Myalgic encephalomyelitis, more commonly referred to as chronic fatigue syndrome (CFS) is a complex long-term illness characterized by extreme tiredness that is not relieved with sleep or rest.  It is a common condition with over 200,000 cases yearly in the United States, and it affects a disproportionate number of women, in fact, four women are affected for every one man. CFS can be diagnosed at any age, but it is predominantly in young to middle age adults. The cause of this disorder is unknown, and there is no single test to confirm a diagnosis which can be problematic for those who suffer. Symptoms can vary, but they may include: fatigue, problems with memory or concentration, sore throat, headache, enlarged lymph nodes in armpits or neck, muscle or joint pain, extreme exhaustion after physical or mental exercises, dizziness, or sleep that is not refreshing. 

CFS can look similar to other disorders. CFS, fibromyalgia, and lupus are very similar symptomatically, so it is important to rule out any other illness and get a true diagnosis.  Your doctor will check for any thyroid disorders, anemia, or even diabetes. All of these can cause fatigue. They will also check for any sleep disorders such as sleep apnea, restless leg syndrome, or insomnia. It is important to rule out any mental health disorders as well since depression and anxiety can cause problems with concentration, fatigue, and difficulty sleeping. Once other illnesses have been ruled out, diagnostic criteria for CFS is evaluated, and that is defined as fatigue that is so severe that it interferes with activities of daily living, is new in onset, is not relieved by rest, and is worsened by physical, mental, or emotional exertion. In addition, one of the following complaints must be present: (1) difficulty with memory or focus or (2) dizziness that is worse when changing position.

The cause of CFS in unknown, but some people are diagnosed with the disorder after a viral infection. In fact, some clinical studies have shown a link between the Epstein-Barr virus and human Herpes 6 virus, but the results are not conclusive. Some patients have abnormal blood hormone levels produced by glands of the pituitary, adrenals, and hypothalamus. Other patients report a physical or emotional trauma before the onset of symptoms. These are all theoretical triggers for CFS, but further research is needed to determine the connection between these ailments and CFS. Ongoing clinical studies are trying to identify a specific cause or a potential biomarker that would predispose someone to this enigmatic disease. 

Symptomatic treatment is necessary as there is no cure for CFS. Antidepressants may be prescribed for depression and anxiety, and they sometimes help with mild pain and sleeplessness as well.  If dizzy episodes are a problem, medicines to regulate blood pressure may be prescribed. Over the counter pain relievers are beneficial in many circumstances, but if they are not helpful, prescription medicines such as Lyrica or Gabapentin may be needed, which are used to treat nerve pain and chronic pain.

Alternative therapies can also be helpful. Acupuncture and massage can help to relieve pain and relax muscles. Deep breathing, meditation, yoga, or tai chi can assist with relieving pain, anxiety, and depression while boosting your energy. Physical therapy can be helpful to maintain flexibility and muscle strength while increasing stamina. In addition, supplements can be valuable to boost your immunity, energy, and mental clarity. Daily vitamins and probiotics combined with a healthy plant based diet is a plus for health and immunity. Some studies have shown that NADH (nicotinamide adenine dinucleotide, a form of Vitamin B3), magnesium, and Omega 3 fatty acids can increase energy levels and boost mental clarity and focus. Of course, talking with a therapist is always beneficial to relieve stress and anxiety. Unfortunately, dealing with any chronic illness is a daily burden that can take a toll on mental health as well as physical health.  

It is important to determine what treatment options work best for you and your lifestyle and this may involve some trial and error. Regardless of what treatment options work best for you, it is important to maintain a healthy diet and lifestyle to remain physically healthy and emotionally positive while dealing with this challenging chronic illness.


Cheryl Moates RN, MSN