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Answer: Chronic fatigue syndrome (CFS), also sometimes called immune dysfunction syndrome or myalgic encephalomyelitis (in Europe), is not a new disorder. In the 19th century the term neurasthenia, or nervous exhaustion, was applied to symptoms resembling CFS. In the 1930s through the 1950s outbreaks of disease marked by prolonged fatigue were reported in the United States and many other countries. Beginning in the early to mid-1980s interest in chronic fatigue syndrome was revived by reports in America and other countries of various outbreaks of long-term debilitating fatigue.

Fatigue that lasts for more than six months, impairs normal activities, and has no identifiable medical or psychological problems to account for it is referred to as unexplained chronic fatigue. This condition, however, is not considered to be chronic fatigue syndrome unless it meets certain criteria [ see Box ]. If it does not meet these criteria, then the condition is referred to as idiopathic chronic fatigue . (Idiopathic simply means that the cause is not known.) It should be noted that six million patient visits are made each year because of fatigue, although only a very small percentage of these can be attributed to actual chronic fatigue syndrome.

Criteria for Chronic Fatigue Syndrome

The Centers for Disease Control define CFS as a distinct disorder with specific symptoms and physical signs after eliminating other identifiable causes of these symptoms and signs.

1. Four or more of the following symptoms must have been present for longer than six months:

Short-term memory loss or a severe inability to concentrate that affects work, school, or other normal activities.
Sore throat.
Swollen lymph nodes in the neck or armpits.
Muscle pain.
Pain without redness or swelling in a number of joints.
Intense or changing patterns of headaches.
Unrefreshing sleep.
After any exertion, weariness that lasts for more than a day.

2. The fatigue must be severe as indicated by the following:

Sleep or rest does not relieve it.
The fatigue is not the result of excessive work or exercise.
The fatigue substantially impairs a person's ability to function normally at home, at work, and in social occasions.
Even mild exercise often makes the symptoms, especially fatigue, much worse.

3. The fatigue must be a new, not lifelong, condition with a definite time of onset. Often, the condition first appears as a viral upper respiratory tract infection marked by some combination of fever, headache, muscle aches, sore throat, earache, congestion, runny nose, cough, diarrhea, and fatigue. Typically, the initial illness is no more severe than any cold or flu.

4. The symptoms must persist. In ordinary infections, symptoms go away after a few days, but in CFS, fatigue and other symptoms recur or continue for months to years. Many patients experience symptoms as recurring bouts of flu-like illness, with each attack lasting from hours to weeks.

Note: Other symptoms reported with CFS but not part of the criteria include intolerance to alcohol, irritable bowel syndrome, dry eyes and mouth, impaired circulation in the hands and feet, visual disturbances, and painful periods in women.

Answer: There is no proven or reliable cure for CFS, and no drug has been developed specifically for this disorder. Patients with the best chance for improvement are those who remain as active as possible and who seek to have some control over the course of the disorder. Patients should seek physicians who are willing to consider the problem as a medical condition with psychiatric components. They should be very wary, however, if the physician recommends excessive and expensive treatments that may have serious adverse effects and that have no proven benefits. For patients with severe CFS that cannot be managed with lifestyle changes and standard medications, asking the physician about enrolling in any available clinical trials may be helpful. Little significant research, however, is being conducted on treatments for CFS. For example, there were no major trials on drug therapies on either CFS or fibromyalgia reported during 2000.

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Question: What Is Chronic Fatigue Syndrome and Its Symptoms?