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😴 Chronic Fatigue 😴 What actually is it?

  • Writer: Biara Webster
    Biara Webster
  • Jul 10, 2019
  • 4 min read



May 2019


Fatigue, Chronic Fatigue, Chronic Fatigue Syndrome: Same Same, but Different?

Everyone gets tired, some people experience fatigue. Chronic Fatigue is more than that. It’s chronic! Fatigue, not alleviated by rest (or coffee!). To be considered Chronic, the ongoing fatigue would be present for at least 4-6 months[i]. 

Chronic Fatigue is associated with numerous conditions: lymes disease, mental illnesses, insomnia, adult-ADHD/ADD, hypothyroidism, cancer (particularly post treatment), medication side-effects, rheumatoid arthritis, post-stroke, post-surgery, chronic pain, Chron’s Disease and Lupus... just to name a few.  


Chronic Fatigue Syndrome

And then there’s Chronic Fatigue Syndrome. There’s debate around the nomenclature, the diagnosis, the pathogenesis, aetiology, the treatment and even the prevalence. 

Chronic Fatigue Syndrome, is also referred to as Myalgic Encephalomyelitis (My = muscle, Algic = Pain, Encephalo = Brain, Mye = Spinal cord, Itis = Inflammation). More recently it has been referred to as Systemic Exertion Intolerance Disease. It is currently considered a neurological disorder, but the symptoms also include immune, gastro-intestinal and metabolic dysfunction.

It is often preceded by a flu-like disease (they get sick with the flu and then never seem to recover), and sometimes a prolonged period of adverse stress – physical or psychological.1 The chronic fatigue symptoms often reflect the symptoms of the preceding illness.[i]

The severity is extreme, from sufferers ‘sort of coping’ to being bed ridden and needing care. Being an “invisible illness,” adding to the stress of the physical symptoms endured, they are often met with misunderstanding and judgement because “well I’m tired too”.  The condition results in a decreased ability to perform usual activities (such as household duties, hobbies and even work); they do not have the energy to do what they used to be able to! This all comes with a decreased confidence in recovery due to fear of exacerbation. 


Diagnosis

The general accepted diagnostic criteria for CFS[i] is symptom based (hence the term “Syndrome”). The patient must present with at least 4 of the symptoms shown in this info-graph, accompanying the persistent fatigue:  



In addition to the above symptoms, there is consideration whether the fatigue has been an issue before (it must be a new onset) and there is attempt to rule-out influence from the other conditions listed above.1 Although some definitions, INCLUDE these conditions[i], hence the confusion and debate! 

There are also many other symptoms that are associated with CFS including: IBS, bloating, nausea, chest pain, night chills/sweating, shortness of breath, visual disturbances (blurred vision, light sensitivity, eye pain, dry eyes), allergies or sensitivities to foods, alcohol, odours, chemicals, medications, noise, poor ability to remain upright, irregular heart rate, dizziness and mood swings. 2

Understandably, 48% of clinicians do not feel confident making a ME/CFS diagnosis and 67% believe it is the most difficult condition to diagnose.[ii]

Although diagnosis is currently symptom and history based, there is often new research coming out attempting to find objective measures to diagnose and understand aetiology. Here’s a few we’ve come across recently:


Treatment

There’s also ongoing research to find optimal treatment for CFS. At the moment the common modalities include:

  • Pharmacological (anti-depressants)

  • CBT

  • Pacing

  • Graded Exercise Therapy 

CBT is also hotly debated1but seems most effective when combined with GET with suggestions that recovery is possible.[i]


DID YOU SAY EXERCISE?! Won’t Exercise make it worse? 


Can it?              Yes. 

Will it?             Not necessarily 


Exercise, specifically, Graded Exercise Therapy (GET), with Cognitive Behavioural Therapy (CBT) and Pacing strategies, are the most common treatment modalities. 

GET is as it sounds: establishing a physical activity baseline and progressively increasing the grade through duration, and then intensity.7

The PACE Trial (“Pacing, graded Activity and Cognitive behavioural therapy; a randomised Evaluation”) has been the biggest study to date being a 5 year long study with 641 patients. It was published in The Lancet in 2011 and showed a combination of GET and CBT to be superior. GET is recommended by most health body’s and Fatigue Centres but has received a lot of criticism, in fact there’s been a bit of drama with publications attempting to devalue the PACE Trial’s outcomes. The arguments appear to be based on the selection criteria (i.e. definition of the disease) and the statistical analysis methods. However PACE published a rebuttal earlier this year[i]defending their results with specific details to the criticisms. 


The Cochrane Review(recognised as the highest standard in evidence-based health care) states that “Patients with CFS may generally benefit and feel less fatigued following exercise therapy, and no evidence suggests that exercise therapy may worsen outcomes”.[ii]

Before we put you to sleep with too much information, we’ll wrap it up here! But stay tuned for PART 2 where you’ll learn about.. 


Other treatment approaches, including Our unique approach to chronic fatigue syndrome


Biara Webster

Exercise Physiologist and Writer 

Written for Specialised Health




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