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Chronic fatigue syndrome: when fatigue is not a weakness, but a diagnosis
This is not laziness, not depression, and not fiction.
«"Just get more rest," "You're fine, don't exaggerate," "Everyone gets tired" - these phrases have been heard more than once by people who have suffered from exhaustion, pain, sleep problems, and memory problems for years. However chronic fatigue syndrome (CFS) — this is not a made-up problem, but recognized medical condition, which changed the idea of the boundaries between the psyche, immunity and energy metabolism.
What is chronic fatigue syndrome?
Chronic fatigue syndrome (CFS). Chronic Fatigue Syndrome, CFS, also Myalgic Encephalomyelitis) is multifactorial disease, which is characterized by:
constant, debilitating fatigue, that does not go away after sleep or rest;
cognitive impairment (clouding of consciousness, impaired concentration, forgetfulness);
deterioration of condition after minor physical or psycho-emotional stress (PEM - post-exertional malaise);
sleep disorders;
headache, muscle pain, fever, sore throat, tender lymph nodes.
Duration of symptoms — from 6 months and older, and they not explained by other diseases.
How is the diagnosis made?
The SHV is diagnosis of exclusion, which is based on a complex of symptoms and carefully ruling out other causes of fatigue (anemia, depression, hypothyroidism, autoimmune diseases, chronic infections, tumors, metabolic disorders, etc.).
Official diagnostic criteria have been approved CDC (Centers for Disease Control and Prevention) and NICE (National Institute for Health and Care Excellence). The basis consists of:
Fatigue lasting ≥6 months that significantly reduces activity level.
Post-exertional malaise (PEM).
Sleep disturbances.
Additional symptoms: cognitive disorders or blood pressure dysregulation.
What causes CVD?
The exact cause is unknown, but there are several interrelated hypotheses:
Viral or bacterial infection (Epstein-Barr virus, cytomegalovirus, SARS-CoV-2)
Immune dysregulation: increased levels of pro-inflammatory cytokines, impaired T-cell activation
Mitochondrial dysfunction: decrease in the energy potential of cells
Hormonal changes (especially the hypothalamic-pituitary-adrenal axis)
Chronic stress or trauma as a trigger
All of these components can run pathological cycle, in which the body does not return to a state of recovery.
What tests can a doctor order?
Although there is no «SCM test,» there is a list of studies that:
Helping rule out other diagnoses.
Identify associated disorders, that can worsen the condition.
These can be:
Complete blood count, ferritin, B12, folic acid
TSH, T3, T4 (thyroid gland)
Liver tests, glucose, electrolytes
Inflammatory markers: CRP, ANA, antistreptolysin
Herpes virus panel (EBV, CMV, HHV-6)
Mitochondrial dysfunction tests (lactate, pyruvate)
Neurocognitive testing (for severe complaints)
What is the treatment for chronic fatigue syndrome?
CFS has no universal treatment, but improvement is possible, especially with an individual approach:
Pacing (energy dosage of activity): learning to avoid PEM
Cognitive behavioral therapy (CBT): effective for anxiety component
Pharmacological support: symptomatic treatment of pain, anxiety, sleep, inflammation
Mitosupportive therapy: coenzyme Q10, carnitine, NADH, B vitamins
Anti-inflammatory supplements: omega-3, curcumin, resveratrol (if indicated)
Work with a psychotherapist — important, but not as a replacement for a diagnosis
Is CFS associated with Long COVID?
Yes. After suffering from COVID-19, a significant proportion of patients report prolonged fatigue, muscle pain, head fog, sleep disturbances, which fully corresponds to the description of CFS. Therefore, Long COVID is considered as trigger form of chronic fatigue, which may require the same approach to diagnosis and treatment.
CFS is a real disease that requires real treatment
It is important to recognize that SCD is not a psychological weakness, a lack of motivation, or a fabrication. It is a condition that significantly affects quality of life, and for which you need multidisciplinary approach — from a family doctor, neurologist, psychotherapist, immunologist, nutritionist.
And most importantly, you are not alone.
Hundreds of thousands of people around the world are going through the same symptoms. Diagnosis can be difficult, but the road to recovery starts with the first — recognition that it's not "in your head" but in your body.
