Autonomic Nervous System Abnormalities
Researchers are investigating links between autonomic system dysfunction and CFS. The autonomic nervous system controls involuntary actions, including regulating blood pressure.
Some people who have CFS also have symptoms of a condition known as neurally mediated hypotension . NMH causes a dramatic drop in blood pressure when a person stands up, for even as few as 10 minutes. Its immediate effects can be light-headedness, nausea, and fainting.
A related condition experienced by some people with CFS is called postural orthostatic tachycardia syndrome . POTS causes a rapid increase in blood pressure when changing from a lying down to a standing up position.
Impact And Prognosis Of Me/cfs
Pharmacoecon Open.
BMC Public Health.J Chronic Fatigue Syndr.
Br J Occup Ther.
- Mild: mobile and self-caring may continue working but will have reduced other activities
- Moderate: reduced mobility, restricted in instrumental activities of daily living, needs frequent periods of rest usually not working
- Severe: mostly housebound limited to minimal activities of daily living severe cognitive difficulties may be wheelchair dependent
- Very severe: mostly bedridden unable to independently carry out most activities of daily living often experience extreme sensitivity to light, sound, and other sensory input
Am J Epidemiol.Chronic Illn.
Qual Life Res.Disabil Rehabil.Occup Med .
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Orthostatic Intolerance And Autonomic Impairment
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Healthcare .
J Thromb Circ Open Access.
Clin Neurophysiol Pract.J Chronic Fatigue Syndr.Clin Sci .Am J Med.PLoS One.Clin Diagn Lab Immunol.J Clin Cell Immunol.Hum Immunol.PLoS One.JAMA.Vivo.J Transl Med.Proc Natl Acad Sci U S A.Front Immunol.
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Chronic Fatigue Syndrome Has A New Name
For the multitude of people suffering from chronic fatigue syndrome, there is some good news. After decades of battling for proper recognition and diagnosis methods, chronic fatigue syndrome is finally recognized as a real disease by the Institute of Medicine and it has been renamed as systemic exertion intolerance disease.
The Institute of Medicine was established in 1970 as an independent, nonprofit organization with the goal of providing unbiased, authoritative advice to government decision makers and the public.
The Institute was asked by the Department of Health and Human Services, the Social Security Administration, the National Institutes of Health, the Food and Drug Administration, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention to form a committee of experts to review the evidence base for myalgic encephalomyelitis/chronic fatigue syndrome.
New diagnostic criteria
The 15-member committee compiled a 235-page report titled, Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining An Illness. Included in the report is a new criteria for diagnosing the illness, to hopefully expedite the provision of care and enhance understanding of the illness among healthcare workers.
The new diagnostic criteria, includes:
A name change
Suffering from a stigma
-The Alternative Daily
What Are The Treatments For Chronic Fatigue Syndrome
There is no cure or approved treatment for CFS, but you may be able to treat or manage some of your symptoms. You, your family, and your health care provider should work together to decide on a plan. You should figure out which symptom causes the most problems and try to treat that first. For example, if sleep problems affect you the most, you might first try using good sleep habits. If those do not help, you may need to take medicines or see a sleep specialist.
Strategies such as learning new ways to manage activity can also be helpful. You need to make sure that you do not “push and crash.” This can happen when you feel better, do too much, and then get worse again.
Since the process of developing a treatment plan and attending to self-care can be hard if you have CFS, it is important to have support from family members and friends.
Don’t try any new treatments without talking to your health care provider. Some treatments that are promoted as cures for CFS are unproven, often costly, and could be dangerous.
Centers for Disease Control and Prevention
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Central Nervous System Abnormalities
Abnormal levels of certain chemicals in the brain system known as the hypothalamus-pituitary-adrenal axis have been proposed as a cause of CFS. This system controls important functions, including sleep, the stress response, and depression. Some people with CFS appear to have imbalances in hormones controlled by the HPA axis, such as cortisol.
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Chronic Fatigue Syndrome Gets New Name Enhanced Recognition
Tasha Kelemen, 42, directs a local non profit. She doesnt look sick, but shes had a hard time convincing peers even doctors that anything is wrong with her.
A typical experience will be the resident comes in, looks at my folder, sees that I have chronic fatigue syndrome listed as my primary diagnosis, and then says to me, Well, I think that must be what I have,’ she recalls, laughing. You sort of learn that theres no point, that you sort of have to control your anger.
The condition known as chronic fatigue syndrome is mysterious and complex. It has stumped the medical system for centuries. Theres no test for it, which Kelemen and others say, along with its current name, makes the condition easy to dismiss.
You might just as well call our illness must sit down disorder,’ she says. Its just universally hated.
For Kelemen, chronic fatigue syndrome has been far more debilitating than the name would suggest.
Fatigue isnt anywhere near what it is, you cannot move, she says.
Kelemen says she developed the disease about 20 years ago, though it took several years for her to pin down a diagnosis. Shed always been active and athletic. She was never depressed. Then she got really sick working in Angola and she just wasnt able to bounce back.
Even so, she hesitates telling people that she has it.
In the beginning, Id tell people I have chronic fatigue syndrome, but I quickly learned the reaction youd get was rolling eyes and a look of confusion.
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Depression Stress And Anxiety
Adjusting to a chronic, debilitating illness sometimes leads to other problems, including depression, stress, and anxiety. Many patients with ME/CFS develop depression during their illness. When present, depression or anxiety should be treated. Although treating depression or anxiety can be helpful, it is not a cure for ME/CFS.
Some people with ME/CFS might benefit from antidepressants and anti-anxiety medications. However, doctors should use caution in prescribing these medications. Some drugs used to treat depression have other effects that might worsen other ME/CFS symptoms and cause side effects. When healthcare providers are concerned about patients psychological condition, they may recommend seeing a mental health professional.
Some people with ME/CFS might benefit from trying techniques like deep breathing and muscle relaxation, massage, and movement therapies . These can reduce stress and anxiety, and promote a sense of well-being.
Diagnosis Of Chronic Fatigue Syndrome
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Clinical criteria
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Laboratory evaluation to exclude non-CFS disorders
The diagnosis of CFS is made by the characteristic history combined with a normal physical examination and normal laboratory test results. Any abnormal physical findings or laboratory tests must be evaluated and alternative diagnoses that cause those findings and/or the patient’s symptoms excluded before the diagnosis of CFS can be made. The case definition is often useful but should be considered an epidemiologic and research tool and in some circumstances should not be strictly applied to individual patients.
In February 2015, the Institute of Medicine published an extensive review of this disease called Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. In this review, they proposed a new name, systemic exertion intolerance disease , and new diagnostic criteria that simplified the diagnosis and emphasized the most consistent features. In addition, the review clearly emphasized the validity of this debilitating disease.
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Etiology Of Chronic Fatigue Syndrome
Etiology of CFS is unknown. No infectious, hormonal, immunologic, or psychiatric cause has been established. Among the many proposed infectious causes, Epstein-Barr virus, Lyme disease, candidiasis, and cytomegalovirus have been proven not to cause CFS. Similarly, there are no allergic markers and no immunosuppression.
Some people who have recovered from COVID-19 infection COVID-19 COVID-19 is an acute, sometimes severe, respiratory illness caused by the novel coronavirus SARS-CoV-2. Prevention is by vaccination, infection control precautions Posttraumatic Stress Disorder Posttraumatic stress disorder is recurring, intrusive recollections of an overwhelming traumatic event recollections last > 1 month and begin within 6 months of the event. The pathophysiology… read more . In addition, in some patients COVID-19 seems to trigger typical CFS, but further study is needed to confirm this association and determine causality.
Various minor immunologic abnormalities have been reported. These abnormalities include low levels of IgG, abnormal IgG, decreased lymphocytic proliferation, low interferon-gamma levels in response to mitogens, poor cytotoxicity of natural killer cells, circulating autoantibodies and immune complexes, and many other immunologic findings. However, none provide adequate sensitivity and specificity for defining CFS. They do, however, underscore the physiologic legitimacy of CFS.
Chronic Fatigue Syndrome Has A New Name Systemic Exertion Intolerance Disease
Many healthcare providers struggle with the diagnosis of chronic fatigue syndrome .
- Is it real or psychosomatic?
- Does it follow an infection such as Lyme disease?
- How does it differ from fibromyalgia or irritable bowel syndrome?
Because of these complexities, the Institute of Medicine was asked by several federal agencies to review the evidence base for CFS.
In 2015 they recommended a new namesystemic exertion intolerance disease or SEID.
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Key Points About Chronic Fatigue Syndrome
- Chronic fatigue syndrome is characterized by profound tiredness.
- Symptoms often worsen with physical or mental activity.
- In addition to severe fatigue, symptoms include light sensitivity, headache, muscle and joint pain, difficulty concentrating, mood swings, and depression.
- Treatments may include medicines, exercise, supplements, and counseling.
Fibromyalgia What Is It
Fibromyalgia is a complex pain disorder that affects the musculoskeletal system, causing widespread chronic pain, aches and tenderness to touch. Fibromyalgia pain can be located in only one part of the body at a time, moving from one area to the next, or pain may be felt all over the body at the same time.
A chronic pain disorder, fibromyalgia heightens the sense of pain in an individual, and is accompanied by sleep issues, fatigue, digestive symptoms as well as mental and social problems.
More women are at the risk of developing fibromyalgia than are men. In fact, of the approximately 10 million Americans suffering from this condition, women are affected more than men with a ratio of about 8 to 2.
Although fibromyalgia is literally translated to mean pain in the tendons, ligaments, and muscles, this condition presents as much more than just pain, with a wide range of symptoms that vary from one person to another.
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Viral And Other Infections
Post-viral fatigue syndrome or post-viral syndrome describes a type of chronic fatigue syndrome that occurs following a viral infection. A recent review found EpsteinâBarr virus antibody activity to be higher in patients with CFS, and that a subset of patients with CFS were likely to have increased EBV activity compared to controls. Viral infection is a significant risk factor for CFS, with one study finding 22% of people with EBV experience fatigue six months later, and 9% having strictly defined CFS. A systematic review found that fatigue severity was the main predictor of prognosis in CFS, and did not identify psychological factors linked to prognosis.
Another review found that risk factors for developing CFS after mononucleosis, dengue fever, or Q-fever included longer bed-rest during the illness, poorer pre-illness physical fitness, attributing symptoms to physical illness, belief that a long recovery time is needed, as well as pre-infection distress and fatigue. The same review found biological factors such as CD4 and CD8 activation and liver inflammation are predictors of sub-acute fatigue but not CFS.
A study comparing diagnostic labels found that people labelled with ME had the worst prognosis, while those with PVFS had the best. Whether this is due to those with more severe or longer-lasting symptoms results in a label with the description of ME, or if being labelled with ME adversely causes a more severe or prolonged illness is unclear.
New Name For Chronic Fatigue Syndrome
I understand that Chronic Fatigue Syndrome is being renamed. I dont get it. Why change a name that is well recognized? Can you tell me what this is all about?
Andrew Weil, M.D. |April 16, 2015
Over the years, Chronic Fatigue Syndrome has been called many things from the dismissive yuppy flu to the very technical myalgic encephalomyelitis, a medical term meaning brain and spinal cord inflammation with muscle pain. For understandable reasons that particular tongue twister never caught on among the public.
Putting the name aside, people still struggle to understand this controversial condition characterized by unexplained, long-lasting fatigue. To help clarify things, the authors of a recent report from the Institute of Medicine came up with a new name systemic exertion intolerance disease, and they endorsed new diagnostic criteria that may help physicians better identify the condition.
The new name was chosen to reflect the consensus among patients, doctors and researchers that the major characteristic of CFS is a sustained depletion of energy after minimal activity, defined medically as postexertional malaise.
The term chronic fatigue syndrome was chosen by the U.S. Centers for Disease Control and Prevention in 1988. Many physicians and researchers consider the term inadequate to describe the disorder, since prolonged fatigue can also characterize other conditions, including depression.
Andrew Weil, M.D.
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How Is Me/cfs Diagnosed
Theres no single test to detect ME/CFS. A diagnosis is made after other possible known causes for symptoms have been excluded.
The earlier the illness is recognised, the sooner you can get help to manage your symptoms. Many people with ME/CFS find it helps to keep a diary of their symptoms so that they can take this to their GP or specialist.
Your GP will usually:
- do a physical and mental examination to rule out other conditions
- ask about recent travel, tick or insect bites, unusual infections, and drug and alcohol use
- review current medication
They may be able to make a diagnosis after 3 or 4 months of seeing a pattern of symptoms. Anyone suspected of having ME/CFS should be considered for routine blood tests to identify other possible illnesses. More investigation may be needed if the diagnosis remains in doubt.
Some people with ME/CFS also have another long-term condition and its important that you talk to your GP about how to manage the symptoms of the 2 conditions.
Numeric Rating Scales Show Prolonged Post
- 2Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- 3Onze Lieve Vrouwe Gasthuis , Amsterdam, Netherlands
Introduction: Muscle pain, fatigue, and concentration problems are common among individuals with myalgic encephalomyelitis/chronic fatigue syndrome . These symptoms are commonly increased as part of the phenomenon of postexertional malaise . An increase in the severity of these symptoms is described following physical or mental exercise in ME/CFS patients. Another important symptom of ME/CFS is orthostatic intolerance, which can be detected by head-up tilt testing . The effect of HUT on PEM has not been studied extensively. For this purpose, we assessed numeric rating scales for pain, fatigue, and concentration pre- and post-HUT. As pain is a core symptom in fibromyalgia , we subgrouped ME/CFS patients by the presence or absence of FM.
NRS scores of pain, fatigue, and concentration were significantly increased even at 7 days post-HUT compared with pre-HUT in ME/CFS patients with and without FM, suggesting that orthostatic stress is an important determinant of PEM.
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Myalgic Encephalomyelitis/chronic Fatigue Syndrome: A New Name & Diagnostic Criteria
Maggie McNulty
In March 2015, a report from the Institute of Medicine was published in the Journal of the American Medical Association to redefine the illness known as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome .
Over the years, clinicians and researchers have developed different diagnostic criteria for ME and CFS however, the two terms describe conditions with similar symptoms. In the World Health Organizations International Classification of Diseases, 10th Revision, both ME and CFS are coded the same and classified as disorders of the nervous system . The term benign myalgic encephalomyelitis was first used in the 1950s in London when describing an outbreak in patients who experienced a variety of symptoms, including malaise, tender lymph nodes, sore throat, pain and signs of encephalomyelitis.
The cause was never found, but it appeared infectious in etiology, and the term benign myalgic encephalomyelitis was used to reflect the absent mortality, the severe muscular pains, the evidence of parenchymal damage to the nervous system and the presumed inflammatory nature of the disorder. Then in 1970, two psychiatrists reviewed reports of 15 of these outbreaks and concluded that the outbreaks were psychosocial phenomena caused by mass hysteria or altered medical perception of the community.
Beyond Myalgic Encephalomyelitis/chronic Fatigue Syndrome
Myalgic encephalomyelitis and chronic fatigue syndrome are serious, debilitating conditions that affect millions of people in the United States and around the world. ME/CFS can cause significant impairment and disability. Despite substantial efforts by researchers to better understand ME/CFS, there is no known cause or effective treatment. Diagnosing the disease remains a challenge, and patients often struggle with their illness for years before an identification is made. Some health care providers have been skeptical about the serious physiological rather than psychological nature of the illness. Once diagnosed, patients often complain of receiving hostility from their health care provider as well as being subjected to treatment strategies that exacerbate their symptoms.
Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome will be a valuable resource to promote the prompt diagnosis of patients with this complex, multisystem, and often devastating disorder enhance public understanding and provide a firm foundation for future improvements in diagnosis and treatment.
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