Chronic fatigue syndrome (CFS), also known as chronic fatigue and immune dysfunction syndrome (CFIDS), is a complex medical illness of unknown cause, without a known cure, but for which there is symptomatic therapy. At The Cleveland Clinic Foundation we believe that an aggressive therapeutic approach to CFS can result in tangible and significant clinical improvement for the majority of patients. The initial step of the management of chronic fatigue syndrome is to make a secure diagnosis. While there is no single diagnostic test, including immunologic tests and virologic tests such as EBV serologies, there are established clinical criteria. Most important is the exclusion of a variety of other conditions that can mimic CSF. Prominent among these include sleep disorders, mood disorders, chronic infections, connective tissue diseases, endocrinopathies, and neurally-mediated hypotension. CFS is related to a variety of other diseases of unknown etiology including fibromyalgia, tension headaches, multiple chemical sensitivities, irritable bowel syndrome, atypical chest pains and others. A comprehensive evaluation of these conditions is essential for adequate diagnosis and treatment.
Once the diagnosis is secured, the treatment plan has four components:
Becoming informed
An understanding of what CFS is and what it can do is an essential element in the quest for wellness. Patients are given numerous reprints and handouts, many of which have been written by members of the Department, and guided to a variety of current sources of reliable information. Many of these can also be found on the internet and include the American Association for Chronic Fatigue Syndrome (www.aacfs.org) which links to a variety of other reliable sources at the National Institutes of Health, the Centers for Disease Control and Prevention and others. Without understanding, coping with an illness is difficult!
Exercise
Randomized controlled clinical trials have demonstrated the effectiveness of low intensity, progressive, aerobic exercise. Obstacles to performing exercise include prominent postexertional fatigue and a failure to understand the relationships among exercise, sleep, energy and the endocrine/immune systems. A carefully graded exercise prescription is generally administered and monitored. Dietary aspects are reviewed as well as the use of supplements.
Mental and Spiritual Health
The mind and body are linked in every physiologic system including the endocrine/immune system. The relationship between mood and chronic fatigue is complex. A detailed assessment of mood including a search for active or past episodes of depression, panic or anxiety are vital in planning a successful treatment program. Often patients become depressed because they cannot cope with a chronic illness such as CFS and then ignore their depression because they believe it is merely secondary to their physical problems. Failure to treat such disordered mood often a limits achieving wellness. At The Cleveland Clinic Foundation we work carefully with counselors psychiatrists interested and sensitive to CFS and related disorders. Even when there are no abnormalities of mood, coping skills for dealing with the stress of a chronic illness are vitally important to strengthen and develop.
Pharmacologic Therapy
Each patient with CFS is an individual. Symptoms and signs may vary radically from one person to another. Therefore, any therapeutic plan must be specifically tailored to the individual's personal situation. Some patients sleep all the time as a result of their CFS, while the majority have difficulty falling or staying asleep. These problems need to be addressed. Muscular aches and pains are often a prominent part of this syndrome and symptomatic relief using analgesic or anti-inflammatory medications are important. As mentioned above, a search for intercurrent mood disorders is essential and treatment with antidepressants often benefits mood, coping, energy and memory and concentration. Prescriptions must be tailored to individual patient needs, for no one drug is best for all.
A variety of experimental therapies may be applied in certain circumstances. An up-to-date description of experimental therapies can be found through the web site of the
American Association for Chronic Fatigue Syndrome (AACFS)
