Chronic fatigue syndrome (CFS)

• CFS is defined by two major criteria, chronic severe fatigue for at least six months not caused by a diagnosable disease or relieved with rest and at least four other specific symptoms that occur at the same time or after the development of severe fatigue.
• The cause of CFS is unknown.
• Risk factors are not clearly understood, but the majority of adults diagnosed are adult women age range of 40s to 50s; pediatric patients diagnosed are usually teenaged.
• The symptoms and signs of CFS are relatively specific: chronic severe fatigue for at least six months not caused by a diagnosable disease and at least four other specific symptoms such as cognitive impairment, muscle and/or joint pains, new types of headaches, tender lymph nodes, sore throat, non-refreshing sleep and malaise after exercise, that occur at the same time or after the development of severe fatigue.
• CFS is diagnosed by the two major criteria and symptoms and signs listed above.
• Treatment of CFS is based on treating the symptoms patients exhibit.
• The prognosis for CFS in adults is only fair to poor; children have a better or good prognosis with treatment.
• Adopting a healthy lifestyle is the usual preventive advise given by clinicians that treat CFS patients.
• Additional sources of information and support groups are available for CFS.

What is chronic fatigue syndrome (CFS)?

Controversy about the definition of chronic fatigue syndrome (CFS) finally led an international panel of CFS research experts in 1994 to establish a precise definition of CFS so that the syndrome could actually be diagnosed. There are two criteria developed by this panel that both define and diagnose CFS. The patient must have both of the following criteria:

1. Have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis
2. Concurrently have four or more of the following symptoms: substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern, or severity; non-refreshing sleep; and post-exertion malaise lasting more than 24 hours

In addition, four symptoms of the symptoms listed above must have persisted or recurred during six or more consecutive months of illness and must not have predated the severe chronic fatigue (the symptoms must have occurred at the same time or after severe chronic fatigue appeared, but not before). Although most of the medical community accepts this definition, there are some that either do not or think the criteria needs revision.

Why so much controversy?

There are at least three major reasons for controversy:

1. Chronic fatigue is a symptom of many illnesses, so chronic fatigue syndrome had to have criteria that distinguished it from similar medical conditions that have chronic fatigue as a major symptom (for example, fibromyalgia, chronic mononucleosis, myalgic encephalomyelitis, neurologic problems, sensitivity to certain chemicals). Other treatable illnesses and conditions that may have chronic fatigue as one symptom among many others include hypothyroidism, cancers, autoimmune diseases, adrenal gland problems, subacute or chronic infections, obesity, sleep apnea, narcolepsy, reactions to medicines, hormonal disorders, schizophrenia, bipolar disorders, eating disorders, depression, alcohol and substance abuse, and malingering.
2. In addition to the two criteria above needed to fit both the definition and diagnosis of CFS, many patients have additional symptoms that, depending on their severity, may predominate and overshadow the CFS symptom criteria. These symptoms include chest pain, abdominal pain, shortness of breath, chronic cough, diarrhea, nausea, night sweats, jaw and muscle stiffness and pain, double vision, and psychological problems such as panic attacks, anxiety, and depression.
3. There is no laboratory test that can give a definitive diagnosis of CFS, and there are no physical signs that specifically identify CFS.

Consequently, the disease is diagnosed by excluding the diseases that may cause the symptoms (termed a diagnosis of exclusion) listed above yet still fit the two defined criteria established by the panel of CFS experts in 1994. It is not unusual for patients to undergo an extensive battery of tests to rule out other diseases before a patient is determined to fit the CFS diagnostic criteria. Unfortunately, many patients that have subsequently been diagnosed to have CFS also have had some of the conditions and symptoms listed above. Without the CFS criteria, diagnosis would even be more controversial.
Controversy still remains, some individuals want to rename the disease, some clinicians want to change the 1994 criteria and others do not. Until a definitive cause is proven, controversies about names, diagnosis, treatments, and other aspects of CFS will likely remain.