occurs in individuals from all socioeconomic groups
whilst most fatigue syndromes are of short duration & resolve spontaneously, people with CFS for more than 5 yrs tend to remain symptomatic, although function may improve slowly over time. A US study estimated a cumulative 5 yr recovery rate of 31%.
may be triggered by specific infections such as EBV / glandular fever / infectious mononucleosis which is reknown for causing fatigue as its main symptom, and this may last 3 months or well beyond that.
Diagnostic criteria:
fatigue:
clinically evaluated, unexplained, persistent or relapsing fatigue persistent for 6 months or more, that:
is of new or definite onset
is not the result of ongoing exertion
is not substantially alleviated by rest
results in substantial reduction in previous levels of occupational, educational, social or personal activities
and four or more of the following symptoms that are concurrent, persistent for 6 months or more & which did not predate the fatigue:
impaired short term memory or concentration
sore throat
tender cervical or axillary lymph nodes
muscle pain
multi-joint pain without arthritis
headaches of a new type, pattern or severity
unrefreshing sleep
post-exertional malaise lasting more than 24 hours
Management:
provide information about CFS to help pts understand their illness
encourage increasing levels of physical & mentals tasks, starting at a level tolerated without significant exacerbation of symptoms
sleep management aiming to establish a regular, unbroken, night-time sleep pattern & to improve perceptions of the quality of sleep:
establish regular bed-time routine:
going to bed when “sleepy” rather than “tired”
put the light out immediately rather than reading or watching TV in bed
“anchoring” the sleep routine by setting the alarm to the same rising time each day
judicious use of sedative-hypnotic medication to achieve sleep
use of analgesics for relief of musculoskeletal pain
avoiding (preferably) daytime naps or keeping them under 30mins
gentle exercise during the day
consider assistance from sleep specialist
symptomatic drug Rx:
many pts report increased susceptibility to drug adverse effects, so minimise & start low dose
consider contact with support groups
enlist social welfare agencies
References:
Chronic fatigue syndrome - Clinical Practice Guidelines 2002. MJA 6 May 2002 vol 176 supplement