Q&A

  • Chronic fatigue syndrome (CFS) is a serious illness. Individuals with CFS become easily tired after doing simple tasks or minor exercise. They experience a lack of well-being. Doctors consider a patient as suffering from CFS if the patient reports severe fatigue that lasts for at least 6 months.[1]

    The Institute of Medicine (2015) provides a definition of CFS. They state that CFS patients can no longer be as active as they were before they developed the illness. CFS patients also find it difficult to make judgments and decisions. CFS sufferers do not wake up refreshed after rest or sleep. They may also develop unpleasant symptoms when standing up.[2]

    [1] Ryckeghem H, Delesie L, Tobback E, Lievens S, Vogelaers D, Mariman A. Exploring the potential role of the advanced nurse practitioner within a care path for patients with chronic fatigue syndrome. J Adv Nurs. 2017 Jul;73(7):1610-1619. doi: 10.1111/jan.13244. Epub 2017 Jan 18.

    [2] Jason LA, McManimen S, Sunnquist M, Brown A, Newton JL, Strand EB. Examining the Institute of Medicine’s Recommendations Regarding Chronic Fatigue Syndrome: Clinical Versus Research Criteria. J Neurol Psychol. 2015;2015(Suppl 2). pii: http://www.avensonline.org/wp-content/uploads/JNP-2332-3469-S2-0002.pdf. Epub 2015 Nov 25.

  • A group of doctors created the name Chronic Fatigue Syndrome in the late 1980s. CFS was used as a name for an illness called chronic Epstein –Barr virus syndrome. CFS is now also called: Myalgic encephalomyelitis (ME), chronic fatigue immune dysfunction, and systemic exertion intolerance disease (SEID). [1]

    Some people dislike the name Chronic Fatigue Syndrome (CFS). They believe that when people hear the name CFS they do not take the illness seriously. People suffering from CFS may also be negatively labeled because of the name of this disease.

    [1] Unger ER, Lin JS, Brimmer DJ, Lapp CW, Komaroff AL, Nath A, Laird S, Iskander J. CDC Grand Rounds: Chronic Fatigue Syndrome – Advancing Research and Clinical Education. MMWR Morb Mortal Wkly Rep. 2016 Dec 30;65(5051):1434-1438. doi: 10.15585/mmwr.mm655051a4.

  • Doctors and researchers do not know the exact cause of Chronic Fatigue Syndrome (CFS). Chronic fatigue syndrome remains a controversial condition. Doctors have been researching CFS for over 30 years. Doctors today still do not agree on the origins and causes of CFS.

    Researches (in America) hope to create a fresh start and simplify how we understand this disease. These researchers created a new concept for CFS called Systemic Disease Exertion Intolerance (2015).

    Many researchers currently think that an infection may cause CFS. They also believe that CFS has psychological causes, which makes the condition last for a long time. Patients also experience symptoms that are caused by inflammation, immune and muscular problems.[1] The World Health Organization (WHO) classifies CFS as a disorder of the nervous system. [2]

    [1] de Korwin JD, Chiche L, Banovic I, Ghali A, Delliaux S, Authier FJ, Cozon G, Hatron PY, Fornasieri I, Morinet F. [Chronic fatigue syndrome: A new disorder?] Rev Med Interne. 2016 Dec;37(12):811-819. doi: 10.1016/j.revmed.2016.05.003. Epub 2016 May 31. French.

    [2] Glassford JA. The Neuroinflammatory Etiopathology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome(ME/CFS). Front Physiol. 2017 Feb 17;8:88. doi: 10.3389/fphys.2017.00088. eCollection 2017.

  • CFS is characterized by a long lasting severe fatigue that doctors can not explain. Individuals experience low physical and mental energy. Patients symptoms become worse after physical or mental effort. Sufferers can experience difficulty making judgments and decisions after they use even a small amount of energy. They can also experience muscle pain after they do small amounts of exercise. Patients symptoms can last up to weeks. Their symptoms also continue after sleep or rest. Patients often suffer from poor sleep. [1]

    CFS patients may develop unpleasant symptoms when they stand up. A patient can often feel better after they lie down. Individuals may have fever and irritable bowel syndrome (IBS). Patients also report headaches, poor concentration and short-term memory. Chronic fatigue syndrome can also cause pain and disability.[2]

    [1] Rowe PC, Underhill RA, Friedman KJ, Gurwitt A, Medow MS, Schwartz MS, Speight N, Stewart JM, Vallings R, Rowe KS. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer. Front Pediatr. 2017 Jun 19;5:121. doi: 10.3389/fped.2017.00121. eCollection 2017. Review.

    [2] Thompson DP, Antcliff D, Woby SR. Symptoms of chronic fatigue syndrome/myalgic encephalopathy are not determined by activity pacing when measured by the chronic pain coping inventory.Physiotherapy. 2017 Aug 4. pii: S0031-9406(17)30077-9. doi: 10.1016/j.physio.2017.07.005. [Epub ahead of print]

  • Many doctors believe that CFS is linked to the immune system. They believe that a (viral) infection is sometimes the cause of CFS.[1] Doctors say that an infection is often the cause when early symptoms of CFS are seen. [2] Researchers are now publishing many new studies on the biological and medical side of CFS. The authors of these studies may find more links between CFS and the immune system.

    Not all researchers agree that there is a link between CFS and the immune system. Doctors often see cases of CFS that are not caused by infection. Doctors need to find a different cause for CFS in these cases.

    [1] Mensah FKF, Bansal AS, Ford B, Cambridge G. Chronic fatigue syndrome and the immune system: Where are we now? Neurophysiol Clin. 2017 Apr;47(2):131-138. doi: 10.1016/j.neucli.2017.02.002. Epub 2017 Apr 12. Review.

    [2] Hornig M, Gottschalk CG, Eddy ML, Che X, Ukaigwe JE, Peterson DL, Lipkin WI. Immune network analysis of cerebrospinal fluid in myalgic encephalomyelitis/chronic fatigue syndrome with atypical and classical presentations. Transl Psychiatry. 2017 Apr 4;7(4):e1080. doi: 10.1038/tp.2017.44.

    • Chronic fatigue syndrome most commonly affects people in their 40s and 50s. Women are more likely to get chronic fatigue syndrome than men.
    • An individual may be more likely to develop CFS if they see a doctor many times for minor illnesses. Some patients see their doctor about small illnesses up to 15 years before they are diagnosed with CFS.
    • CFS can be triggered by infectious illnesses, such as: Epstein-Barr virus, Q fever, and viral meningitis.
    • Researchers found that some 10 year old children told their mothers that they never or hardly ever played sport. They discovered that these individuals had twice the risk of developing CFS as adults. [1]
    • People may develop CFS if they have traits, such as; negative emotions, stress, and not looking after their own interests. Someone may also develop CFS if they show characteristics such as; perfectionism, and high moral standards, when compared with healthy subjects. [2]

    [1]Peter D White What causes chronic fatigue syndrome?: Infections, physical inactivity, and enhanced interoception may all play a part BMJ. 2004 Oct 23; 329(7472): 928–929. doi: 10.1136/bmj.329.7472.928

    [2] Brooks SK, Chalder T, Rimes KA. Chronic Fatigue Syndrome: Cognitive, Behavioural and Emotional Processing Vulnerability Factors. Behav Cogn Psychother. 2017 Mar;45(2):156-169. doi: 10.1017/S1352465816000631. Epub 2017 Jan 18.

  • Many CFS patients experience anxiety, according to a recent study. Patients often become anxious about their own health. Many people do not understand the CFS illness, and this can make sufferers feel insecure. Also, many people may not believe that the CFS patient suffer from a real illness. Patient may feel even more anxious because of this lack of belief. [1]

    A patient’s anxiety can often make CFS worse. And, CFS can make a patient’s anxiety more severe. Doctors need to treat both the physical and psychological symptoms of CFS.[2] Many people who have chronic medical illnesses suffer from anxiety. Doctors should check if a CFS patient has anxiety. A Patient’s anxiety can be managed with the right treatment.

    [1] Daniels J, Brigden A, Kacorova A. Anxiety and depression in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): Examining the incidence of health anxiety in CFS/ME.  Psychol Psychother. 2017 Sep;90(3):502-509. doi: 10.1111/papt.12118. Epub 2017 Feb 28.

    [2] Daniels J, Loades ME. A Novel Approach to Treating CFS and Co-morbid Health Anxiety: A Case Study.

    Clin Psychol Psychother. 2017 May;24(3):727-736. doi: 10.1002/cpp.2042. Epub 2016 Oct 6.

  • Researchers have no doubt that significant depression often accompanies CFS. They state this a recent study.[1] CFS and major depression often overlap. Doctors may need to prescribe antidepressants and refer patients to psychotherapy when a patient is depressed. [2]

    [1]Larkin D, Martin CR. The interface between chronic fatigue syndrome and depression: A psychobiological and neurophysiological conundrum. Neurophysiol Clin. 2017 Apr;47(2):123-129. doi: 10.1016/j.neucli.2017.01.012. Epub 2017 Mar 15.

    [2]Rollnik JD. [Chronic Fatigue Syndrome: A Critical Review].Fortschr Neurol Psychiatr. 2017 Feb;85(2):79-85. doi: 10.1055/s-0042-121259. Epub 2017 Feb 24. Review. German.

  • Doctors often have difficulty diagnosing CFS. Scientists do not have a clear explanation for the cause of CFS. Also, scientists do not completely understand how CFS develops. Doctors have no test that can say for certain that a person has CFS.[1] They also have no way to measure the disease. Doctors need to look at a persons symptoms to see if they have CFS. They need to see if a persons brain and body symptoms look like CFS symptoms. [2]

    [1] Rollnik JD.[Chronic Fatigue Syndrome: A Critical Review]. Fortschr Neurol Psychiatr. 2017 Feb;85(2):79-85. doi: 10.1055/s-0042-121259. Epub 2017 Feb 24. Review. German.

    [2] Germain A, Ruppert D, Levine SM, Hanson MR.Metabolic profiling of a myalgic encephalomyelitis/chronic fatigue syndrome discovery cohort reveals disturbances in fatty acid and lipid metabolism. Mol Biosyst. 2017 Jan 31;13(2):371-379. doi: 10.1039/c6mb00600k.

     

  • Doctors currently diagnose CFS by looking at a person’s symptoms. Doctors can find it difficult to diagnose this disease accurately.

    Authors of a study looked at a way to measure a person’s biological condition. They found that it may be possible to use visible and near-infrared (Vis-NIR) spectroscopy to diagnose CFS. The researcher believe that this technology would make it easier to find out, for certain, if a person has CFS. [1]

    [18]Sakudo A. Potential use of visible and near-infrared spectroscopy for the analysis and diagnosis of chronic fatigue syndrome (Review). Mol Med Rep. 2016 Sep;14(3):1875-9. doi: 10.3892/mmr.2016.5476. Epub 2016 Jul 7. Review.

  • Many CFS patients have nutritional deficiencies. Many doctors recommend the use of nutritional supplement for these CFS patients. Nutritional supplements are very effective when used together with a pacing program. Doctors believe that when used at the same time supplements and pacing can help patients better perform daily routines and activities. [1]

    Researcher have also found that omega three fatty acid supplements can help minimize CFS symptoms.[2]

    [1]Castro-Marrero J, Sáez-Francàs N, Santillo D, Alegre J. Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome. Br J Pharmacol. 2017 Mar;174(5):345-369. doi: 10.1111/bph.13702. Epub 2017 Feb 1. Review.

    [2] Jones K, Probst Y.Role of dietary modification in alleviating chronic fatigue syndrome symptoms: a systematic review.Aust N Z J Public Health. 2017 Aug;41(4):338-344. doi: 10.1111/1753-6405.12670. Epub 2017 Jun 14.

  • The authors of the PACE trial set out to see if pacing therapy, cognitive behavior therapy (CBT) and graded exercise therapy (GET) are good ways to treat CFS. The authors of the study concluded that CBT and GET worked the best. [1]

    Researchers first believed that the PACE trial method worked. They thought that this method may lead to recovery. Doctors and patients now criticize the PACE trial method. Patients reported that the cognitive behavior therapy did not work. They also said that the graded exercise therapy may have made their CFS symptoms worse. [2]

    [1]The planning, implementation and publication of a complex intervention trial for chronic fatigue syndrome: the PACE trial

    Peter D. White, Trudie Chalder, Michael Sharpe

    BJPsych Bull. 2015 Feb; 39(1): 24–27. doi: 10.1192/pb.bp.113.045005

    [2]Shepherd CB. PACE trial claims for recovery in myalgic encephalomyelitis/chronic fatigue syndrome – true or false? It’s time for an independent review of the methodology and results. J Health Psychol. 2017 Aug;22(9):1187-1191. doi: 10.1177/1359105317703786. Epub 2017 Apr 9.

  • Researchers, doctors and patients have many different opinions on the topic of exercise therapy and CFS. Some patients say that their CFS symptoms become worse after exercise. Other patients say that they feel better after exercise therapy.

     

    Researches of one study found that CFS patients benefit from exercise therapy. Patients said they felt less fatigued after exercise. The researchers discovered that exercise therapy did not make the patients’ CFS symptoms worse. They also found that exercise therapy helped patients sleep. Patients were also able to do more physical tasks after exercise therapy. The researchers concluded that overall patients’ general health improved with exercise therapy. [1]

    [1]Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome.

    Cochrane Database Syst Rev. 2017 Apr 25;4:CD003200. doi: 10.1002/14651858.CD003200.pub7. Review.

  • Many doctors believe that pacing is a good way to help patients have more energy. Patients can better complete their daily tasks when they pace.[1]

    However, doctors do not know if pacing makes patients more physically active in general.

    [1]Ferrar KE, Smith AE, Davison K. Pacing, Conventional Physical Activity and Active Video Games to Increase Physical Activity for Adults with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc. 2017 Aug 1;6(8):e117. doi: 10.2196/resprot.7242.

  • CFS Patients normally receive Cognitive behavioral therapy (CBT) as their first type of treatment. However, not all doctors believe that this type of treatment works. Authors of some studies show that CFS is a good treatment. Authors of other studies show that patients do not like CBT.

    One study found that cognitive behavior therapy helps patients with CFS. Patients could function better after CBT. [1]

    A patient’s feelings towards CBT treatment is very important. A patient who does not like CBT may have poor treatment results. The therapist needs to listen to the patient and be sensitive. [2]

    Authors of a study wanted to see if patients still felt good 10 years after CBT treatment. They found that, in general, CBT helped with fatigue in the long-term. Individuals were also able to do more physical tasks, even after 10 years. [3]

    [1] M. Sharpe, K. Hawton, S. Simkin, C. Surawy, A. Hackmann, I. Klimes, T. Peto, D. Warrell, V. Seagroatt Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial. BMJ. 1996 Jan 6; 312(7022): 22–26.

    [2] Picariello F, Ali S, Foubister C, Chalder T.‘It feels sometimes like my house has burnt down, but I can see the sky’: A qualitative study exploring patients’ views of cognitive behavioural therapy for chronic fatigue syndrome. Br J Health Psychol. 2017 Sep;22(3):383-413. doi: 10.1111/bjhp.12235. Epub 2017 Mar 28.

    [3] Janse A, Nikolaus S, Wiborg JF, Heins M, van der Meer JWM, Bleijenberg G, Tummers M, Twisk J, Knoop H. J PsychosomLong-term follow-up after cognitive behaviour therapy for chronic fatigue syndrome.  Res. 2017 Jun;97:45-51. doi: 10.1016/j.jpsychores.2017.03.016. Epub 2017 Mar 27.

  • Researches wanted to see if they could help improve CFS patients’ symptoms of pain and fatigue. They used lidocaine injections. The researchers found that the initial results showed that lidocaine injections may work. They discovered that these injections could lessen clinical fatigue symptoms in CFS patients. [1]

    [1] Staud R, Kizer T, Robinson ME.Muscle injections with lidocaine improve resting fatigue and pain in patients with chronic fatigue syndrome. J Pain Res. 2017 Jun 26;10:1477-1486. doi: 10.2147/JPR.S139466. eCollection 2017.

  • Doctors think it is important to deal with CFS a patient’s insomnia. They believe that this may reduce a patient’s fatigue. A patient may also deal with stressful situations better if their insomnia is treated. Doctors believe that insomnia may be one reason chronic fatigue lasts so long in CFS patients. Doctors who deal with a patient’s insomnia may find the patient reacts better to CFS treatment. [1]

    [1] Kallestad H, Jacobsen HB, Landrø NI, Borchgrevink PC, Stiles TC.The role of insomnia in the treatment of chronic fatigue. J Psychosom Res. 2015 May;78(5):427-32. doi: 10.1016/j.jpsychores.2014.11.022. Epub 2014 Dec 5.

  • Doctors state that currently there are no FDA-approved drugs available for the treatment of CFS. [1] Doctors do, however, believe that other medications may be helpful in the treatment of pain, insomnia, OI and other CFS symptoms. [2]

    Researchers say that in traditional Chinese Medicine Herba Epimedii is used to treat CFS. They believe that Herba Epimedii does have positive effects. [3]

    [1] Castro-Marrero J, Sáez-Francàs N, Santillo D, Alegre J.Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome. Br J Pharmacol. 2017 Mar;174(5):345-369. doi: 10.1111/bph.13702. Epub 2017 Feb 1. Review.

    [2] Rowe PC, Underhill RA, Friedman KJ, Gurwitt A, Medow MS, Schwartz MS, Speight N, Stewart JM, Vallings R, Rowe KS.Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer. Front Pediatr. 2017 Jun 19;5:121. doi: 10.3389/fped.2017.00121. eCollection 2017. Review.

    [3] Chi A, Shen Z, Zhu W, Sun Y, Kang Y, Guo F.Characterization of a protein-bound polysaccharide from Herba Epimedii and its metabolic mechanism in chronic fatigue syndrome. J Ethnopharmacol. 2017 May 5;203:241-251. doi: 10.1016/j.jep.2017.03.041. Epub 2017 Mar 27.

  • Many researchers believe that patients with CFS are very sensitive to their physical body. Patients can be very concerned with their physical well-being. They may notice small changes in their health condition. They can even be hyper sensitive to their symptoms.

    Authors of a study suggest that because CFS patients are so sensitive to their symptoms they make their illness last longer. Doctors say that it is unhelpful for patients to pay too much attention to their symptoms. Patients who look at their symptoms in a negative way can also make their CFS last longer. [1]

    Researcher have found that cognitive processes are important in CFS. Patients who look at their symptoms in a positive way can help their recovery. Patients who practice more flexible thinking may also improve their CFS symptoms.

    [1] Hughes A, Hirsch C, Chalder T, Moss-Morris R.Attentional and interpretive bias towards illness-related information in chronic fatigue syndrome: A systematic review. Br J Health Psychol. 2016 Nov;21(4):741-763. doi: 10.1111/bjhp.12207. Review.

  • Authors of a study found that psychological well-being is poor in CFS participants, when compared to healthy individuals. The authors found that physical pain was not the main cause of CFS patient’s poor well-being. They discovered that the patient’s psychological experiences is the cause of their low well-being. Doctors know that living with a chronic illness can be hard and psychologically difficult. They believe that this may be the reason CFS patients have such poor well-being.  [1]

    [1]Jackson H, MacLeod AK.Well-being in Chronic Fatigue Syndrome: Relationship to Symptoms and Psychological Distress. Clin Psychol Psychother. 2017 Jul;24(4):859-869. doi: 10.1002/cpp.2051. Epub 2016 Oct 13.

    • Chronic fatigue syndromeaffects between 0.006% and 3% of the population.  Women are at higher risk than men.[1]
    • CFS affects children and adolescents as well as adults. [2]
    • More than 2 million people in the United States have CFS. [3]
    • Pediatric chronic fatigue syndrome affects at least 1% of secondary school children in the UK.[4]

    [1] Cleare AJ, Reid S, Chalder T, Hotopf M, Wessely S. Chronic fatigue syndrome. BMJ Clin Evid. 2015 Sep 28;2015. pii: 1101. Clin Psychol Psychother. 2017 May;24(3):727-736. doi: 10.1002/cpp.2042. Epub 2016 Oct 6.

    [2] Rowe PC, Underhill RA, Friedman KJ, Gurwitt A, Medow MS, Schwartz MS, Speight N, Stewart JM, Vallings R, Rowe KS.Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer. Front Pediatr. 2017 Jun 19;5:121. doi: 10.3389/fped.2017.00121. eCollection 2017. Review.

    [3] Naviaux RK, Naviaux JC, Li K, Bright AT, Alaynick WA, Wang L, Baxter A, Nathan N, Anderson W, Gordon E.Metabolic features of chronic fatigue syndrome. Proc Natl Acad Sci U S A. 2016 Sep 13;113(37):E5472-80. doi: 10.1073/pnas.1607571113. Epub 2016 Aug 29.

    [4] Brigden A, Loades M, Abbott A, Bond-Kendall J, Crawley E.Practical management of chronic fatigue syndrome or myalgic encephalomyelitis in childhood. Arch Dis Child. 2017 Jun 28. pii: archdischild-2016-310622. doi: 10.1136/archdischild-2016-310622. [Epub ahead of print] Review.

  • Children can suffer from CFS. Children can feel unsure about their illness because CFS has no known cause. They may feel like people think they are making it up. They may also feel that other people are labeling them in a bad way. A child’s CFS may become worse because of these bad feeling.

    According to some doctors there needs to be more diagnosis of CFS in children. Researchers also believe that there needs to be talks between doctors and teachers. They hope that these things can help children deal with their condition.[1]

    Some children that suffer from CFS can not go to school. Some children can go to school part-time and some go to school full-time. Some children need to use a wheelchair. There are children who can not go out of the house. Others can only stay in bed. Researchers believe that child CFS sufferers vary from 0.1-0.5% of the population.[2]

    [1] Parslow RM, Harris S, Broughton J, Alattas A, Crawley E, Haywood K, Shaw A.Children’s experiences of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review and meta-ethnography of qualitative studies. BMJ Open. 2017 Jan 13;7(1):e012633. doi: 10.1136/bmjopen-2016-012633.

    [2] Rowe PC, Underhill RA, Friedman KJ, Gurwitt A, Medow MS, Schwartz MS, Speight N, Stewart JM, Vallings R, Rowe KS.Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer. Front Pediatr. 2017 Jun 19;5:121. doi: 10.3389/fped.2017.00121. eCollection 2017. Review.

  • CFS is a complex disease. Researcher believe that stressful situations can lead to CFS.

     

    Researchers of a study found that certain stressful events may trigger CFS. Researcher list these stressful events as: pregnancy, spousal abuse, mobbing, eating disorders, car accident, economic problems and changes in sleep habits. [1]

    Doctors should ask patients about these life events. Doctors who know this information may diagnose a patient’s CFS earlier.

    [1] Gimeno Pi I, Guitard Sein-Echaluce ML, Rosselló Aubach L, Torres Puig-Gros J, Fernández Solà J.Stressful Events in the Onset of Chronic Fatigue Syndrome. Rev Esp Salud Publica. 2016 Aug 18;90:e1-7. English, Spanish.

  • Individuals living with CFS are not able to do the same physical activities that healthy individuals can. They are overall less active. A patient’s lack of activity can cause more health problems.[43]

    CFS patients experience extreme fatigue. Fatigue is very upsetting and can create poor quality of life. [44] Fatigue can make people feel week both physically and psychologically.

    Patients who live with a chronic illness like CFS often find it extremely tiring both physically and emotionally.

    [1] Ferrar KE, Smith AE, Davison K.Pacing, Conventional Physical Activity and Active Video Games to Increase Physical Activity for Adults with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc. 2017 Aug 1;6(8):e117. doi: 10.2196/resprot.7242.

    [2] Wang T, Yin J, Miller AH, Xiao C.A systematic review of the association between fatigue and genetic polymorphisms. Brain Behav Immun. 2017 May;62:230-244. doi: 10.1016/j.bbi.2017.01.007. Epub 2017 Jan 12. Review.

  • CFS has a huge impact on society. This disease causes a loss in productivity. CFS also costs society a lot in medical expenses.

    CFS sufferers make up 0.006% – 3% of the population, yet only 27-41% are employed. Because many CFS sufferers’ can not work, society has a loss in productivity. Society needs to make up for this gap in production. [1]

    [1] Rimbaut S, Van Gutte C, Van Brabander L, Vanden Bossche L. Chronic fatigue syndrome – an update. Acta Clin Belg. 2016 Jun 17:1-8. [Epub ahead of print]

  • CFS is a more severe illness than chronic fatigue. Fatigue, functioning, symptoms, and psychological distress is more severe in patients with CFS. Patients report chronic fatigue to their doctors at least twice as often as they report CFS.[1]

    [1] L Darbishire, L Ridsdale, P T Seed Distinguishing patients with chronic fatigue from those with chronic fatigue syndrome: a diagnostic study in UK primary care. Br J Gen Pract. 2003 Jun; 53(491): 441–445.

  • Researchers have found that long periods of rest can be harmful for CFS sufferers. They say there is no evidence that rest is a good treatment for CFS. [47]

    Scientists of a study discovered that CFS patients who napped in the afternoon became more sleepy during the day. These patients also found it hard to think clearly throughout the day. [48]

    [1] Steven Reid, Trudie Chalder, Anthony Cleare, Matthew Hotopf, Simon Wessely Chronic fatigue syndrome BMJ. 2000 Jan 29; 320(7230): 292–296.

    [2] Zoe M. Gotts, Jason G. Ellis, Vincent Deary, Nicola Barclay, Julia L. NewtonThe Association between Daytime Napping and Cognitive Functioning in Chronic Fatigue Syndrome PLoS One. 2015; 10(1): e0117136. Published online 2015 Jan 9. doi: 10.1371/journal.pone.0117136

  • Researcher of a study learned that doctors that help CFS patients have good listening skills. Doctors are also helpful when they respect and trust their patients. They should also create a relationship with their CFS patients. Doctors also need to look at the progress and development of their patient’s condition. They should also look at the patient as a whole person, and not only at their disease. [1]

    [1] Simon MC Horton, Fiona Poland, Swati Kale, Maria de Lourdes Drachler, Jose Carlos de Carvalho Leite, Maggie A McArthur, Peter D Campion, Derek Pheby, Luis Nacul Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in adults: a qualitative study of perspectives from professional practice BMC Fam Pract. 2010; 11: 89. Published online 2010 Nov 15. doi: 10.1186/1471-2296-11-89

  • Researchers conducted a study to see if CFS patients are happy with the support they get from their doctors. Many CFS patients said that they are not happy with the support they get from their doctors. They said that their doctors did not give them enough information. They also said that their doctor did not give them emotional support. Patients and doctors also often disagreed about the cause of, and treatment for, CFS. Many patients decided to look for alternative or complementary types of treatment. [1]

    Researcher of another study found that patients were unhappy with their health services. Patients  often said that they had negative experiences of their health services. Doctors were also often unhappy about the level of care they were able to give patients with CFS. Doctors often felt frustrated because of this. [2]

    [1] AK Knudsen, LV Lervik, SB Harvey, CMS Løvvik, AN Omenås, A Mykletun Comparison of chronic fatigue syndrome/myalgic encephalopathy with other disorders: an observational study  JRSM Short Rep. 2012 May; 3(5): 32. Published online 2012 May 21. doi: 10.1258/shorts.2011.011167

    [2] S Ax, V H Gregg, D Jones Chronic fatigue syndrome: sufferers’ evaluation of medical support. J R Soc Med. 1997 May; 90(5): 250–254.

  • Most patients with CFS improve. Yet, CFS patients often do not fully recover. Many CFS patients will never be able to do the same tasks and activities they did before they developed the disease. [1]

    Scientists looked at CFS sufferers after a medium period of time had passed, since they developed their illness. They learned that 20-50% of adults showed some improvement. 6% of patients with CFS were able to do the same activities and tasks they did before they developed the disease. [2]

    Authors of a study found that if CFS is not treated, only about 10% of patients recover. Patients first experienced CFS symptoms 2 to 4 years before this study was taken. Patients that are concerned about the medical cause of their disease seem to be less likely to recover. [3]  Psychological factors, such as the way a person thinks, has an influence on a patient’s recovery. [4]

    [1] A. Wilson, I. Hickie, A. Lloyd, D. Hadzi-Pavlovic, C. Boughton, J. Dwyer, D. Wakefield Longitudinal study of outcome of chronic fatigue syndrome. BMJ. 1994 Mar 19; 308(6931): 756–759.

    [2] Steven Reid, Trudie Chalder, Anthony Cleare, Matthew Hotopf, Simon Wessely Chronic fatigue syndrome BMJ. 2000 Jan 29; 320(7230): 292–296.

    [3] Michael Sharpe, David Wilks Fatigue BMJ. 2002 Aug 31; 325(7362): 480–483.

    [4] J H Vercoulen, C M Swanink, J F Fennis, J M Galama, J W van der Meer, G Bleijenberg Prognosis in chronic fatigue syndrome: a prospective study on the natural course. J Neurol Neurosurg Psychiatry. 1996 May; 60(5): 489–494.

  • Researchers of a study found that some children were still missing school approximately 45.5 months after their illness started. Some children still spent a lot of time in bed. Other children (two-thirds) had recovered and were doing normal activities once again. Children took 38 months to recover, on average. Most children recovered. [1]

    Children seem to recover better than adults. 54%-94% of children show improvement after up to six years. [2]

    [1] L Rangel, M E Garralda, M Levin, H RobertsThe course of severe chronic fatigue syndrome in childhood.J R Soc Med. 2000 Mar; 93(3): 129–134. doi: 10.1177/014107680009300306

    [2] Steven Reid, Trudie Chalder, Anthony Cleare, Matthew Hotopf, Simon Wessely Chronic fatigue syndrome BMJ. 2000 Jan 29; 320(7230): 292–296.

  • Children with CFS can suffer from depression.[1]

    [1]G A Walford, W M Nelson, D R McCluskey Fatigue, depression, and social adjustment in chronic fatigue syndrome. Arch Dis Child. 1993 Mar; 68(3): 384–388

  • The press often explains CFS in a way that is too simple. They describe CFS as a psychological illness, a lot of the time. Press reporters also often say that they are unhappy with doctors and health professionals. [1]

    The mass media’s description of recent cases of CFS is often wrong or confusing. [2]

    [1]G. MacLean, S. Wessely Professional and popular views of chronic fatigue syndrome. BMJ. 1994 Mar 19; 308(6931): 776–777.

    [2] AK Knudsen, LV Lervik, SB Harvey, CMS Løvvik, AN Omenås, A Mykletun Comparison of chronic fatigue syndrome/myalgic encephalopathy with other disorders: an observational study  JRSM Short Rep. 2012 May; 3(5): 32. Published online 2012 May 21. doi: 10.1258/shorts.2011.011167

  • People have started using the Internet to learn about health conditions. They have become more active on the Internet over the last 10 years. Patients no longer have to rely only on the media or doctors to learn about their illnesses. Patients can also get information about their health through websites, online support groups and Internet discussion forums. [1]

    CFS sufferers who do not want others to know about their illness can remain unknown when they use the Internet. Patients who do not have much energy, like CFS patients, can use the Internet. CFS patients who can not leave their house can connect with a group and be social through the Internet.

    [1] AK Knudsen, LV Lervik, SB Harvey, CMS Løvvik, AN Omenås, A Mykletun Comparison of chronic fatigue syndrome/myalgic encephalopathy with other disorders: an observational study  JRSM Short Rep. 2012 May; 3(5): 32. Published online 2012 May 21. doi: 10.1258/shorts.2011.011167

  • Researchers of a study found that the memory of CFS patients does not work as well as the memory of healthy individuals. They also learned that patients with CFS do not have the same power of attention as healthy individuals. [1]  Tests have shown that individuals with CFS can not process information quickly. [2]

    Many adolescents with CFS say they find it hard to pay attention and concentrate. These adolescents usually do not do well at school. [3]

    Many researchers have asked children with CFS to do attention tasks. These researchers have learned that when children with CFS do these tasks they have less control over their attention. [4]

    [1] E Joyce, S Blumenthal, S Wessely Memory, attention, and executive function in chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. 1996 May; 60(5): 495–503.

    [2] Anthony J. Ocon Caught in the thickness of brain fog: exploring the cognitive symptoms of Chronic Fatigue Syndrome Front Physiol. 2013; 4: 63. Published online 2013 Apr 5. doi: 10.3389/fphys.2013.00063

    [3] Linde N. Nijhof, Sanne L. Nijhof, Gijs Bleijenberg, Rebecca K. Stellato, Jan L. L. Kimpen, Hilleke E. Hulshoff Pol, Elise M. van de Putte The impact of chronic fatigue syndrome on cognitive functioning in adolescents Eur J Pediatr. 2016; 175: 245–252. Published online 2015 Sep 3. doi: 10.1007/s00431-015-2626-1

    [4] Kei Mizuno, Yasuyoshi Watanabe Neurocognitive impairment in childhood chronic fatigue syndrome Front Physiol. 2013; 4: 87. Prepublished online 2013 Mar 17. Published online 2013 Apr 19.

  • Scientists found that most patients with chronic fatigue syndrome have sleep disorders. A patient’s poor sleep is likely to be one reason they are fatigued during the day. The scientists found that sleep disorders may be an important cause of CFS. [1]

    Researchers learned that fatigue in CFS patients may be effected by the way CFS patients view their sleep. Patients who believed they slept badly during the night were likely to be constantly fatigued the next day. [2]

    [1] R Morriss, M Sharpe, A L Sharpley, P J Cowen, K Hawton, J Morris Abnormalities of sleep in patients with the chronic fatigue syndrome. BMJ. 1993 May 1; 306(6886): 1161–1164.

    [2] Charlotte Russell, Alison J. Wearden, Gillian Fairclough, Richard A. Emsley, Simon D. KyleSubjective but Not Actigraphy-Defined Sleep Predicts Next-Day Fatigue in Chronic Fatigue Syndrome: A Prospective Daily Diary Study Sleep. 2016 Apr 1; 39(4): 937–944. Published online 2016 Apr 1. doi: 10.5665/sleep.5658

  • Doctors gave patients herbal and homeopathic medicines. The patient’s symptoms were recorded before and after the medicines were given. The doctors found that herbal and homeopathic medicines do not help treat CFS. [1]

    [1] Edward Leyton, Hugh Pross Chronic Fatigue Syndrome: Do herbs or homeopathy help? Can Fam Physician. 1992 Sep; 38: 2021–2026.

  • The British definition of CFS is focuses on metal fatigue. The American definition of CFS focuses on the need for physical symptoms. The Americans believe that CFS is related to the immune system or infectious disease. [1]

    [1] Steven Reid, Trudie Chalder, Anthony Cleare, Matthew Hotopf, Simon Wessely Chronic fatigue syndrome BMJ. 2000 Jan 29; 320(7230): 292–296.

  • Scientists note that posttraumatic stress disorder (PTSD) is more common in individuals with CFS, when compared with healthy individuals. Some people suffer from CFS for their entire life. These people are also more likely to suffer from PTSD all their life, when compared with healthy individuals. [1]

    [1] Elizabeth Dansie, Pia Heppner, Helena Furberg, Jack Goldberg, Dedra Buchwald, Niloofar Afari The Comorbidity of Self-Reported Chronic Fatigue Syndrome, Posttraumatic Stress Disorder, and Traumatic Symptoms Psychosomatics. Author manuscript; available in PMC 2013 May 1. Published in final edited form as: Psychosomatics. 2012 May; 53(3): 250–257. Published online 2012 Jan 31. doi: 10.1016/j.psym.2011.08.007

  • Children and adolescents with chronic fatigue syndrome (CFS) befit from: graded activities, exercise program, family sessions, and supportive care; when used together. Researchers found that together these types of treatment are more helpful than supportive care by itself. Children and adolescents may recover from CFS if they use all of these types of treatments. [1]

    [1] R Viner, A Gregorowski, C Wine, M Bladen, D Fisher, M Miller, S El Neil Outpatient rehabilitative treatment of chronic fatigue syndrome (CFS/ME) Arch Dis Child. 2004 Jul; 89(7): 615–619. doi: 10.1136/adc.2003.035154