|
|
|
Overview |
|
|
Definition |
|
Chronic fatigue syndrome (CFS) involves fatigue that is sufficiently intense
and persistent to reduce normal daily activities by at least 50% for a minimum
of six months. Women account for 70% of cases of CFS, with the typical patient
being a Caucasian woman in her mid-20s to late 40s. The prevalence is 4 to 10
formally diagnosed cases per 100,000 U.S. adults (18 years or older). Women are
affected almost twice as often as men. |
|
|
Etiology |
|
Although not conclusive, CFS may be precipitated by infectious agents (for
example, Borrelia burgdorferi), herpesviruses, Candida albicans,
and parasitic agents. This may very well be a multifactorial pathologic entity
with lifestyle and constitutional/psychological makeup a factor.
|
|
|
Risk Factors |
|
- Stressed immune system caused by recent acute illness, chronic health
problems, emotional factors (anxiety, depression), or poor nutrition
- Possibly environmental pollutants and
contaminants
|
|
|
Signs and Symptoms |
|
- Sudden onset of severe fatigue, developing over a few hours to a few
days and often after an acute viral illness
- Low-grade fever (less than 100.4°F) and chills
- Sore throat
- Lymphadenopathy
- Myalgias and arthralgias
- Headaches
- Sleep disturbances
- Decreased ability to concentrate or remember
- Allergies
- General muscle
weakness
|
|
|
Differential
Diagnosis |
|
Rule out conditions producing fatigue.
- Fibromyalgia
- Psychiatric: extreme anxiety, depression
- Endocrine or metabolic: hypothyroidism, diabetes, pituitary
insufficiency, hypoparathyroidism, hypercalcemia, Addison's disease, chronic
renal failure
- Pharmacologic: use of sleeping pills, antihypertensives, or
tranquilizers
- Infectious: subacute bacterial endocarditis, hepatitis, AIDS,
syphilis, Lyme disease, intestinal parasites, tuberculosis, cytomegalovirus,
toxoplasmosis, fungal disease
- Musculoskeletal disorders, neoplastic or hematologic
conditions
- Cardiopulmonary: chronic congestive heart failure, chronic
obstructive pulmonary disease
- Immunologic: systemic lupus erythematosus,
hypogammaglobulinemia
- Toxic disorders: lead or mercury poisoning
- Inadequate sleep or sleep
apnea
|
|
|
Diagnosis |
|
|
Physical Examination |
|
The patient may appear exhausted and obviously ill, eyes with dark circles,
ecchymosis in the throat, swollen tonsils, and enlarged lymph nodes in the neck.
However, physical appearance may be normal. |
|
|
Laboratory Tests |
|
No tests are specifically diagnostic for CFS. The minimal battery of tests
should include all of the following (with further tests indicated on an
individual basis).
- Complete blood count with leukocyte differential
- Erythrocyte sedimentation rate
- Serum alanine aminotransferase, total protein, albumin, globulin,
calcium, alkaline phosphastase, phosphorus, glucose, blood urea nitrogen,
electrolytes, and creatinine
- Glucose tolerance test
- Thyroid-stimulating hormone assay
- Urinalysis
- Lyme disease titer and C-reactive
protein
|
|
|
Other Diagnostic
Procedures |
|
- Clinical interview should note any recent history of mononucleosis,
hepatitis, or long-lasting influenza and family history of infectious diseases,
allergies, anergy, asthma, and cancer.
- Review of lifestyle issues/medical history (include diet and drug
use—alcohol, tobacco, and recreational drugs plus
current medications such as antibiotics, steroids, birth control pills, and
chemotherapy).
- Review of symptoms should note the occurrence of frequent sore
throats and swollen glands, colds, or other infections; hormonal imbalances;
menstrual irregularities; hypoglycemia; energy level; functional abnormalities
of the digestive system (indigestion, gas, abdominal pain), the respiratory
system (shortness of breath), and cardiovascular system (palpitations); and the
mental and emotional state (foggy, confused, emotionally unstable).
- It may be helpful to test for viral infections such as Lyme disease,
and for rheumatoid factor, allergies, hepatitis A and B antibodies, and
HIV.
|
|
|
Treatment Options |
|
|
Treatment Strategy |
|
Patients require both symptomatic and emotional support. |
|
|
Drug Therapies |
|
Antidepressant and other psychoactive drugs appear to be most
successful.
- The tricyclic antidepressants doxepin (Sinequan) and amitriptyline
(Elavil) relieve depression, insomnia, muscle tension and pain, general fatigue,
nasal congestion, gastritis, and neurologic symptoms. Side effects include dry
mouth, drowsiness, constipation, tachycardia (elevated heart rate), and weight
gain. Start at one-tenth to one-fourth the usual clinical dose.
- Fluoxetine (Prozac) is another antidepressant that increases brain
serotonin levels, may improve energy level, and relieves fatigue but not sleep
disorders. Its side effects include increased insomnia and anxiety, rashes,
digestive upsets, and impaired sexual functioning.
- Benzodiazepines, such as alprazolam (Xanax), clonazepam (Klonopin),
or lorazepam (Ativan), are used to treat anxiety. Their side effects are
sedation, amnesia, and withdrawal symptoms (insomnia, abdominal and muscle
cramps, vomiting, sweating, tremors, and convulsions).
- Aspirin, nonsteroidal anti-inflammatory drugs, or acetaminophen
relieve muscle and joint pains, headache, and fever. Side effects include
possible renal damage, gastrointestinal bleeding, abdominal pain, nausea, and
vomiting.
- Nonsedating antihistamines relieve allergy symptoms. These include
astemizole (Hismanal) and loratadine (Claritin). Side effects are drowsiness,
fatigue, and headache.
- Histamine blockers, such as cimetidine (Tagamet) and ranitidine
(Zantac), block production of stomach acid, stimulate T-cell function, and
improve energy.
- For antihypotensive therapy, fludrocortisone (Florinef) is currently
being tested in clinical trials; side effects are elevated blood pressure and
fluid retention.
- Gammaglobulin therapy is given intramuscularly two to three times per
month for passive immunity. It is expensive (as much as $1,000 per treatment),
with no clear evidence of efficacy. Side effects are nausea, dizziness,
transient flu-like symptoms, headache, and low blood pressure.
- Transfer factor triggers an active immune response.
- Alpha-interferon enhances immune function.
- Ampligen is a synthetic nucleic acid product that stimulates
interferon production. It is
experimental.
|
|
|
Complementary and Alternative
Therapies |
|
Following nutritional guidelines and using herbs and homeopathic remedies as
needed may be effective in alleviating the debilitating symptoms of chronic
fatigue and strengthening overall vitality. Counseling, support groups,
meditation, yoga, and progressive muscle relaxation are stress management
techniques that may be helpful for people with CFS. |
|
|
Nutrition |
|
- Avoid refined foods, sugar, caffeine, alcohol, saturated fats, dairy
products, and gluten-containing grains.
- Increase fresh vegetables, legumes, whole grains (non-gluten),
protein, and essential fatty acids (nuts, seeds, and cold-water
fish).
- Beta-carotene (50,000 IU/day) to strengthen immune
function.
- Vitamin C (1,000 mg three to six times/day) to increase
endurance.
- B-complex (50 to 100 mg/day or 2 ml IM one to two times/week) with
additional B6 (100 mg/day) and B5 (100 to 250 mg/day) to reduce the effects of
stress.
- Magnesium aspartate (400 to 1,000 mg/day) to support energy
production.
- L-Carnitine (330 mg one to three times/day) supports energy
production in the cells.
|
|
|
Herbs |
|
Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
noted.
A tincture of adaptogenic herbs may help increase resistance to stress and
strengthen the immune system. These herbs include Siberian ginseng
(Eleutherococcus senticosus), schizandra berry (Schizandra chinensis),
ashwaganda root (Withania somnifera), gotu kola (Centella
asiatica), and astragalus root (Astragalus membranaceus). Take 20 to
30 drops bid to tid. Adaptogens are generally safe to take long-term and may
need to be taken for four to six months for maximum benefit. Some people may
require several days respite from ginseng after several weeks of use.
Herbs that support overall vitality and relieve the effects of exhaustion
include the following: Licorice root (Glycyrrhiza glabra), lomatium root
(Lomatium dissectum), skullcap (Scutellaria lateriflora),
passionflower (Passiflora incarnata), lavender (Lavandula
angustifolia), and rosemary leaf (Rosmarinus officinalis). Take 20 to
30 drops bid to tid. Licorice root is contraindicated in hypertension.
Essential oils of jasmine, peppermint, and rosemary are calming and
restorative and may be used in aromatherapy. Place several drops in a warm bath,
an atomizer, or cotton ball. |
|
|
Homeopathy |
|
An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and
potency. |
|
|
Acupuncture |
|
Chronic fatigue syndrome is related to deficiencies in multiple organ systems
which can be addressed with acupuncture treatment. It could be used with custom
formulations of Chinese herbs. |
|
|
Massage |
|
Therapeutic massage is helpful in reducing stress-related symptoms, improving
circulation, and increasing the overall sense of
well-being. |
|
|
Patient Monitoring |
|
Schedule follow-up visits every three to six months or whenever there is an
exacerbation of the condition or new symptoms. Patients taking psychoactive
drugs or speculative therapies should be monitored
closely. |
|
|
Other
Considerations |
|
|
Complications/Sequelae |
|
- Depression
- Continuing morbidity
|
|
|
Prognosis |
|
One-third of patients recover quickly (within months), one-third recover
within two years, and one-third suffer at least some degree of long-term
disability. |
|
|
Pregnancy |
|
The effects of herbs in pregnancy have not been fully investigated and
treatment should be undertaken only with physician supervision. High doses of
vitamin C should be avoided. |
|
|
References |
|
Castro M. The Complete Homeopathy Handbook. New York, NY: St Martin's
Press; 1990.
Fukuda K, et al. The chronic fatigue syndrome: a comprehensive approach to
its definition and study. Ann Intern Med. 1994;121:953-959.
Management of CFS: Pharmacologic therapy and nonpharmacologic therapy.
Centers for Disease Control and Prevention. Accessed at
www.cdc.gov/ncidod/diseases/cfs/mgmt1.htm on January 4, 1999.
Noble J, ed. Textbook of Primary Care Medicine. 2nd ed. St Louis, Mo:
Mosby-Year Book, Inc; 1996:918-922.
Scalzo R. Naturopathic Handbook of Herbal Formulas. 2nd ed. Durango,
Colo: Kivaki Press; 1994:S/A18-S/A19.
Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats
Publishing; 1988:418-421. |
|
Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |