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chronic_fatigue_syndrome

Chronic fatigue syndrome

Introduction:

  • prevalence of CFS in community is 0.2-0.7%
  • predominantly effects young adults
  • 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
chronic_fatigue_syndrome.txt · Last modified: 2011/07/23 01:13 (external edit)