as hemoglobin levels, thyroid function test, kidney function, ESR CRP, ECG, brain scan and CSF analysis.

The National Academy of Medicine has built a criterion to diagnose the disease clinically.

It requires:

  • all the following three manifestations should be present.

Fatigue: Reduced ability to perform daily activities that were done prior to the disease, for 6 months or more, with severe fatigue, unrelieved by rest.

PEM (Post-exertion malaise): Worsening of symptoms after physical or mental stress, which was previously well tolerated.

Unrefreshing sleep: Feeling tired after a good night’s sleep

  • one of the following two symptoms to be present,

Cognitive/intellectual issues: Difficulties in thought and function, worsened by exertion or stress.

Orthostatic intolerance: Difficulty and worsening of symptoms on staying upright and standing, which is not completely improved by lying down.

  • the symptoms present should be there for more than six months in a moderate to severe intensity for at least 50% of the time.

Managing the disease

A lot of research is being directed toward finding the treatment of chronic fatigue syndrome. Yet no cure has been found till now. Symptomatic and supportive interventions may help the patient during the disease periods. Cognitive-behavioral therapy and graded exercises were once treatment options but advanced researches recommend against these methods.


The symptoms remit and relapse, and could persist for years. In up to half of the patients, the disease settles down enough to let them go back to work. Factors such as longer disease duration, severe fatigue, preceding depression and anxiety are related to a worse outcome. While good prognostic indicators are less fatigue, a good sense of control over symptoms and no physical dependence due to disease.

How to live with CFS:

CFS is a life-changing disease. It affects life from the most basic levels, daily activities. Patients and their families work together with healthcare providers to understand the illness and finding their way while dealing with the issues. Each patient slowly and gradually learns their mental and physical activity limits, and develops their routines within those limits. This gives them better control over the disease and lessens relapses.


CFS is a debilitating and long-lasting condition of continuous fatigue and post-exertion malaise. It does not fully settle with rest and may even occur after a good night’s sleep. It is diagnosed on set criteria and still under research for treatment. Current management options revolve around symptomatic support and to make activities more adjusted and manageable to the patient’s tolerance.

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