Chronic Fatigue Syndrome–Diagnosis and Prognosis

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How Is It Diagnosed?

According to the CDC (Centers for Disease Control) as of 2013, more than 1 million people in the United States have chronic fatigue syndrome, 0.35% of the population at that time. An obvious question is, for a disorder that occurs only 12% as often as fibromyalgia, what possible ways to diagnose it could there be? In short, none. There are currently no diagnostic tests that can confirm the presence of CFS in a patient. Nevertheless, there are criteria based on the commonly observed symptoms. A doctor must perform blood and urine tests that can exclude or confirm other illnesses as the cause and still weigh your range of symptoms against the other difficultly (yes, that is a word!) diagnosed conditions like fibromyalgia in case you have one of those instead. He or she should also rule out mental disorders, existing or previously experienced illnesses, and medication side effects.

The CDC and most doctors currently use a case definition produced by a group of CFS experts in 1994 to diagnose the condition:

  • “The individual has severe chronic fatigue for 6 or more consecutive months that is not due to ongoing exertion or other medical conditions associated with fatigue (these other conditions need to be ruled out by a doctor after diagnostic tests have been conducted)
  • The fatigue significantly interferes with daily activities and work
  • The individual concurrently has four or more of the following symptoms:
    • post-exertion malaise lasting more than 24 hours
    • unrefreshing sleep
    • significant impairment of short-term memory or concentration
    • muscle pain
    • pain in the joints without swelling or redness
    • headaches of a new type, pattern, or severity
    • tender lymph nodes in the neck or armpit
    • a sore throat that is frequent or recurring

These symptoms persisted or recurred during 6 or more consecutive months of illness and they cannot have first appeared before the fatigue.” (http://www.cdc.gov/cfs/case-definition/index.html)

Any other common symptoms associated with CFS should not be used in its diagnosis, though they likely confirm its presence afterwards.

What’s the Prognosis?

As with fibromyalgia, there is no cure, but unlike FMS, neither are there any FDA-approved medications to treat it as a specific disorder. The frequent changes that occur in the nature of a patient’s CFS and cycles of remission and relapse also make it a difficult disorder to treat. But, as with any incurable illness, the symptoms can be managed with some success, depending on the patient and the severity and variability of his or her symptoms.

Medications can be prescribed to treat sleep problems and lack of energy, pain, depression, and gastrointestinal problems while regulating sleep patterns, managing and reducing stress, physical therapy and exercise, and therapy for emotional problems can also help. CFS sufferers have also found that alternative therapies such as massage therapy, acupuncture, hydrotherapy, and yoga seem to help relieve symptoms as well. All in all, there is not much difference in treatment between chronic fatigue syndrome and fibromyalgia syndrome.

 

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Chronic Fatigue Syndrome–Definition and Symptoms

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What Is It?

Chronic fatigue syndrome (CFS)–aka chronic fatigue and immune dysfunction syndrome (CFIDS) aka myalgic encephalomyelitis (ME)–is an illness characterized by intense, deep, and persistent fatigue and exhaustion. Definite immune system abnormalities have been found in the majority of CFS patients, hence the alternate names (“myalgic” = of or relating to myalgia, which is muscle pain; “encephalomyelitis = inflammation of the brain and spinal cord, usually due to viral infection).

About 1 million, less than 1%, of Americans have CFS, and among them, more women are affected than men. The cause is unknown–though current thoughts trend toward infection, immune disorder, or neurological disorder–and there is no cure. CFS produces some similar symptoms to fibromyalgia syndrome (FMS) and the two often occur together, but there are differences.

What Are the Symptoms?

A syndrome is a set of symptoms that occur together, indicating the existence of a particular disease. Therefore, chronic fatigue syndrome most commonly presents the following set of symptoms:

  • as stated above, overwhelming, persistent fatigue
  • post-exertional malaise–disproportionate exhaustion lasting at least a day after mental or physical exercise
  • pain–muscle pain; joint pain without swelling or redness; headaches
  • unrefreshing sleep; sleep difficulties
  • impaired memory and concentration; brain fog, cognitive difficulties
  • frequent or recurring sore throats
  • tender and/or enlarged lymph nodes in the neck and armpits
  • other flu-like symptoms

Additional symptoms (and disorders) that often occur along with these are:

  • gastrointestinal problems
  • allergies and sensitivities to foods, odors, chemicals, medications
  • depression, mood swings, irritability
  • visual disturbances (blurry sight, light sensitivity, eye pain)
  • dizziness, balance problems, fainting; difficulty maintaining an upright posture
  • chills, night sweats
  • gynecological problems, including PMS
  • chronic inflammation of the bladder wall (interstitial cystitis), chronic pelvic pain
  • temporomandibular joint disorder (TMJ)

I think what really sets CFS apart from FMS are the flu-like symptoms that often precipitate and accompany the illness. If not for a lack of these flu-like symptoms, I would believe that I have chronic fatigue syndrome rather than fibro. But who knows. I could even have both, which is called comorbidity–the simultaneous presence of 2 (or more) chronic medical conditions in 1 person. Many fibro and CFS sufferers can attest to having comorbidity.

Are you a CFS sufferer? Do you experience comorbidity? How do you cope?

Forced Hiatus

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I have been forced to go on hiatus (or hibernation, really) for the past couple of weeks because of a flare-up of fatigue. It’s times like these when I wonder whether or not I have Chronic Fatigue Syndrome, whether instead of FMS or along with it. I often consider this muscle-withering, spirit-sapping, energy-eradicating, and brain-muffling fatigue to be much worse and more difficult to deal with than the pain. At least with the pain, I have a chance to work through it or maybe only experience a flare in one body part. But with fatigue, my whole body is encased in and weighed down by exhaustion. And depression and lowered self-worth soon follow. They say that misery loves company. Well, so does fatigue! I finally broke down last night and cried a bit. But my husband was there and comforted me and reassured me how much he appreciates and values me and everything I do for him/us. Nonetheless, I still feel fairly useless…

But, I know better than to become mired down in such negative feelings because not only do they not make the situation any better but also emotional stress leads to increased pain and fatigue, which I DEFINITELY do not want to happen. So, my husband and I have resolved to have a frank and proactive discussion about adjustments we can make to make weekdays easier for the both of us. And hopefully, my appointment with the rheumatologist, which should be set up soon, will give me some options for treating my fatigue.

I also have trouble with this particular symptom because when it’s this bad, I can barely get out of bed to manage my basic needs. The cycle of negative thoughts and self-image is perpetuated by this lack of self-care and further feeds the depression and fatigue and inactivity.

How can I fix this or help myself do better during these times? Well, I have noticed recently that sometimes when I’m fatigued but still attempt to do something I need to get done, I don’t feel much more tired afterwards as I always expect to. Part of what prevents me from getting out of bed is the fear that activity will only make me feel more tired and worsen my muscle aches and soreness. But in such instances as the one mentioned before, I know this not to be true, at least most of the time. So, I’m determined to train myself not to have that negative mentality and to make myself accomplish one good, useful thing a day. And when my “fatigue-self” protests, I can tell it that I have all the rest of the day, hours, to “recuperate” from the activity and so it shouldn’t complain!!

Plus, accomplishing one activity usually spurs an emotional boost, which can give one the motivation to get something else done. But as long as you only focus on one thing at a time, you aren’t overwhelmed and bogged down by the stress and pressure of all the myriad chores, errands, and activities that you need to do.

I think that the first step to overcoming fatigue that you can do on your own, is re-train your thinking and stop negative thoughts in their tracks. Give yourself credit for even the littlest things you have been able to accomplish and focus on one thing at a time. Doing this helps me to not feel so overwhelmed and I’ve just gotten away from it lately. Also, do things that help take your mind off of your inactivity–read an exciting book, watch an uplifting show or movie, do a hobby (like crocheting) that does not require the use of your entire body–and help keep you encouraged and positive. Prayer and spiritual reflection comfort and strengthen me while reading dramatic sci-fi novels, watching British mystery shows, and crocheting help to distract me. What successful steps have you taken to stem the effects of fatigue?

Fibromyalgia Syndrome–Definition and Symptoms

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What Is It?

Fibromyalgia–“fibro” = fibrous, or of fibers, and “myalgia” = muscle pain–syndrome (FMS; hereafter referred to as “FMS”, “fibromyalgia”, or “fibro”) is a musculoskeletal disorder marked by widespread muscle pain. This pain is thought to be caused by overactive nerves in the body overloading the brain with pain signals. Why this condition develops is unknown. The symptoms that characterize FMS are often part or the main feature of other diseases as well, making it easy to misdiagnose. It affects many more women than men as well as middle-aged than younger and approximately 2-5% of the American population.

What Are the Symptoms?

A syndrome is a set of symptoms that occur together, indicating the existence of a particular disease. Therefore, fibromyalgia syndrome most commonly presents the following set of symptoms:

  • as stated above, widespread pain; such pain usually occurs in the muscles, but can also be felt in the tendons and ligaments (the soft fibrous tissues), and the joints
  • tenderness, or sensitivity to touch (also considered a decreased pain threshold); this can be experienced body-wide but it is particularly noticed at specific pressure points throughout the body
  • fatigue that is chronic and disproportionate to preceding activity, possibly even debilitating; this symptom also includes low stamina
  • difficulty sleeping and/or getting restful sleep
  • memory and concentration difficulties, often referred to as “brain fog” and sometimes “fibro fog”
  • depression and/or anxiety and mood swings

Additional symptoms that accompany these main ones are commonly associated with FMS but occur in varying combinations:

  • digestive problems such as gastroesophageal reflux disease (GERD), aka acid reflux, and irritable bowel syndrome (IBS)
  • irritable or overactive bladder
  • chronic headaches, migraines, or tension headaches
  • hypersensitivity to cold or heat; skin rashes and irritation
  • temporomandibular disorder (TMJ), which can include face or jaw pain and ringing in the ears
  • muscle and/or joint stiffness, particularly in the morning
  • chronic tension, knots, cramping, weakness, and spasms in the muscles
  • abdominal pain or cramping
  • difficulty with balance and impaired coordination
  • dryness of the mouth, nose or eyes
  • tingling or numbness in the hands or feet
  • weight gain

Personally, I experience all 6 of the main symptoms and 7-12 of the additional symptoms. Any of these symptoms can be triggers for a flare-up of fibro pain. The opposite can also happen, where an increase in fibro pain can make another symptom flare-up, for example sensitivity to touch/tenderness. This sometimes ends up locking into a never-ending cycle, where each symptom is triggered by another and then triggers something else, or just triggers its trigger right back (did that make any sense?). Alleviating just one of the symptoms in the cycle can break it and give you a chance to get results treating the other symptoms, too.

What about you? What’s your personal combination of FMS symptoms?