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Chronic fatigue syndrome is a condition with a diverse range of symptoms but particularly characterised by profound and persistent tiredness.
Formerly known as myalgic encephalomyelitis (ME) it is often viewed as a new disease but doctors now believe it has been around for decades.
When ME was first outlined as a condition in the 1980s many doctors were sceptical about whether it was a real condition or "all in the mind". Medical experts have now developed a list of criteria which identify chronic fatigue syndrome.
How do I know I have CFS?
One in five people consulting their GP report chronic tiredness but only a small proportion of these have CFS. The main feature of CFS is overwhelming tiredness which disrupts the ability to carry out normal activities.
The US Center for Disease Control has developed a list of diagnostic criteria for the condition. Four or more from the following symptoms must be present for at least six months:
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short term memory loss or severe concentration problem |
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mild fever |
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nausea or irritable bowel syndrome |
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sore throat |
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swollen glands |
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muscle pain |
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pain in a number of joints |
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headaches |
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unrefreshing sleep |
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severe tiredness after exertion lasting more than 24 hours |
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A number of other symptoms are commonly found such as sensitivity to light, dizziness, irritability, panic attacks, irritable bowel symptoms, menstrual problems, rashes, unexplained weight loss or gain and fever. |
The symptoms of CFS are not those of normal tiredness - the fatigue is severe and unrelentless and even a little exercise makes the tiredness much worse. It substantially affects the ability to live a normal life.
Other conditions which will be ruled out first include rheumatoid arthritis, lupus, multiple sclerosis or diseases such as cancer, diabetes or anaemia. Blood tests will generally be carried out to eliminate these conditions. Other conditions such as fibromyalgia have overlapping symptoms.
Some researchers speculate that exposure to chemicals or allergies may be a factor while some see as it an immune system reaction to stress. However, the depression that may accompany symptoms is seen as a reaction to the debilitating effects of the disease rather than the cause.
What causes it?
There is no know means of transmission for CFS but it appears that acute viral infections can trigger it. Many people report having a bout of flu which prompted development of the symptoms. If may often start with a headache and muscle aches and fatigue that don't go away after a week or two like normal flu like viruses.
How common is it?
Chronic fatigue is a common problem associated with a large number of medical conditions, but most of these are not CFS. The CDC in the US estimates that it affects about three or four people in every 1000 and some doctors believe it is under diagnosed, with many people enduring the symptoms and many doctors attributing them to other factors including stress and depression.
CFS was initially diagnosed much more often in Caucasian women and in people aged between 20 and 50. It is being diagnosed in increasing numbers of children and it is recognised that it affects all ethnic groups and all income groups.
Is there a cure?
Of those patients who are able to undertake a modest amount of exercise the majority report some improvement in symptoms. However, exercise needs to be built up slowly as overdoing it can make symptoms much worse. Antidepressants may be prescribed and these have been shown to reduce fatigue after a few weeks in some patients. A low dose of a tricyclic antidepressant such as amitriptylline at bedtime helps promote sleep and improve the disturbed patterns that often accompany CFS.
For muscle aches and pains anti-inflammatory drugs such as aspirin or ibuprofen may be prescribed.
A number of other drugs are being or have been trialed for CFS, notably Ampligen. However, there is no standard treatment or cure.
Most people will have to experience continued symptoms for a period of months or even years, though there are a number of measures which can alleviate some of them.
What about alternative medicine?
Alternative therapies are sought out by many who do not find improvement from conventional medicine. A combination of traditional and Western remedies is often tried. Herbal remedies, acupuncture, osteopathy, massage and aromatherapy are widely used though there is debate about their merits.
Some doctors recommend including fish oil supplements, zinc, magnesium and vitamin C in the diet and most see a healthy balanced diet as important.
Stress management and relaxation techniques may also be useful while some patients have benefited from cognitive therapy to help them cope with their condition
Support is often seen as one of the best ways to help manage CFS.
What is the prognosis?
The CDC says 45% of sufferers will regain at least 80% of their former abilities within five years and a further 10% within 10 years.The rest will achieve no more than half their normal abilities. Periods of relapse and remission are common. Stress usually worsens symptoms and some doctors believe it may contribute to the onset of symptoms. Most doctors stress that a gradual approach in returning to normal activities is vital - people who are too keen to return to active work will often suffer a relapse.
How could cannabis help?
Cannabis could be useful for treatment of CFS/ME in a number of areas. To relieve the chronic pain, to aid sleep in order to feel refreshed the next day, as well as to aid in recovering from exercise which is extremely important but incredibly difficult to maintain for someone with CFS/MS. Also cannabis could be a useful tool to help combat the inevitable sense of depression which comes with a long term chronic illness. The associated symptoms of IBS could also benefit from a ingestion of cannabis to help relieve tension in the digestive system.
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