Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is the most common name[1] used to designate a significantly debilitating[2]medical disorder or group of disorders[3] generally defined by persistent fatigue accompanied by other specific symptoms for a minimum of six months in adults (and 3 months in children/adolescents[4]), not due to ongoing exertion, not substantially relieved by rest, and not caused by other medical conditions.[2] The disorder may also be referred to as myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS), chronic fatigue immune dysfunction syndrome (CFIDS), or several other terms. Biological, genetic, infectious and psychological mechanisms have been proposed for the development and persistence of symptoms but the etiology of CFS is not understood and may have multiple causes.[5][6] There is no diagnostic laboratory test or bio-marker for CFS.[2]

Symptoms of CFS include post-exertional malaise; un-refreshing sleep; widespread muscle and joint pain; sore throat; headaches of a type not previously experienced; cognitive difficulties; chronic, often severe, mental and physical exhaustion; and other characteristic symptoms in a previously healthy and active person. Persons with CFS may report additional symptoms including muscle weakness, increased sensitivity to light, sounds and smells, orthostatic intolerance, digestive disturbances, depression, and cardiac and respiratory problems.[7] It is unclear if these symptoms represent co-morbid conditions or are produced by an underlying etiology of CFS.[5] CFS symptoms vary from person to person in number, type, and severity.[8]

Cognitive behavioral therapy

Cognitive behavioral therapy, a form of psychological therapy often used to treat chronically ill patients,[62] is a moderately effective treatment for CFS[30][56]that “can be useful in treating some CFS patients.”[62] Since the cause or causes of CFS are unknown, CBT tries to help patients understand their individual symptoms and beliefs and develop strategies to improve day-to-day functioning whatever the cause of the symptoms. CBT is also thought to help patients by removing unhelpful illness beliefs which may perpetuate the illness.[63]

A Cochrane Review meta-analysis of 15 randomized, controlled cognitive behavioral therapy trials with 1043 participants concluded that CBT was an effective treatment to reduce the symptom of fatigue. Four reviewed studies showed that CBT resulted in a clinical response for 40% of participants vs 26% of those treated with “usual care”. Similarly, in three studies CBT worked better than other types of psychological therapies (48% vs 27%). The effects may diminish after a course of therapy is completed; the reviewers write that “the evidence base at follow-up is limited to a small group of studies with inconsistent findings” and encourage further studies.[64] A 2007 meta-analysis of 5 CBT randomized controlled trials of chronic fatigue and chronic fatigue syndrome reported 33-73% of the patients improved to the point of no longer being clinically fatigued.[65] A 2010 meta-analysis of trials that measured physical activity before and after CBT showed that although CBT effectively reduced fatigue, activity levels were not affected by CBT and changes in physical activity were not related to changes in fatigue. They conclude that the effect of CBT on fatigue is not mediated by a change in physical activity.[66]

References
  1. ^ abcEvangard B, Schacterie R.S., Komaroff A. L. (Nov 1999). “Chronic fatigue syndrome: new insights and old ignorance”. Journal of Internal Medicine246 (5): 455–469. doi:10.1046/j.1365-2796.1999.00513.x. PMID10583715. http://www3.interscience.wiley.com/cgi-bin/fulltext/119095441/PDFSTART. Retrieved 2009-10-21.
  2. ^ abc“Chronic Fatigue Syndrome: Case Definition”. CDC. 2006-05-03. http://www.cdc.gov/cfs/case-definition/index.html. Retrieved 2009-01-22.
  3. ^Sanders P, Korf J (2008). “Neuroaetiology of chronic fatigue syndrome: an overview”. World J. Biol. Psychiatry9 (3): 165–71.doi:10.1080/15622970701310971. PMID17853290.
  4. ^ abcdGuideline 53: Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy). London: = National Institute for Health and Clinical Excellence. 2007. ISBN1-84629-453-3. http://guidance.nice.org.uk/CG53.
  5. ^ abcdefgAfari N, Buchwald D (2003). “Chronic fatigue syndrome: a review”. Am J Psychiatr160 (2): 221–36. doi:10.1176/appi.ajp.160.2.221. PMID12562565.http://ajp.psychiatryonline.org/cgi/content/full/160/2/221.
  6. ^“Chronic Fatigue Syndrome Causes”. Centers for Disease Control and Prevention. October 15, 2010. http://www.cdc.gov/cfs/causes/index.html. Retrieved 2012-12-20.
  7. ^ abcWyller VB (2007). “The chronic fatigue syndrome–an update”. Acta neurologica Scandinavica. Supplementum187: 7–14. doi:10.1111/j.1600-0404.2007.00840.x. PMID17419822.
  8. ^ abc“Chronic Fatigue Syndrome (CFS), Symptoms”. Centers for Disease Control and Prevention. 2012-05-14. http://www.cdc.gov/cfs/symptoms/index.html. Retrieved 2012-09-23.

62. ^ abNational Center for Infectious Diseases (26 May 2006). “CFS Treatment Options”. Centers for Disease Control and Prevention.http://www.cdc.gov/cfs/cfstreatment.htm. Retrieved 24 February 2010.

63^Wolfe F; Chalmers A; Littlejohn GO & Salit I (1995). Fibromyalgia, Chronic Fatigue Syndrome, and Repetitive Strain Injury: Current Concepts in Diagnosis, Management, Disability, and Health Economics. New York: Haworth Medical Press. p. 142. ISBN1-56024-744-4. http://books.google.com/?id=Da0jf7agNvgC&pg=PA142.

64^Price JR, Mitchell E, Tidy E, Hunot V (2008). Price, Jonathan R. ed. “Cognitive behaviour therapy for chronic fatigue syndrome in adults”. Cochrane Database Syst Rev (3): CD001027. doi:10.1002/14651858.CD001027.pub2. PMID18646067.

65^Malouff JM et al. (June 2008). “Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis”. Clin Psychol Rev28 (5): 736–45.doi:10.1016/j.cpr.2007.10.004. PMID18060672.

66^Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G (January 2010). “How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity”. Psychol Med40 (8): 1–7. doi:10.1017/S0033291709992212. PMID20047707.

30^ abcWhiting P, Bagnall AM, Sowden AJ, Cornell JE, Mulrow CD, Ramirez G (September 2001). “Interventions for the treatment and management of chronic fatigue syndrome: a systematic review”. JAMA286 (11): 1360–8. doi:10.1001/jama.286.11.1360. PMID11560542. http://jama.ama-assn.org/cgi/content/full/286/11/1360.