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Chronic Fatigue Syndrome Causes, Symptoms and Treatment

The encephalomyelitis Myalgic , commonly known as chronic fatigue syndrome , is characterized among other things by persistent and unexplained fatigue that lasts despite the efforts of the person. Considered a neurological disease, it often appears suddenly, leading to rapid and significant deterioration of health. It is a non-contagious syndrome, not transmissible genetically.

Myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS) also has symptoms that have a significant impact on work and personal activities, including muscle and joint pain, and general malaise . All these symptoms occur without the doctor being able to connect them to any disease. Sometimes, an event may seem to be connected to it: most often, a viral or bacterial infection, but perhaps also an immunization, anesthesia, physical trauma, exposure to environmental pollutants, etc.

All age groups (even children) and all ethnic groups may be affected by this syndrome. The women in are 2 to 4 times more affected than men.

Although there are references to chronic fatigue syndrome until the 1750s, it was not until 1988 that it was formally recognized as a disease, then in 1992 by the World Health Organization ( WHO) . More than 1,000 names have already described this condition (some are still commonly used), including neurasthenia, postviral syndrome or yuppies syndrome (“Young Urban Professionals”), since it strikes especially between 20 and 40 years, even if there are teenagers, children or older people with the disease.

Causes of Chronic Fatigue Syndrome (Myalgic Encephalomyelitis)

Most people with chronic fatigue syndrome lived a healthy and active life before being struck by the disease.

The hypothesis of a viral or bacterial infection is increasingly considered, because we can often identify an infection as a trigger. This infection could eventually lead to a dysfunction of the immune system in cells or biochemical elements responsible for fighting infections . For some, exposure to certain pesticides or insecticides could be involved.

Evolution of Chronic Fatigue Syndrome (Myalgic Encephalomyelitis)

The chronic fatigue syndrome evolves variably. It’s most acute manifestations usually last 2 years and can return cyclically. The symptoms tend to decrease with time. Not everyone is completely cured, but progressively, the majority of sufferers find a good deal of their abilities. It is estimated that fatigue usually disappears after 5 years on average, knowing that fatigue becoming more intermittent is probably about to disappear.

Diagnostic of Chronic Fatigue Syndrome (Myalgic Encephalomyelitis)

Medical teams ask a person with extreme and chronic fatigue to undergo numerous medical tests . It is a question of detecting the disease in question and several diseases lead to a significant reduction of energy, as for example examples, fibromyalgia, hypotension, chronic infectious mononucleosis, hypothyroidism and the syndrome of the irritable bowel, cancers, and many inflammatory or autoimmune diseases … Chronic fatigue syndrome can only be recognized as such when all other possible diseases have been eliminated by examinations and assessments.

Nor should chronic fatigue syndrome be confused with depression. Unlike the depressed person who does not enjoy anything, the “chronic weary” appreciates the happiness of life, but runs out quickly, resulting in frustration and a sense of imprisonment.

According to the Canadian Consensus on Myalgic Encephalomyelitis / Chronic Fatigue Syndrome, the diagnosis of chronic fatigue syndrome can only be made if the symptoms of chronic fatigue , fatigue after exercise , sleep disorders and significant pain be present. The patient must also have at least 2 neurological or cognitive symptoms, and at least one endocrine, immune, or autonomic nervous system symptom (see the Symptoms section ).

In children , the symptoms can vary a lot from one day to another, but are as important as in adults. In them, the diagnosis can be made if the characteristic symptoms last for more than 3 months.

Symptoms of Chronic Fatigue Syndrome (Myalgic Encephalomyelitis)

  • An unexplained persistent fatigue that lasts more than 6 months (3 months for children) ;
  • Recent or early onset fatigue
  • This fatigue is not related to intense physical or mental exercise;
  • The fatigue increases after exercise or moderate mental , and tends to persist longer than 24 hours;
  • non-restorative sleep ;
  • The tiredness persists even after rest periods  ;
  • drop in school performance , professional, sports, school;
  • A reduction or abandonment of activities;
  • Of unexplained muscle pain , quite similar to the pain caused by fibromyalgia (in about 70% of people), often accompanied by significant and unusual headaches;
  • Neurological or cognitive problems  : confusion, short-term memory loss, difficulty concentrating, disorientation, difficulty in visual focusing, hypersensitivity to noise and light, etc .;
  • Manifestations of autonomic nervous system  : difficulty standing upright (standing, sitting or walking), pressure drop when standing up, feeling dizzy, extreme pallor, nausea, irritable bowel syndrome , frequent urination , palpitations , cardiac arrhythmia, etc .;
  • Neuroendocrine manifestations  : instability of body temperature (below normal, periods of sweating, feverish sensation, cold extremities, intolerance to extreme temperatures), significant weight change, etc .;
  • Immune manifestations  : frequent or recurrent sore throat, armpit and groin sensitive lymph nodes, recurrent flu symptoms, allergies or food intolerances, etc.
Fukuda’s criteria for diagnosing chronic fatigue syndrome

To diagnose this disease, two major criteria must be present:
– Fatigue greater than 6 months with a decrease in activities;
– An absence of apparent cause.

In addition, at least 4 minor criteria must be present among the following:
– Memory disorder or significant difficulties of concentration;
– Irritation of the throat;
– Cervical stiffness or axillary lymphadenopathy (underarm glands);
– Muscle aches;
– joint pain without inflammation;
– Unusual headache (headache)
– Non-restful sleep
– General fatigue, greater than 24 hours after physical exercise.

People at risk for Chronic Fatigue Syndrome (Myalgic Encephalomyelitis)

  • The women are 2 to 4 times more likely to suffer than men.
  • This syndrome is most common between 20 and 40 years of age , but can affect any age group.

Risk factors

Although physicians can sometimes identify events that may have contributed to the onset of the disease (viral infection, physical or psychological stress, etc.), the uncertainty surrounding it prevents the presentation of specific risk factors.


Can we prevent?
Unfortunately, as long as the causes of this chronic disease remain unknown, there is no way to prevent it. According to the French Association of Chronic Fatigue Syndrome and Fibromyalgia 5 , many people are unaware that they are ill and therefore do nothing to treat themselves. By remaining attentive to one’s general state of health, one can however accelerate the diagnosis and benefit more quickly from a therapeutic management.
Measures to prevent or mitigate periods of fatigue
  • In good days, avoid excessive activity, but also psychological stress. The  overuse  can make the symptoms recur;
  • Set aside daily relaxation periods   (listening to music, meditation, visualization, etc.) and focus your energies on recovery;
  • Sleep enough. Having a regular sleep cycle promotes restful rest;
  • Plan your activities for the week from an endurance perspective . The most functional period of a day is often from 10 am to 2 pm;
  • Break the isolation by participating in a  support group  (see Support Groups below  );
  • Avoid caffeine, a fast stimulant that disrupts sleep and causes fatigue;
  • Avoid alcohol, which causes exhaustion  in many people with chronic fatigue syndrome;
  • Avoid consuming too many  fast sugars  at the same time (cookies, milk chocolate, cakes, etc.). The resulting drop in  blood sugar is  tiring the body.

Medical treatments of chronic fatigue syndrome

The cause of this syndrome is not known with certainty, there is no specific treatment for chronic fatigue syndrome whose effectiveness has been clearly demonstrated.
In practice, the treatments aim at relieving the symptoms , giving the patient maximum autonomy and maximizing his abilities .

As the treatment is not specific, many approaches are interesting to aim to reduce as much as possible the exhaustion of the patients:
– Follow rules of health hygiene and dietetics;
– Very slow muscular rehabilitation (sometimes sessions of only 2 minutes 2 to 3 times a week at the beginning);
– Search and cure the focus of infection (teeth, sinuses …);
– Relaxation, sophrology, meditation, yoga;
– behavioral therapy, psychological support;
– Regulation of sleep;
– Eliminate allergy factors and treat allergies (common in this syndrome);
– Balance the intestinal flora;
– treat respiratory disorders;
– Treat a post-traumatic stress disorder resulting from old trauma.

According to the Canadian Consensus on Myalgic Encephalomyelitis / Chronic Fatigue Syndrome, treatments must ideally respect the person’s rhythm and its limits. Here is an overview of the recommendations included in this report.

Self-help approaches

The goal of an autotherapy strategy is to help the person with energy conservation, minimize symptoms and improve coping skills and ability to perform daily activities.

Get to know the disease and ways to fight it

It is important to know the disease and what to expect in order to develop self-care strategies. The person must learn to recognize the warning signs and stop before they have exceeded their limits . It is advantageous to know the techniques of relaxation and stress reduction, energy conservation (see complementary approaches ) and avoid known aggravating factors .

Developing adaptability

  • Use your impressions and experiences to determine your activity limits .
  • Set aside time to rest and indulge in an activity that we like.
  • Gradually push your limits, when you are able, without ever giving them up.

Improve sleep
Use all techniques to improve sleep .

  • Go to bed at regular hours.
  • Take a warm bath.
  • Do not use the bed for anything other than sleeping or sexual activities.
  • Calm mental activity through meditation or relaxation techniques, etc.
  • See our file Did you sleep well? .

Have a balanced diet

  • Ensure a balanced and nutritious diet (see How to eat well? ).
  • Eat at regular times.
  • Drink enough.
  • If needed, take dietary supplements and a multienzyme tablet for irritable bowel syndrome or digestive problems.
Two therapies that work: towards a new therapeutic approach?

–  The combination of progressive physical activity and medical follow-up led to an improvement in energy levels and physical abilities for 61% of subjects.
– The combination of cognitive-behavioral therapy and medical follow-up resulted in a decrease in symptoms with comparable efficacy (for 59% of subjects).
On the other hand, the group of patients who followed the strategy of self-care alone (as described in this sheet: adapting to illness, reducing activities accordingly, etc.) saw their symptoms decrease by only 42%, a result roughly equivalent to that of medical monitoring alone. The approach advocated in this study is based on the premise that it is possible to recover from this syndrome, instead of having to constantly adapt to it by combining several approaches. (See our new Chronic Fatigue Syndrome: 2 therapies that work , for more details.)


Physical activity

An initial assessment should precede the development of a program of activity under the supervision of a qualified person in exercise physiology that has a thorough knowledge of chronic fatigue syndrome. The goal of this program is to improve the ability to function well on a daily basis, while respecting the cardiovascular capacities highlighted during the evaluation. However, it is imperative to decide for yourself the intensity and cadence of the exercises .

discomfort or physical fatigue disproportionate after exercise is a characteristic distinctive and criteria for chronic fatigue syndrome. A physical exercise program must be adapted to each patient to avoid relapse or aggravate symptoms. It may be appropriate to start with periods of activity as brief as 2 minutes, 3 times a week. Physical exercise is important to prevent muscle wasting related to inactivity as well as to fight against fatigue.


Many medications have been suggested to treat chronic fatigue syndrome and none has been shown to be effective in relieving this syndrome as a whole.

Sleep Disorders In
addition to the treatment strategies described above, the physician may prescribe, as appropriate,low-dose tricyclic antidepressants , zopiclone, clonazepam, and L-tryptophan. These drugs sometimes also have an action on the pains.
Selective serotonin reuptake inhibitors (eg Prozac) may worsen sleep problems.


Analgesics . As a basic treatment: paracetamol or acetaminophen . Aspirin, ibuprofen, nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose tricyclic antidepressants, gabapentin or baclofen may be useful for a short period of time.

Methylphenidate, oral cyanocobalamin (vitamin B12), modafinil, amantadine, dextroamphetamine. Most of these drugs have only a short-term effect. High-dose vitamin B12 injections benefited some people even though they had a normal blood count (CBC).

Cognitive problems
Methylphenidate, modafinil, nimodipine, dextroamphetamine, cyanocobalamin (vitamin B12) sometimes gives some results .

Depression, anxiety
Against depression doctors may prescribe serotonin reuptake inhibitors (SSRIs), low-dose tricyclic antidepressants (which also reduce muscle pain), and anxiolytics to treat the symptoms associated with depression. Note that anxiety and depression are also supported by behavioral and cognitive therapies.

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