Medical Professionals: Medical FAQs
Is this a real disease?
Yes, chronic fatigue syndrome (CFS), also known as chronic fatigue and immune dysfunction
syndrome (CFIDS), is a real disease. Although there is no known etiology and no diagnostic marker, there is substantial objective evidence for a physiological
How do I know that people are not just depressed, or copping out?
Many research studies have looked at the differences between CFS and major depressive illness and outcome data supports the fact that CFS is not the same as depression, although some people experience depression, generally secondary to the onset of CFS symptoms.
How do I diagnose the patient who presents with complaints of unrelenting fatigue?
The diagnosis of CFS is done by excluding illnesses that present with similar symptoms, such as hypothyroidism. A thorough history and physical, including a neurological and psychological assessment and exclusionary labs are ordered. If these standard reviews and basic tests don't suggest other possible causes, CFS is a likely possibility.
What are the symptoms of CFS?
CFS is a multi-symptom, complex illness. It is more than "just fatigue." Most patients state that their illness began with flu-like symptoms that never fully improved. The fatigue of this illness is substantial and significantly interferes with daily functioning. The 1994 International Case Definition, although designed for researchers, is loosely interpreted by clinical practitioners for diagnostic purposes. In addition to
debilitating fatigue, the case definition requires four of eight other "common" symptoms to be present at the same time. These eight case definition criteria
- post-exertional malaise
- unrefreshing sleep
- disturbed memory and cognition
- muscle pain
- joint pain
- headaches of a new type
- sore throat,
- tender cervical (neck) or axillary (armpit) lymph nodes
Of note: patients frequently present with symptoms that differ in type and number than those required by the case definition; however, if the fatigue criteria is met and the patient has concurrent multiple symptoms (including two or more from the case definition), the provider experienced in CFS management will likely make the diagnosis of CFS after excluding other potential illnesses.
Do children and adolescents get CFS and, if so, are the signs and symptoms the same?
Yes, children as young as age five have been diagnosed. Pediatrician David Bell, MD, FAAP, in the CFIDS Research Review, Fall 2000, discusses pediatric CFS, citing that symptoms appear to be similar, yet he has observed some differences:
- symptoms in young children most often have an onset with headache or irritable bowel syndrome
- the cognitive disturbances of CFS are often confused with attention deficit disorder
- orthostatic intolerance may be more common in children with CFS than adults with CFS
- symptoms for children are equally severe, but tend to migrate.
In addition, Dr. Bell states that since young children are often unable to verbalize what they are experiencing it is difficult to distinguish symptom patterns and many do not see themselves as being ill because they have no clear reference to normal health.
He also adds that prognosis appears to be better for children. Research on CFS in the pediatric population is limited. We have assumed that symptoms and course
of illness are the same, but this may not be the case.
How do I treat CFS?
Since there is no cure, treatment is symptomatic and supportive. Aggressive symptom management for pain, sleep problems, gastrointestinal complaints, orthostatic intolerance, and other disruptive symptoms is indicated. Depression and anxiety often accompany CFS as the person makes the multiple adjustments to a chronic illness. These adjustments are often life-altering as people lose their jobs, economic security, homes, and social
support systems. Referral to a mental health professional may be indicated to help build coping skills.
Persons with CFS are often my most difficult cases. How do I deal with them?
By providing supportive treatment in the form of empathetic listening, learning as much about the disease as possible and approaching the patient in an accepting, non-judgmental manner, a better relationship is possible. It is imperative that the patient and provider establish feelings of mutual respect
and trust for there is much trial and error involved in treating CFS.
I've been asked to sign off on disability statements. What do I do?
The Social Security Administration recognizes CFS as a potentially disabling condition. However, winning any disability case can be a lengthy, frustrating experience. Thorough medical documentation is essential, as is knowledge about CFS. Materials that assist with the disability process are available at The CFIDS Association of America.
What's the prognosis for persons with CFS?
Debate still surrounds the prognosis of CFS. Based on limited research data available, it appears that the majority of patients with CFS improve within five years of becoming ill. Based on statistical data from the Centers for Disease Control and Prevention, if symptoms last for five years, it is unlikely that the illness will improve significantly in subsequent years. In and of itself, CFS does not appear to directly create fatal complications. It is imperative that depression be detected and treated to help prevent the possibility of
suicide. Although no studies have been done on suicide and CFS, there are anecdotal reports of suicide in the CFS population.
Where can my patients and I learn more about CFS?
The CFIDS Association of America serves as a clearinghouse for information about chronic fatigue and immune dysfunction syndrome. Information is available for health care providers and consumers.
Articles of Interest
- The Physical Basis of CFS, by Anthony L. Komaroff, MD
- Contrasting Chronic Fatigue Syndrome (CFS) and Major Depressive Disorder (MDD), by
Terri Lupton, BSS, RN
- The Role of Laboratory Tests in Diagnosis of Chronic Fatigue Syndrome, by Charles W. Lapp, MD
- Treating Pediatric CFS, by David S. Bell, MD, FAAP
- Disability Evaluation in a Nutshell, by Douglas Smith