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Chronic fatigue syndrome
Classification and external resources
ICD-10 G93.3
ICD-9 780.71
DiseasesDB 1645
MedlinePlus 001244
eMedicine med/3392 ped/2795
MeSH D015673
.Сhronic fatigue syndrome (CFS) is the most common name[1] given to a variably debilitating disorder or disorders generally defined by persistent fatigue unrelated to exertion, not substantially relieved by rest and accompanied by the presence of other specific symptoms for a minimum of six months.^ Defining and managing chronic fatigue syndrome.

^ Fatigue exacerbated by exercise and not relieved by rest.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Living with chronic fatigue syndrome (CFS): .
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

[2] .The disorder may also be referred to as post-viral fatigue syndrome (PVFS, when the condition arises following a flu-like illness), myalgic encephalomyelitis (ME), or several other terms.^ Post-infection fatigue syndrome following Q fever.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Chatterjee T. Chronic fatigue syndrome or myalgic encephalomyelitis in children and adolescents.
  • Chronic Fatigue Syndrome: eMedicine Pediatrics: General Medicine 19 January 2010 9:53 UTC emedicine.medscape.com [Source type: Academic]

^ Fatigue may also be associated with a psychiatric disorder.
  • Chronic Fatigue Syndrome: eMedicine Pediatrics: General Medicine 19 January 2010 9:53 UTC emedicine.medscape.com [Source type: Academic]

.The etiology (cause or origin) of CFS is currently unknown and there is no diagnostic laboratory test or biomarker.^ There is no validated diagnostic test for CFS (Level I).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ There is currently no convincing evidence that retroviruses cause CFS (Level I).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Their own “CFS Toolkit for Professionals,” devotes an entire section to "cognitive behavior therapy" (psychotherapy) and another section to “graded exercise.” The introduction to the CDC Toolkit states, “As yet, there are no diagnostic tests or laboratory markers for CFS, and its pathophysiology is unknown."
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

[2]
.Fatigue is a common symptom in many illnesses, but CFS is a multi-systemic disease and is relatively rare by comparison.^ As in many chronic diseases, children with CFS face significant functional limitations (eg, frequent absences from school, disruptions in social activities, adjustments in family dynamics) surrounding the symptoms and treatment of their illness.
  • Chronic Fatigue Syndrome: eMedicine Pediatrics: General Medicine 19 January 2010 9:53 UTC emedicine.medscape.com [Source type: Academic]

^ Because there are no tests that can confirm a diagnosis of CFS, many people have trouble accepting their disease or getting their friends and family to do so.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ "We believe that the management and treatment of psychological symptoms in people with CFS should be similar to that for people with other chronic medical illnesses.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[3] .Symptoms of CFS include widespread muscle and joint pain; cognitive difficulties; chronic, often severe, mental and physical exhaustion; and other characteristic symptoms in a previously healthy and active person.^ Muscle pain, joint pain .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Other long-term symptoms include: .
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ As a distinct clinical entity, chronic fatigue syndrome (CFS) has only recently been defined for adults as a distinct disorder characterized by chronic (often relapsing but always debilitating) fatigue lasting at least 6 months (occasionally lasting much greater lengths of time), which causes impaired overall physical and mental functioning.
  • Chronic Fatigue Syndrome: eMedicine Pediatrics: General Medicine 19 January 2010 9:53 UTC emedicine.medscape.com [Source type: Academic]

.CFS patients may report additional symptoms including muscle weakness, hypersensitivity, orthostatic intolerance, digestive disturbances, depression, poor immune response, and cardiac and respiratory problems.^ Treatment for orthostatic intolerance may aid approximately 50% of patients.
  • Chronic Fatigue Syndrome: eMedicine Pediatrics: General Medicine 19 January 2010 9:53 UTC emedicine.medscape.com [Source type: Academic]

^ Q. What makes you suspicious that CFS may be a patient's problem?
  • Chronic Fatigue Syndrome Help 19 January 2010 9:53 UTC fmscommunity.org [Source type: Academic]

^ Anecdotally, numerous investigators and clinicians have noted that pediatric patients with CFS and their family members are inclined to deny the need for psychological assistance for their personal problems, to minimize the role of stressors in their symptoms, and to reject suggestions that psychological assistance may facilitate their recovery.
  • Chronic Fatigue Syndrome: eMedicine Pediatrics: General Medicine 19 January 2010 9:53 UTC emedicine.medscape.com [Source type: Academic]

[4] .It is unclear if these symptoms represent co-morbid conditions or are produced by an underlying etiology of CFS.[5] All diagnostic criteria require that the symptoms must not be caused by other medical conditions.^ All these symptoms are very common among CFS patients.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ However, if you have persistent, unexplained tiredness and other typical CFS symptoms but do not quite meet these criteria (for instance, if you have had symptoms for less than 6 months), you may still be presumed to have CFS, and you may need treatment.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ It is unclear how CFS is represented in the published literature, particularly with medical textbooks.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

The quality of life is "particularly and uniquely disrupted" in CFS.[6]
.CFS is thought to have an prevalence of 4 adults per 1,000 in the United States.^ In the United States, prevalence estimates among adolescents reported by Marshall 160 depended on the method of case acquisition.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Based on a conservative assumption of a community prevalence of CFS of 0.2% (200 cases per 100 000 population), this implies an annual cost to the Australian community of $525 million.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ One-month prevalence of mental disorders in the United States: based on five epidemiologic catchment area sites.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[7] .According to the ME Association [8] it affects an estimated 250,000 people in the UK. For unknown reasons CFS occurs most often in people in their 40s and 50s, more often in women than men,[9][10] and is less prevalent among children and adolescents.^ CFS in children and adolescents — .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Women are more likely to have CFS. .
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ Most people with fatigue do not have CFS. .
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

[11] Full recovery from the condition occurs in only 5-10% of cases.[11]
.Whereas there is agreement on the genuine threat to health, happiness and productivity posed by CFS, various physicians' groups, researchers and patient advocates promote different nomenclature, diagnostic criteria, etiologic hypotheses and treatments, resulting in controversy about many aspects of the disorder.^ Although these results suggest that the type of combination therapy used to treat Addison's disease is not going to be helpful in ME/CFS, the research group wisely point out that ME/CFS is a heterogeneous condition and that there could well be a subset of patients with disturbances in the hypothalamic-pituitary-adrenal axis that could respond to hormonal treatments.
  • Chronic Fatigue Syndrome Help 19 January 2010 9:53 UTC fmscommunity.org [Source type: Academic]

^ Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ The Work Group deliberated through what avenue to best shape CFS research and decided to focus on neuroimmune mechanisms.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

.The name CFS itself is controversial as many patients and advocacy groups, as well as some experts, want the name changed as they believe that it stigmatizes by not conveying the seriousness of the illness.^ Prejudice against patients "claiming CFS" can infect everyone from family members to neighbors to church groups.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ Comerford: If you have an effective IEP in place, CFS patients can do well, and they feel better about themselves.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Unfortunately but not surprisingly, no celebrities wanted to come forward and reveal that they have CFS. Attracting more patient participation in CFSAC meetings, including the issue of web casting.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[12]

Contents

Classification

Notable definitions include:[4]
.
  • CDC definition (1994)[13]—the most widely used clinical and research description of CFS,[5] it is also called the Fukuda definition and was based on the Holmes or CDC 1988 scoring system.^ This is definitely a time for input and we are at a place in the CDC research program where we need your input here.
    • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

    ^ I review the first pediatric CFS case definition and e-mail my thoughts back to one of the researchers.
    • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

    ^ For that matter, the article presenting the CDC’s Fukuda definition clearly indicated that the next task was to identify subgroups, but the CDC continues to lump more vague conditions under the CFS umbrella.
    • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

    [14] .The 1994 criteria require the presence of four or more symptoms beyond fatigue, where the 1988 criteria require six to eight.^ In routine clinical practice, a diagnosis of CFS may be appropriate even though the requirement of four out of eight additional symptoms is not formally met (see Box B).
    • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

    ^ If fatigue is prolonged beyond six months, is disabling, and is accompanied by other characteristic constitutional and neuropsychiatric symptoms, then a diagnosis of chronic fatigue syndrome (CFS) should be considered.
    • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

    ^ Katon W, Russo J. Chronic fatigue syndrome criteria: a critique of the requirement for multiple physical complaints.
    • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

    [15]
  • .
  • The Oxford criteria (1991)[16]—includes CFS of unknown etiology and a subtype called post-infectious fatigue syndrome (PIFS).^ Living with chronic fatigue syndrome (CFS): .
    • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

    ^ B: Diagnostic criteria for chronic fatigue syndrome 6 .
    • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

    ^ What is chronic fatigue syndrome (CFS)?
    • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

    .Important differences are that the presence of mental fatigue is necessary to fulfill the critera and symptoms are accepted that may suggest a psychiatric disorder.^ Diagnosis relies on the presence of characteristic symptoms and exclusion of alternative medical and psychiatric disorders (Level IV).
    • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

    ^ People with severe or prolonged depression, severe anxiety symptoms, or those assessed as being at risk of self-harm may require psychiatric evaluation.
    • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

    ^ For example, it may be evident that an adolescent's 45-minute walk to school produces fatigue and other symptoms that last all day.
    • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

    [4]
.Using different case definitions may influence the types of patients selected[18] and there is research to suggest subtypes of patients or disease exist.^ Are there tools that patients can use?
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Snell: There is not much information from CDC on patient selection and what researchers are assessing.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ I review the first pediatric CFS case definition and e-mail my thoughts back to one of the researchers.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

[19][20][21][22] .Clinical practice guidelines—with the aim of improving diagnosis, management, and treatment—are generally based on case descriptions.^ Clinical practice guidelines - 2002 .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Guidelines for the development and implementation of clinical practice guidelines.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Clinical practice guidelines--2002.

.An example is the CFS/ME guideline for the National Health Service in England and Wales, produced in 2007 by the National Institute for Health and Clinical Excellence (NICE).^ The DHHS should pursue making CFS a topic of training for health care providers, wherever appropriate at regional and national conferences sponsored by the Department.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ The National Center for Health Marketing, home of the CFS Public Awareness Campaign.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ The DE isn’t here, but we have agencies within NIH—the National Institute of Child Health and Human Development has a disabilities group.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[15]

Naming

.Chronic fatigue syndrome (CFS) is the most commonly used designation,[1] but widespread approval of a name is lacking.^ Human herpesviruses in chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Patarca R. Cytokines and chronic fatigue syndrome.

^ Home treatment is the most important part of treating chronic fatigue syndrome (CFS).
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

[23] .Different authorities on the illness view CFS as a central nervous system, metabolic, infectious or post-infectious, cardiovascular, immune system or psychiatric disorder, and that different symptom profiles may be caused by a number of various disorders.^ Diagnosis relies on the presence of characteristic symptoms and exclusion of alternative medical and psychiatric disorders (Level IV).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ And if you have a sleep disturbance caused perhaps by a virus or set of viruses in this disorder, then also your sleep will be off and in turn your immune system will be off.
  • CHRONIC FATIGUE SYNDROME 19 January 2010 9:53 UTC www.garynull.com [Source type: Original source]

^ People with severe or prolonged depression, severe anxiety symptoms, or those assessed as being at risk of self-harm may require psychiatric evaluation.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[19]
.Over time and in different countries many names have been associated with the condition(s).^ We had a large number of adhesion markers and it will take awhile to sort through the many different names that appear when you start doing the bioinformatic searches.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

.Aside from CFS, some other names used include Akureyri disease, benign myalgic encephalomyelitis, chronic fatigue immune dysfunction syndrome, chronic infectious mononucleosis, epidemic myalgic encephalomyelitis, epidemic neuromyasthenia, Iceland disease, myalgic encephalomyelitis, myalgic encephalitis, myalgic encephalopathy, post-viral fatigue syndrome, raphe nucleus encephalopathy, Royal Free disease, Tapanui flu and yuppie flu (considered pejorative).^ Human herpesviruses in chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Patarca R. Cytokines and chronic fatigue syndrome.

^ Defining and managing chronic fatigue syndrome.

[24][25] .Many patients would prefer a different name such as "myalgic encephalomyelitis", believing the name "chronic fatigue syndrome" trivializes the condition, prevents it from being seen as a serious health problem, and discourages research.^ Patarca R. Cytokines and chronic fatigue syndrome.

^ Defining and managing chronic fatigue syndrome.

^ Chronic fatigue syndrome Popular works.

[12][26][27]
.A 2001 review referenced myalgic encephalomyelitis symptoms in a 1959 article by Acheson, stating ME could be a distinct syndrome from CFS, but in literature the two terms are generally seen as synonymous.^ People with chronic fatigue syndrome (CFS) are generally 25 to 45 years of age.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ The main symptom of chronic fatigue syndrome (CFS) is a devastating tiredness or exhaustion that has lasted at least 6 months and does not improve much with rest.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ Bagnall AM, Whiting P, Richardson R, Sowden AJ. Interventions for the treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis.

[28] .A 1999 review explained the Royal Colleges of Physicians, Psychiatrists, and General Practitioners in 1996 advocated the use of chronic fatigue syndrome instead of myalgic encephalomyelitis or ME which was in wide use in the United Kingdom, "because there is, so far, no recognized pathology in muscles and in the central nervous system as is implied by the term ME."[1][29] The 1996 report received some acceptance, but also harsh criticism that patients' views had been excluded.^ Patarca R. Cytokines and chronic fatigue syndrome.

^ Defining and managing chronic fatigue syndrome.

^ Chronic fatigue syndrome Popular works.

In 2002, a Lancet commentary noted the recent report by the "Working Group on CFS/ME"[30] used the compromise name CFS/ME stating, "The fact that both names for the illness were used symbolises respect for different viewpoints whilst acknowledging the continuing lack of consensus on a universally acceptable name."[23]

Signs and symptoms

Onset

.The majority of CFS cases start suddenly,[31] usually accompanied by a "flu-like illness"[5] while a significant proportion of cases begin within several months of severe adverse stress.^ Majority of cases followed an infective illness.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Artman replied that she was still collecting them with the aim of having an email for everyone within the next several months.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ In my case, I had an extreme viral onset that was like a severe case of influenza; it was like Texas flu or Swine flu, both of which I had during the years in which they were pandemic.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

[31][32][33] .An Australian prospective study found that after infection by viral and non-viral pathogens, a sub-set of individuals met the criteria for CFS, with the researchers concluding that "post-infective fatigue syndrome is a valid illness model for investigating one pathophysiological pathway to CFS".[34] However, accurate prevalence and exact roles of infection and stress in the development of CFS are currently unknown.^ A case study of chronic fatigue syndrome.

^ Walsh CM, Zainal NZ, Middleton SJ, Paykel ES. A family history study of chronic fatigue syndrome.

^ Hyams KC. The investigation of chronic fatigue syndrome: a case-study of the limitations of inductive inferences and non-falsifiable hypotheses in medical research.

Many significant risk factors for developing CFS are known, but "definitive evidence that would be meaningful for clinicians is lacking".[35]

Symptoms

.The most commonly used diagnostic criteria and definition of CFS for research and clinical purposes were published by the United States Centers for Disease Control and Prevention (CDC).^ CDC should not be allowed to control of this disease.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ Another way to state it: For every $1.00 Congress authorized to be spent on CFS research, CDC spent only $0.43 on research, stole another $0.39 and spent it on other programs, and then lost track of the remaining $0.18 and can't account for that at all.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ This is definitely a time for input and we are at a place in the CDC research program where we need your input here.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[5] The CDC definition of CFS requires the following two criteria be fulfilled:[2]
  1. A new onset (not lifelong) of unexplained, persistent fatigue unrelated to exertion and not substantially relieved by rest, that causes a significant reduction in previous activity levels.
  2. Four or more of the following symptoms that last six months or longer:
  • Impaired memory or concentration
  • Post-exertional malaise, where physical or mental exertions bring on "extreme, prolonged exhaustion and sickness"
  • Unrefreshing sleep
  • Muscle pain (myalgia)
  • Pain in multiple joints (arthralgia)
  • Headaches of a new kind or greater severity
  • Sore throat, frequent or recurring
  • Tender lymph nodes (cervical or axillary)
.There are no medical tests or physical signs to diagnose CFS,[11] so testing is used to rule out other potential causes for symptoms.^ There is no treatment for CFS itself, but many of its symptoms can be treated.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ There are no tests for CFS. Doctors can diagnose it only by ruling out other possible causes of your fatigue.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ There's no where else to turn, but to find others.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

[13] .When symptoms are attributable to other conditions, the diagnosis of CFS is excluded.^ We live and cope with CFS with difficulty, often struggling with symptoms for years or decades without diagnosis, as I did, without even physician support, as members of this committee know.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ For this reason, it can be diagnosed only after a thorough evaluation has ruled out other conditions with similar symptoms .
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ CFS causes symptoms that are the same as many other diseases, especially early on.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

.The CDC specifically refers to several illnesses with symptoms resembling those of CFS: "mononucleosis, Lyme disease, lupus, multiple sclerosis, fibromyalgia, primary sleep disorders, severe obesity and major depressive disorders.^ He has symptoms of my illness with major sleep problems since age 4.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ It also includes information to help you find a support group for people with CFS. The site is maintained by the National Center for Infectious Diseases of the Centers for Disease Control and Prevention (CDC).
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ I also have Chronic Lyme Disease, another politically charged illness, which I contracted as a child.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

Medications can also cause side effects that mimic the symptoms of CFS."[2]

Activity levels

.Patients report critical reductions in levels of physical activity[36] and a reduction in the complexity of activity has been observed,[37] with reported impairment comparable to other fatiguing medical conditions[38] such as late-stage AIDS,[39] lupus, rheumatoid arthritis, chronic obstructive pulmonary disease (COPD), and the effects of chemotherapy.^ Coeliac disease and chronic fatigue syndrome.

^ Van Houdenhove B, Neerinckx E, Onghena P, Vingerhoets A, Lysens R, Vertommen H. Daily hassles reported by chronic fatigue syndrome and fibromyalgia patients in tertiary care: a controlled quantitative and qualitative study.

^ Brouwers FM, Van Der Werf S, Bleijenberg G, Van Der Zee L, Van Der Meer JW. The effect of a polynutrient supplement on fatigue and physical activity of patients with chronic fatigue syndrome: a double-blind randomized controlled trial.

[40] .CFS affects a person's functional status and well-being more than major medical conditions such as multiple sclerosis, congestive heart failure, or type II diabetes mellitus[6][41] The severity of symptoms and disability is the same in both genders[42] with strongly disabling chronic pain,[43] but despite a common diagnosis the functional capacity of individuals with CFS varies greatly.^ The disability is equivalent to that of some well known, very severe medical conditions.” As an individual with CFS who is currently attempting to navigate through the Social Security Administration labyrinth, I can tell you first hand that it is indeed a battle of attrition.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ This committee has heard of the personal toll that CFS has taken on me, as well as countless sufferers.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Solomon L, Nisenbaum R, Reyes M, Papanicolaou DA, Reeves WC. Functional status of persons with chronic fatigue syndrome in the Wichita, Kansas, population.

[44] .While some lead relatively normal lives, others are totally bed-ridden and unable to care for themselves.^ As I stated previously, we would much rather lead “normal” lives and be contributing members of society.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Some people find the fatigue, pain, and thinking problems caused by CFS greatly hamper their lives, but other people are not nearly as affected.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

.Employment rates vary with over half unable to work and nearly two-thirds limited in their work because of their illness.^ A good relationship with your doctor is important, because the two of you will need to work together to find a combination of medicines and behavior changes that will help you get better.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

.More than half were on disability benefits or temporary sick leave, and less than a fifth worked full-time.^ Even if they can’t work full time, they can certainly earn a lot more than they could on disability.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Number two, a large proportion, perhaps less than half, have also thyroid imbalance in the bargain.
  • CHRONIC FATIGUE SYNDROME 19 January 2010 9:53 UTC www.garynull.com [Source type: Original source]

^ Because I cannot work full time, I do not qualify for employee sponsored health care plans.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[45]

Pathophysiology

.The mechanisms and pathogenesis of chronic fatigue syndrome are unknown.^ Human herpesviruses in chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Patarca R. Cytokines and chronic fatigue syndrome.

^ Defining and managing chronic fatigue syndrome.

[11] .Research studies have examined and hypothesized about the possible biomedical and epidemiological characteristics of the disease, including oxidative stress, genetic predisposition,[46] infection by viruses and pathogenic bacteria, hypothalamic-pituitary-adrenal axis abnormalities , immune dysfunction as well as psychological and psychosocial factors.^ Hypothalamic-pituitary-adrenal axis reactivity in chronic fatigue syndrome and health under psychological, physiological, and pharmacological stimulation.

^ It was to be a research definition for a surveillance study at CDC and NIH would do testing for what was behind an outbreak of diseases.” EBV and other Herpes Viruses are known to lay latent.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ When a researcher requests additional information about study data reported at a scientific conference or publication, authors sometimes refuse to provide it.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

.Although it is unclear which factors are a cause, or consequence, of CFS, various models are proposed.^ Although the cause of chronic fatigue syndrome (CFS) is not well understood, the fatigue is real and can make day-to-day activities difficult.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ Although CFS can cause a variety of symptoms, new symptoms could be caused by another illness or medical condition that may need to be evaluated and treated.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ It's likely that a number of factors or triggers come together to cause CFS. .
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

[47][48][49]
.A 2009 study suggested a link between the retrovirus xenotropic murine leukemia virus-related virus (XMRV) and chronic fatigue syndrome in the United States.^ Patarca R. Cytokines and chronic fatigue syndrome.

^ Defining and managing chronic fatigue syndrome.

^ Successful treatment of chronic fatigue syndrome with midodrine: a pilot study.

[50] .Three follow-up studies using different methodology were however unable to confirm this association.^ She said that if CDC investigators are using a broader case definition than those used in more focused studies, the research will yield different results.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ It is important to note that studies differ substantially in patient selection, intensity and duration of treatment provided, and suitability of the "control" interventions used for comparison.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Among 2075 people followed up in 19 published studies of the outcome of prolonged fatigue and CFS, there was one death by suicide and two unrelated deaths.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[51][52][53]

Treatment

.Many patients do not fully recover from CFS even with treatment, and there is no universally effective curative option.^ There is no treatment for CFS itself, but many of its symptoms can be treated.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ Although there is no cure for CFS, many of its symptoms do respond to treatment.
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ There is a perverse incentive for disability and health insurance companies to cheat the patient as long as no one checks up on their activities.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

[54] .Diets, physiotherapy, dietary supplements, antidepressants, pain killers, pacing, and complementary and alternative medicine have been suggested as ways of managing CFS. Cognitive behavioural therapy (CBT) and graded exercise therapy (GET) have shown moderate effectiveness for many patients in multiple randomized controlled trials.^ Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Managing patients with CFS — .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Managing patients with CFS Management .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[28][55][56][57] .As many of the CBT and GET studies required patients to visit a clinic, severely affected patients may have been excluded.^ People with severe or prolonged depression, severe anxiety symptoms, or those assessed as being at risk of self-harm may require psychiatric evaluation.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Moreover, many studies have significant refusal and drop-out rates, which may reflect on the acceptability of the treatment regimens.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Clinical Overview "To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all."
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[55]
.Patient surveys have found that pacing is reported to be the most helpful intervention.^ But that should help most of the patients most of the time.
  • CHRONIC FATIGUE SYNDROME 19 January 2010 9:53 UTC www.garynull.com [Source type: Original source]

^ This is most prominent in patients who report a post exertional fatigue.
  • CHRONIC FATIGUE SYNDROME 19 January 2010 9:53 UTC www.garynull.com [Source type: Original source]

^ In a survey of adolescents with CFS, general practitioners were considered to be most helpful when they recognised the illness, acknowledged its effects, provided ongoing support, and monitored progress.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[58]

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT), a form of psychological therapy often used to treat chronically ill patients,[59] is a moderately effective treatment for CFS[60] that "can be useful in treating some CFS patients."[59] 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.[61]
.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 symptoms of fatigue.^ Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Cognitive behavioral therapy and exercise for chronic fatigue syndrome.

.Comparing CBT with "usual care," four reviewed studies showed that CBT was more effective (40% vs 26%).^ Klimas: Four years ago I was funded by the DOD to do study comparing Gulf War Syndrome compared CFS in collaboration with the CDC. In this study we collected samples from 105 people.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ In the US and UK, four studies have provided a more realistic estimate of 0.2% to 0.7% (that is, 200-700 cases per 100 000 people).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

.In three studies, CBT worked better than other types of psychological therapies (48% vs 27%).^ It isn't the fact that any one of those things is better than any other.
  • CHRONIC FATIGUE SYNDROME 19 January 2010 9:53 UTC www.garynull.com [Source type: Original source]

^ Klimas noted that the prevalence of CFS cases in the CDC study is higher than in some others, which raises concern over how researchers are defining an incidence.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Klimas: Your success rate on symptom management is a lot better than any that we’ve heard from other very well experienced clinicians.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

.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.^ Alternatively, a meta-analysis of smaller, well-characterised studies may support key findings.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ II: Consistent evidence from two randomised controlled studies from independent centres, a single multicentre randomised controlled study or a population-based epidemiological study.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Level IV evidence represents consensus opinions of experts, including working group members, based on clinical experience and limited scientific data.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[62] .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.^ Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Human herpesviruses in chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Patarca R. Cytokines and chronic fatigue syndrome.

[60] .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.^ Accordingly, the patient's current level of disability should be carefully assessed, with a review of the duration and intensity of physical activity that can be undertaken without precipitating prolonged fatigue.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Brouwers FM, Van Der Werf S, Bleijenberg G, Van Der Zee L, Van Der Meer JW. The effect of a polynutrient supplement on fatigue and physical activity of patients with chronic fatigue syndrome: a double-blind randomized controlled trial.

^ Flexibility in the level of physical and mental activity undertaken to allow for such fluctuations ("pacing") should be explicitly discussed.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

.They conclude that the effect of CBT on fatigue is not mediated by a change in physical activity.^ Accordingly, the patient's current level of disability should be carefully assessed, with a review of the duration and intensity of physical activity that can be undertaken without precipitating prolonged fatigue.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Brouwers FM, Van Der Werf S, Bleijenberg G, Van Der Zee L, Van Der Meer JW. The effect of a polynutrient supplement on fatigue and physical activity of patients with chronic fatigue syndrome: a double-blind randomized controlled trial.

^ In people with CFS, fatigue is typically exacerbated by relatively minor physical or mental activity, and is associated with a protracted recovery period lasting hours or days.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[63]
.CBT has been criticised by patients' organisations because of negative reports from some of their members,[23] which have indicated that CBT can sometimes make people worse.^ Food and environmental intolerances Though not considered a "cause" of CFS, some patients with chronic fatigue report food intolerances that can exacerbate symptoms.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Management involved getting young people to make some decisions in all of the above areas, because the consequences of the illness were actually greater than the illness itself.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ CFS patients reported they had experienced a negative interaction with a healthcare provider.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[64]

Graded exercise therapy

.Graded exercise therapy (GET) is a form of physical therapy.^ CFS. The most common were cognitive behavior therapy, anti-depressants, graded exercise or exercise, and supplements.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ White PD, Fulcher KY. Chronic fatigue syndrome, deconditioning, and graded exercise therapy.

^ Hatcher S. Review: cognitive behavioural therapy and graded exercise show the most promise for chronic fatigue syndrome.

.A meta-analysis of five randomized trials found that patients who received exercise therapy were less fatigued after 12 weeks than the control participants, and the authors cautiously conclude that GET shows promise as a treatment.^ Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ A small, randomized, placebo-controlled trial of the use of antiviral therapy for patients with chronic fatigue syndrome.

^ Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomized controlled trial.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[65] .A systematic review published in 2006 included the same five RCTs, noting that "no severely affected patients were included in the studies of GET".[55] Surveys conducted on behalf of patient organizations commonly report adverse effects.^ Anderson highlighted Med-Byte, an online repository available to anyone in the world that offers 1,000 peer-reviewed resources, including virtual patients and patient cases.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ In an Australian study conducted in a specialist setting, 150 65 of 103 patients (63%) who had had symptoms for about five years reported abatement of symptoms and improvement in functional capacity over the next three years, but complete recovery was uncommon (6%).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Since 2005, the CDC has spent upwards of $11 million total to begin to study 30 patients and publish three papers.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[23][64][66][58]

Pacing

Pacing is an energy management strategy which encourages behavioral change while acknowledging patient fluctuations in symptom severity and delayed exercise recovery. .Patients are advised to set manageable daily activity/exercise goals and balance activity and rest to avoid over-exertion which may worsen symptoms.^ Paul LM, Wood L, Maclaren W. The effect of exercise on gait and balance in patients with chronic fatigue syndrome.

^ As a general principle of good management of patients with CFS, it can be useful to introduce the concept of self-monitoring of key symptoms and associated disability.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Relaxation training and stress management may be useful for some patients.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

.Those able to function within their individual limits are encouraged to gradually increase activity and exercise levels while maintaining established energy management techniques.^ As exercise tolerance improves, duration and intensity of activity can be gradually increased.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Over time the level of activity attempted is slowly increased at a rate determined by the patient's response.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Subtle abnormalities of cardiac function with exercise have been described 407 - 409 (Level III-2).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

.The goal is to gradually increase the level of routine functioning of the individual.^ Routine analysis of immune function (lymphocyte subsets, immunoglobulin levels), infectious disease serology, or environmental toxins are not recommended.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Physical and intellectual activities should be "paced" according to the individual's functional capacity (Level IV).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[67] .A small randomised controlled trial concluded that pacing had statistically better results than relaxation/flexibility therapy.^ Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ A double-blind, placebo-controlled trial of intravenous immunoglobulin therapy in patients with chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Intravenous immunoglobulin (IVIG): Four double-blind, placebo-controlled trials of therapy with IVIG (based on a hypothesis of disturbed immunity in people with CFS) have been published.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[68][69] .A 2009 survey of 828 Norwegian CFS patients found that pacing was evaluated as useful by 96% of the participants.^ Using the questionnaires and re-sorting the participants, Reeves concluded there were 43 patients with CFS in that Wichita hospital stay.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ Etiology of CFS Dr. Glaser asked what new approaches the CDC is using to determine the etiology of CFS. Dr. Monroe said that etiology may not necessarily be part of the GCRC study, noting the potential time lag between when a patient is identified and when he or she is evaluated.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ There are immune markers that are found in subgroups of CFS patients and nobody else.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

[58]

Other

.Other treatments of CFS have been proposed but their effectiveness has not been confirmed.^ "We believe that the management and treatment of psychological symptoms in people with CFS should be similar to that for people with other chronic medical illnesses.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Evaluation of the evidence for other factors proposed to contribute to the pathophysiology of CFS .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Parekh confirmed that the Quality of Life Subcommittee would take the lead in planning a meeting on the topic of CFS and barriers to work, taking input from other interested members.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[70] Medications thought to have promise in alleviating stress-related disorders include antidepressant and immunomodulatory agents.[71] The evidence for antidepressants is mixed[72] and their use remains controversial.[73] .Many CFS patients are sensitive to medications, particularly sedatives, and some patients report chemical and food sensitivities.^ Has as a primary concern CFS patients’ continued lack of access to medical care.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Some studies have suggested an overlap between CFS and multiple chemical sensitivity (MCS) 82 , 87 , 117 - 124 Gulf War syndrome 124 , 125 - 128 and " sick building" syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ When patients have been definitively diagnosed with a medical or psychiatric condition known to be associated with marked fatigue, a separate diagnosis of CFS is generally not justified.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[74] .CFS patients have a low placebo response compared to patients with other diseases.^ She has been told that CFS does not fit in rheumatology, infectious disease, or any other subgroup.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ The comprehensiveness and extent of representation of CFS information was included, and CFS was compared with to other illnesses.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Mostly what’s going on in the GCRC study is to look at CFS patients’ response to the psychosocial stressor—a speaking test.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[75]

Prognosis

Recovery

.A systematic review of 14 studies of the outcome of untreated people with CFS found that "the median full recovery rate was 5% (range 0–31%) and the median proportion of patients who improved during follow-up was 39.5% (range 8–63%).^ C: Support and resources for people with CFS 14 .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ By contrast, full recovery in patients with established CFS is less common.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ A summary of them can be found in the systematic review by Bagnall et al [ 31 ].
  • BioMed Central | Full text | Chronic fatigue syndrome: aetiology, diagnosis and treatment 19 January 2010 9:53 UTC www.biomedcentral.com [Source type: Academic]

.Return to work at follow-up ranged from 8 to 30% in the three studies that considered this outcome."^ Retrospective studies suggest CFS may follow RRV infection 30 , 70 , 217 (Level III-2).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Average age of follow-up patient is 23 years, with a range of 13-33.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Also, most studies of CFS in the pediatric age range have followed the CDC criteria.
  • Chronic Fatigue Syndrome: eMedicine Pediatrics: General Medicine 19 January 2010 9:53 UTC emedicine.medscape.com [Source type: Academic]

.... ."In five studies, a worsening of symptoms during the period of follow-up was reported in between 5 and 20% of patients."^ I will follow this up for six months and report again."
  • Our Earth Clinic collection of remedies to Cure Chronic Fatigue Syndrome. 19 January 2010 9:53 UTC www.earthclinic.com [Source type: General]

^ Hot flashes between/hot flashes during & after period .
  • Diagnose-Me: Condition: Chronic Fatigue / Fibromyalgia Syndrome 19 January 2010 9:53 UTC www.diagnose-me.com [Source type: Academic]

^ However, a study published in the British Medical Journal found that patient education on CFS and a graded exercise program can greatly improve CFS symptoms in many cases.
  • Diagnose-Me: Condition: Chronic Fatigue / Fibromyalgia Syndrome 19 January 2010 9:53 UTC www.diagnose-me.com [Source type: Academic]

.A good outcome was associated with less fatigue severity at baseline, a sense of control over symptoms and not attributing illness to a physical cause.^ Factors associated with poorer outcomes include illness duration, subjective cognitive impairment and somatic symptoms, 143 - 151 as well as high levels of fatigue or functional impairment and a low sense of control over symptoms.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Concurrent psychological disorder, somatic symptoms, high levels of fatigue and a low sense of control over symptoms are associated with poorer outcomes (Level II).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Additional elements of good clinical management are the development of a clear and mutual understanding of the nature of the illness; a sensible approach to physical and mental activity; and realistic expectations about long-term outcome possibilities.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[76] .Another review found that children have a better prognosis than adults, with 54–94% having recovered by follow-up compared to less than 10% of adults returning to pre-morbid levels of functioning.^ People with CFS for more than five years tend to remain symptomatic, although function may improve slowly over time (Level II).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Two studies evaluating chronic fatigue in children reported that 77%-94% recovered or their condition improved.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Monroe replied that in Dr. Reeves’ opinion, the CDC ex officio should be higher up in the agency organization than the program level.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[77] .According to the CDC, delays in diagnosis and treatment can reduce the chance of improvement.^ It should be no surprise that, 25 years after the first effort by CDC to study the phenomenon of “CFS,” 85 percent of patients today still have no diagnosis (according to CDC).
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

[78]

Mortality

.Two studies were published in 2006 that directly addressed mortality in CFS. One retrospective study of deaths in individuals chronicled on a memorial list from a national CFS support group reported a greater likelihood of death from heart failure, suicide, and cancer.^ CFS does not preferentially affect individuals from upper socioeconomic groups (contrary to the notion of "yuppie flu").
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Retrospective studies suggest CFS may follow RRV infection 30 , 70 , 217 (Level III-2).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ The pattern of alteration seen in people with CFS in these studies contrasts with that seen in people with major depression, suggesting different pathophysiological processes in these two syndromes.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

.The ages of death for these three conditions were significantly younger than in the general population respectively.^ This ethnic group makes up less than 40 percent of the Australian general population.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ About 12 percent of the CFS population is Northern European, an ethnic group that makes up less than 1 percent of the general population.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

.Significant limitations of the study were the inability to check the accuracy of the cause of death, or CFS diagnosis of the individuals.^ Making a diagnosis of CFS should also mark the end of investigations to exclude other causes of illness (except at annual review - see Box 2.2 ).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Among 2075 people followed up in 19 published studies of the outcome of prolonged fatigue and CFS, there was one death by suicide and two unrelated deaths.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Of those individuals who are fortunate enough to get a proper diagnosis, the CFS patient community heavily relies on friends and family for economic assistance.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[79] .A larger 14 year follow up study of persons with CFS reported that all-cause mortality or suicide rates of individuals were not significantly different from standardized mortality rates (SMRs).^ These studies included mean follow-up periods ranging from six months to four years, suggesting that suicide rates and overall mortality are not increased in people with CFS. .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ However, case-control studies indicate that such "elevated" antibody titres are also found in healthy individuals many years after the original infection.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ In prospective studies, rates of self-reported improvement vary from 11%-64%, 140 - 143 and worsening at 12-18 months was reported in 15%-20%.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[80]

Epidemiology

.Due to the multiple definitions of CFS, estimates of its prevalence vary widely.^ In primary care settings, estimates of the prevalence of CFS are between 0.5% and 2.5%, depending on the intensity of medical, psychiatric and laboratory evaluation ( Box 1.1 ).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ The entire CDC program in CFS, headed by Dr. Reeves, clearly needs to be investigated by GAO. The result of this unfortunate name (and the new CDC definition of CFS) extends widely.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

.Studies in the United States have previously found between 4 and 2500 cases of CFS for every 100,000 adults.^ The true prevalence of CFS can only be determined in large-scale community studies employing adequate case detection and characterisation techniques.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ However, case-control studies indicate that such "elevated" antibody titres are also found in healthy individuals many years after the original infection.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ In the United States, prevalence estimates among adolescents reported by Marshall 160 depended on the method of case acquisition.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[81] .The CDC states that more than 1 million Americans have CFS and approximately 80% of the cases are undiagnosed.^ The CDC approximates that sinusitis affects 32 million Americans.
  • Chronic Fatigue Syndrome Help 19 January 2010 9:53 UTC fmscommunity.org [Source type: Academic]

^ Based on a 1999 study of adults in the United States, CFS is thought to affect approximately 4 per 1,000 adults.
  • Our Earth Clinic collection of remedies to Cure Chronic Fatigue Syndrome. 19 January 2010 9:53 UTC www.earthclinic.com [Source type: General]

^ CFS is said to occur more frequently among women than men and among white Americans than in Americans of other racial/ethnic groups.
  • PA-07-265: Chronic Fatigue Syndrome: Pathophysiology and Treatment (R01) 19 January 2010 9:53 UTC grants.nih.gov [Source type: Academic]

[11] .All ethnic and racial groups appear susceptible to the illness, and lower income groups are slightly more likely to develop CFS.[10] A 2009 meta-analysis showed that compared with the White American majority, African Americans and Native Americans have a significantly higher risk of CFS.[82] More women than men get CFS — between 60 and 85% of cases are women; however, there is some indication that the prevalence among men is underreported.^ Some groups report a higher rate of depression in young people with CFS compared with other chronic illnesses, 160 but the sample sizes were small and such series are susceptible to selection bias.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ MICHELE GALANTE, MD: The role of antibiotics is certainly there in cases where all else is failing, where the system has been debilitated from too much drug usage before.
  • CHRONIC FATIGUE SYNDROME 19 January 2010 9:53 UTC www.garynull.com [Source type: Original source]

^ In primary care settings, estimates of the prevalence of CFS are between 0.5% and 2.5%, depending on the intensity of medical, psychiatric and laboratory evaluation ( Box 1.1 ).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

.The illness is reported to occur more frequently in people between the ages of 40 and 59.[9] CFS is less prevalent among children and adolescents than adults.^ CFS in children and adolescents — .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ In studies of children and adolescents with CFS the outcome is significantly better than in adults.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ CFS in children and adolescents CFS in young people .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[11] .Blood relatives of people who have CFS appear to be more predisposed.^ People with CFS for more than five years tend to remain symptomatic, although function may improve slowly over time (Level II).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ In people with CFS, fatigue is typically exacerbated by relatively minor physical or mental activity, and is associated with a protracted recovery period lasting hours or days.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ For people who are depressed for any reason, a good way to deal with this is to bring this into our center, to ground us and to feel more whole.
  • CHRONIC FATIGUE SYNDROME 19 January 2010 9:53 UTC www.garynull.com [Source type: Original source]

[10][83] .There is no direct evidence that CFS is contagious, though it is seen in members of the same family; this is believed to be a familial or genetic link but more research is required for a definite answer.^ Prejudice against patients "claiming CFS" can infect everyone from family members to neighbors to church groups.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ I review the first pediatric CFS case definition and e-mail my thoughts back to one of the researchers.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ Indeed, there is growing evidence that the disorder is heterogeneous, and it will probably prove to have no single or simple aetiology.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[84]

Risk factors

A recent systematic review included 11 primary studies that had assessed various demographic, medical, psychological, social and environmental factors to predict the development of CFS/ME, and found many had reported significant associations to CFS.[35] The reviewers concluded that the lack of generalizability and replication between studies meant that "none of the identified factors appear suitable for the timely identification of patients at risk of developing CFS/ME within clinical practice."

Associated diseases

.Some diseases show a considerable overlap with CFS. Thyroid disorders, anemia, and diabetes are a few of the diseases that must be ruled out if the patient presents with appropriate symptoms.^ List tests that need to be given to rule out diseases that give similar symptoms: Hepatitis C, congestive heart failure, diabetes, both types of anemia, leukemia, onset of Alzheimers or Parkinson's – these are just some of the illnesses that should be on this list.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ To talk about one particular therapy is not appropriate because each person has their own constitution and the classical homeopath works to find that constitutional remedy or the remedy that is appropriate to the detailed picture of symptoms that the patient presents at that particular time.
  • CHRONIC FATIGUE SYNDROME 19 January 2010 9:53 UTC www.garynull.com [Source type: Original source]

^ As the causes of CFS are "unexplained", there is an obvious overlap between the diagnostic criteria for the somatoform disorders and CFS. 16 , 90 , 109 - 112 .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[13][15][85]
.People with fibromyalgia (FM, or fibromyalgia syndrome, FMS) have muscle pain and sleep disturbances.^ Studies of combination therapy with a low dose tricyclic antidepressant and an NSAID in people with fibromyalgia showed beneficial effects on muscle pain and sleep disturbance, but not on fatigue or mood.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Buskila D. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.
  • Chronic Fatigue Syndrome - Information, Guides, and References 19 January 2010 9:53 UTC modern-bibliography.tripod.com [Source type: Academic]
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Van Houdenhove B. Chronic fatigue syndrome, fibromyalgia, and complex regional pain syndrome type I. Psychosomatics 2003;44(2):173-4.

.Fatigue and muscle pain occurs frequently in the initial phase of various hereditary muscle disorders and in several autoimmune, endocrine and metabolic syndromes; and are frequently labelled as CFS or fibromyalgia in the absence of obvious biochemical/metabolic abnormalities and neurological symptoms.^ Buskila D. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.
  • Chronic Fatigue Syndrome - Information, Guides, and References 19 January 2010 9:53 UTC modern-bibliography.tripod.com [Source type: Academic]
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Reduced oxidative muscle metabolism in chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ What you describe sounds like cfs, chronic fatigue syndrome, and also fibromyalgia symptoms.
  • Our Earth Clinic collection of remedies to Cure Chronic Fatigue Syndrome. 19 January 2010 9:53 UTC www.earthclinic.com [Source type: General]

.December 2008" style="white-space:nowrap;">[citation needed] Multiple chemical sensitivity, Gulf War syndrome and post-polio syndrome have symptoms similar to those of CFS,[86][87] and the latter is also theorized to have a common pathophysiology.^ Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Kilburn KH. Symptoms, syndrome, and semantics: multiple chemical sensitivity and chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ A controlled comparison of multiple chemical sensitivities and chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[87]
.Although post-Lyme syndrome and CFS share many features/symptoms, a study found that patients of the former experience more cognitive impairment and the patients of the latter experience more flu-like symptoms.^ Women are more likely to have CFS. .
  • Health Information 19 January 2010 9:53 UTC www.mmc.org [Source type: FILTERED WITH BAYES]

^ Hammond DC. Department of Physical Medicine & Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA. A 21 year old patient reported a relatively rapid onset of serious chronic fatigue syndrome (CFS), with her worst symptoms being cognitive impairments.
  • Chronic Fatigue Syndrome Help 19 January 2010 9:53 UTC fmscommunity.org [Source type: Academic]

^ High levels of rT3 have been found in post-operative patients subsequent to high cortisol output.

[88]
.A 2006 review found that there was a lack of literature to establish the discriminant validity of undifferentiated somatoform disorder from CFS. The author stated that there is a need for proponents of chronic fatigue syndrome to distinguish it from undifferentiated somatoform disorder.^ Human herpesviruses in chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Interventions for the treatment and management of chronic fatigue syndrome: a systematic review.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Patarca R. Cytokines and chronic fatigue syndrome.

.The author also mentioned that the experience of fatigue as exclusively physical and not mental is captured by the definition of somatoform disorder but not CFS.[89] Hysterical diagnoses are not merely diagnoses of exclusion but require criteria to be met on the positive grounds of both primary and secondary gain.^ Physical and mental fatigue at rest .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Diagnosis CFS is diagnosed on clinical grounds.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Fatigue in people with CFS is typically exacerbated by physical tasks previously achieved with ease, and recovery from periods of worsened fatigue can take hours or even days.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[90] .Primary depression can be excluded in the differential diagnosis due to the absence of anhedonia and la belle indifference, the variability (lability) of mood, and the presence of sensory phenomena and somatic signs such as ataxia, myoclonus and most importantly, exercise intolerance with paresis, malaise and general deterioration.^ CFS. The most common were cognitive behavior therapy, anti-depressants, graded exercise or exercise, and supplements.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ In adults presenting for medical assessment with fatigue states the most common alternative diagnosis to consider is major depression.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Patients who complain of persisting "fatigue" or "tiredness" may be describing any one of a diverse range of clinical phenomena, ranging from muscle weakness to dyspnoea or depressed mood.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

.December 2008" style="white-space:nowrap;">[citation needed] Feeling depressed is also a commonplace reaction to the losses caused by chronic illness[91] which can in some cases become a comorbid situational depression.^ Lehman AM, Lehman DR, Hemphill KJ, Mandel DR, Cooper LM. Illness experience, depression, and anxiety in chronic fatigue syndrome.

^ Creswell C, Chalder T. The relationship between illness attributions and attributional style in Chronic Fatigue Syndrome.

^ Chronic exposure to industrial solvents, insecticides or pesticides may cause an illness resembling CFS 417 - 419 (Level IV).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

Co-morbidity

.Many CFS patients will also have, or appear to have, other medical problems or related diagnoses.^ CFS patients appear to be alcohol intolerant.

^ Has as a primary concern CFS patients’ continued lack of access to medical care.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ The New Jersey CFS Association, which just held its fall physician/patient conference, has awarded its third medical student scholarship.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

.Co-morbid fibromyalgia is common, where only patients with fibromyalgia show abnormal pain responses.^ Recently there have been studies with two thousand patients showing something called circulating immune complex is abnormal.
  • CHRONIC FATIGUE SYNDROME 19 January 2010 9:53 UTC www.garynull.com [Source type: Original source]

^ (CNS) function resulting from an abnormal immune response against a common antigen; 16 , 165 , 166 .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[92] .Fibromyalgia occurs in a large percentage of CFS patients between onset and the second year, and some researchers suggest fibromyalgia and CFS are related.^ Asbring P, Narvanen AL. Ideal versus reality: physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia.

^ Responding to a question about the link between HLA [human leukocyte antigen] and CFS, Dr. Rowe said she had not measured HLA levels in all of her patients, but that she has read other research where there has been an association.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Imagine that—in one year, a million dollars, a science director, and 20-some proposals promising very exciting research.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[93] .As previously mentioned, many CFS sufferers also experience symptoms of irritable bowel syndrome, temporomandibular joint pain, headache including migraines, and other forms of myalgia.^ They have been evaluated not only in patients with CFS, but in a wide variety of other closely related and often chronically debilitating medical and psychological disorders (eg, chronic pain, chronic daily headache, irritable bowel syndrome and chronic depression).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ The comprehensiveness and extent of representation of CFS information was included, and CFS was compared with to other illnesses.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Rejection by family, friends, peers and doctors leads many to experience CFS as a "delegitimising" illness.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

.CFS patients have significantly higher rates of current mood disorders than the general population.^ As with many other chronic medical disorders, it is better for patients with CFS to be empowered through appropriate self-management and self-monitoring techniques 482 rather than passively submitting to fruitless investigations and marginally effective medical interventions.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ When patients have been definitively diagnosed with a medical or psychiatric condition known to be associated with marked fatigue, a separate diagnosis of CFS is generally not justified.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ However, certain agents have been found to be beneficial for patients with CFS, particularly those with significant mood or sleep disturbances.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[94] .Compared with the non-fatigued population, male CFS patients are more likely to experience chronic pelvic pain syndrome (CP/CPPS), and female CFS patients are also more likely to experience chronic pelvic pain.^ Human herpesviruses in chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Patarca R. Cytokines and chronic fatigue syndrome.

^ IgG1 subclass deficiency in patients with chronic fatigue syndrome [letter].
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[95] .CFS is significantly more common in women with endometriosis compared with women in the general USA population.^ There is a slight increase in anxiety among CFS patients compared with the control group, particularly with panic attacks, which occur about 10 percent more frequently.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ In samples of patients from treatment centres, CFS appears to be more common in women (typically in a ratio of 2-3:1 30 ), but this may be because women attend all levels of medical care more frequently than men.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ The base rate of depression among adolescents in Victoria is 20 percent, which is comparable to the rate among those with CFS. There is a 7 percent increase in depression among the more severe cases of CFS that is associated with: .
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[96]

History

In 1934 an outbreak then referred to as atypical poliomyelitis (at the time it was considered a form of polio) occurred at the Los Angeles County Hospital. .It strongly resembled what is now called chronic fatigue syndrome and affected a large number of nurses and doctors.^ Human herpesviruses in chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Patarca R. Cytokines and chronic fatigue syndrome.

^ Defining and managing chronic fatigue syndrome.

[97] In 1955 at the Royal Free Hospital in London, United Kingdom, another outbreak occurred that also affected mostly the hospital staff. .Also resembling CFS, it was called both Royal Free disease and benign myalgic encephalomyelitis and formed the basis of descriptions by Acheson, Ramsay, and others.^ Depression in patients with neuromyasthenia (benign myalgic encephalomyelitis).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Some people with CFS have Myalgic Encephalomyelitis, but in the US, this more accurate term for a subgroup of people with the illness is not recognized.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ What other terms are commonly used for CFS? In the United Kingdom the earlier term "myalgic encephalomyelitis" ("ME") 47 is still in use, and in the United States the term "chronic fatigue and immune dysfunction syndrome" (CFIDS) is in widespread popular use.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[98] .In 1969 benign myalgic encephalomyelitis was first classified into the International Classification of Diseases under Diseases of the nervous system.^ Changing the name from Myalgic Encephalomyelitis (as it was known in Canada, Australia, and Britain) and Epidemic Neuromyesthenia (as it was known in the United States – or for that matter, “chronic Epstein-Barr Virus,” the name NIH first gave to the disease, to “chronic fatigue syndrome,” has had international consequences.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ Better alternatives for a name would be: (a) to adopt the name that has been in continuous use for 50 years internationally, Myalgic Encephalomyelitis; (b) compromise: adopt the designation in the World Health Organization's current International Classification of Diseases - "ICD-10", in which "CFS" is classified in G93.3, the code created for Myalgic Encephalomyelitis in the late 1960s.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ We would encourage the classification of CFS as a “Nervous System Disease” as worded in the ICD-10 G93.3.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

[99]
.The name chronic fatigue syndrome was proposed in the 1988 article, "Chronic fatigue syndrome: a working case definition", (the Holmes definition), to replace chronic Epstein-Barr virus syndrome.^ Human herpesviruses in chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ The chronic fatigue syndrome: a comprehensive approach to its definition and study.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Patarca R. Cytokines and chronic fatigue syndrome.

.This research case definition was published after US Centers for Disease Control and Prevention epidemiologists examined patients at the Lake Tahoe outbreak.^ I review the first pediatric CFS case definition and e-mail my thoughts back to one of the researchers.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ In fact, the case working definition that's used by the Center for Disease Control to diagnose chronic fatigue requires, as a major criteria, that you exclude all other possible illnesses of which there are many since fatigue is so ubiquitous across illnesses.
  • CHRONIC FATIGUE SYNDROME 19 January 2010 9:53 UTC www.garynull.com [Source type: Original source]

^ She said that if CDC investigators are using a broader case definition than those used in more focused studies, the research will yield different results.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[14][100][101] In 2006 the CDC commenced a national program to educate the American public and health care professionals about CFS.[102]

Society and culture

Economic impact

.Reynolds et al (2004), estimated that the illness caused about $20,000 per person with CFS in lost productivity which totals to $9.1 billion per year in the United States.^ Later the cost was reduced to $20,000 per year.
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

^ In 2004, it was estimated that the costs associated with having a family member ill with CFS is approximately $20,000 per family per year.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ In the United States, prevalence estimates among adolescents reported by Marshall 160 depended on the method of case acquisition.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[19][103]

Social issues

.A study found that CFS patients report a heavy psychosocial burden.^ A qualitative study of people with CFS found that lack of perceived medical support and understanding was associated with increased seeking of alternative medicine.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Mostly what’s going on in the GCRC study is to look at CFS patients’ response to the psychosocial stressor—a speaking test.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ However, certain agents have been found to be beneficial for patients with CFS, particularly those with significant mood or sleep disturbances.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[104] .A survey by the Tymes Trust reported that children with CFS often state that they struggle for recognition of their needs and/or they feel bullied by medical and educational professionals.^ Comerford: If you have an effective IEP in place, CFS patients can do well, and they feel better about themselves.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ People with CFS often have concurrent depression, and this need not exclude the diagnosis.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ We need something with government authority, like the tablets down from the hill saying that there is such a thing as CFS in children and that it can be very disabling.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[105] .The ambiguity of the status of CFS as a medical condition may cause higher perceived stigma.^ The report calls for further research into the condition but warns that it may be years before a physical cause is found.
  • Chronic Fatigue Syndrome Help 19 January 2010 9:53 UTC fmscommunity.org [Source type: Academic]

^ A qualitative study of people with CFS found that lack of perceived medical support and understanding was associated with increased seeking of alternative medicine.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Chronic exposure to industrial solvents, insecticides or pesticides may cause an illness resembling CFS 417 - 419 (Level IV).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[106]

Support groups

.A study found that CFS patients in support groups reported no change in negative interactions compared to an improvement in negative interactions reported by those treated with Cognitive Behavioural Therapy.^ The role of patient support groups — .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Those who scored as “well” compared with the whole CFS group: .
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ CFS patients reported they had experienced a negative interaction with a healthcare provider.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

[107] .Patients with greater amounts of negative interactions received worse social support on average than disease-free cancer patients or healthy controls which, in turn, led to greater fatigue severity and functional impairment than CBT-treated patients.^ A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ A randomized double-blind placebo-controlled trial of moclobemide in patients with chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ A double-blind, placebo-controlled trial of intravenous immunoglobulin therapy in patients with chronic fatigue syndrome.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[107]

Doctor-patient relations

.Some in the medical community did not at first recognize CFS as a real condition, nor was there agreement on its prevalence.^ There are standards by which schools are accredited, but those are deliberately broad to give the faculty of the medical schools the latitude to do what they need to do, and to recognize that schools have different missions and different emphases, such as research versus community practice.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ I’m in the Office of Medical Listings Improvement where we’ve formed an ad hoc work group to address the concerns of the CFS community.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ I was at Cal Ripken’s last baseball game, and at some point after the 5th inning I suffered a blackout (as I did the first time in 1994).
  • Obama_Biden_Trasition_Report 20 September 2009 11:011 UTC www.vtcfids.org [Source type: FILTERED WITH BAYES]

[108][109] .There has been much disagreement over proposed causes, diagnosis, and treatment of the illness.^ Making a diagnosis of CFS should also mark the end of investigations to exclude other causes of illness (except at annual review - see Box 2.2 ).
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[110][111][112][113][114] .The context of contested causation may affect the lives of the individuals diagnosed with CFS, affecting the patient-doctor relationship, the doctor's confidence in their ability to diagnose and treat, ability to share issues and control in diagnosis with the patient, and raise problematic issues of reparation, compensation, and blame.^ Diagnosis CFS is diagnosed on clinical grounds.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Importance of the doctor-patient relationship — .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ This will enable doctors to act as advocates for their patients by providing appropriate information to relevant individuals and institutions.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[115] .A major divide exists over whether funding for research and treatment should focus on physiological, psychological or psychosocial aspects of CFS. This division is especially great between patient groups and psychological and psychosocial treatment advocates in Great Britain.^ Seventy-five researchers have been funded to do CFS research.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ The Work Group deliberated through what avenue to best shape CFS research and decided to focus on neuroimmune mechanisms.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ An individualised management program should be carefully negotiated between the patient and doctor, with particular attention to: .
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[114] Sufferers describe the struggle for healthcare and legitimacy due to bureaucratic denial of the condition because of its lack of a known etiology. .Disagreements over how the condition is dealt with by health care systems has resulted in an expensive and prolonged conflict for all involved.^ We have some 30 patients involved, but I’m not sure how all of that works.
  • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

^ Chronic fatigue and the chronic fatigue syndrome: prevalence in a Pacific Northwest health care system.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

^ Management In the early stages reassurance and supportive care is generally all that is required, as most prolonged fatigue states will resolve spontaneously.
  • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

[109][116]

Controversy

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Further reading

  • ed. by (2003). .Jason LA; Fennell PA & Taylor RR. ed.^ Taylor RR, Jason LA. Sexual abuse, physical abuse, chronic fatigue, and chronic fatigue syndrome: a community-based study.
    • Chronic Fatigue Syndrome - Information, Guides, and References 19 January 2010 9:53 UTC modern-bibliography.tripod.com [Source type: Academic]
    • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

    ^ Jason LA, Taylor RR, Kennedy CL, et al.

    ^ Jason LA, Taylor R, Wagner L, et al.
    • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

    .Handbook of Chronic Fatigue Syndrome.^ Shepherd C. Cognitive behaviour therapy for chronic fatigue syndrome.

    ^ Hickie IB, Lloyd AR, Wakefield D. Chronic fatigue syndrome: current perspectives on evaluation and management.
    • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

    ^ Marion L., Washington, DC Accompanying Documents: Testimony to the DHHS Chronic Fatigue Syndrome Advisory Committee; Hypothesis: Chronic fatigue syndrome is cause by dysregulation of hydrogen sulfide metabolism .
    • Chronic Fatigue Syndrome Advisory Committee (CFSAC) 19 January 2010 9:53 UTC www.hhs.gov [Source type: FILTERED WITH BAYES]

    .John Wiley & Sons.^ Chicester: John Wiley and Sons, 1995: 323-334.
    • eMJA: Chronic fatigue syndrome 19 January 2010 9:53 UTC www.mja.com.au [Source type: Academic]

    ISBN 978-0471415121.
     

External links


Wikibooks

Up to date as of January 23, 2010

From Wikibooks, the open-content textbooks collection

Contents

Chapter 1: Introducing

About the authors

I would like to start this new wikibook as part of a interdisciplinary bachelorthesis project. This project consist of making a interdisciplinary thesis by two persons of the Liberal Arts & Sciences Study at the University of Utrecht. I'm doing my project together with Niels van Miltenburg who will approach our subject from the perspective of a philosopher an I, Rik van Velzen, will take a biological approach.

Content

Although CFS has multiple etiologies and treatmeant differ from a wide range of various drug treatments to behavioral therapies (Cognitive Behavioral Therapy[[1]], Behavioral Interventions[2], Counselling, etc.), cfs seem to have some clear biochemical characteristics. For example Dr. De Meirleir was able to predict with an accuracy of 99% [3] which blood samples where from CFS patients by measuring the 37/80 kDa RNase L ratio.[4]

Concept Layout of Book

Type of Book: Textbook/Thesis
Difficulty level: Intermediate/advanced level for University student
Disciplines: (neuro)Biology, philosophy, psychology
Aim of the book: Next to creating a book on Chronic Fatigue Syndrom (CFS) and reflecting on medical/therapeutical approaches of psychosomatica (CFS in this specific case) the aim of this book is to support in writing the bachelor thesis for Niels/Rik's project. --rik 17:43, 2 December 2006 (UTC)

Chapter 2: What is Chronic Fatigue Syndrome

This section is not yet finished. Any help on this section is welcome

Chronic Fatigue Syndrome (CFS)[5], which is also known as myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS), and various other names, is a syndrome (or group of syndromes) of unknown and possibly multiple [[6]], affecting the central nervous system (CNS), immune, and many other systems and organs. There is no simple diagnostic test; CFS is a diagnosis of exclusion, although recent research indicates biological hallmarks of the syndrome, and a diagnostic test is predicted soon.

It is important to be aware that the disease Myalgic Encephalomyelitis, which has had a World Health Organisational classification since 1969, is not the same illness as the subsequently-named 'Chronic Fatigue Syndrome' definitions, although they are sometimes treated as similar [7]. In addition, experts such as Dr Byron Hyde [8] have argued that the various 'CFS' definitions have no practical usefulness, as they are so broad that they clearly encompass those suffering from a range of illnesses, and the concept of 'CFS' should thus be abandoned as in practice it functions to divert attention from fully testing and treating patients for whatever they suffer from, in addition to leading to treatment which is possibly harmful for patients as it is not suitable for their particular illness [9].

In contrast to many of the 'CFS' definitions, Myalgic Encephalomyelitis is not a diagnosis of exclusion [10]. Lack of knowledge of this has led both to people being incorrectly diagnosed with the illness, and also to the stigma that sufferers are complaining of an invisible disease, and must hence have a psychosomatic illness.

Adding to the confusion, some research ostensibly done on 'CFS' population samples has in fact been done on sufferers of M.E., and some research ostensibly done on M.E. has in fact been done using test subjects diagnosed with one of the types of CFS which are quite different from M.E. (for instance the Fukuda criteria), or with those who simply have some sort of fatigue, due to the mistaken belief that M.E. is synonymous with 'chronic fatigue'[11][12](nb some definitions of CFS, such as the 1991 Oxford criteria, are quite synonymous with chronic fatigue and others are not, for instance the Australian CFS definition[13]).

It should not necessarily be concluded that those diagnosed with "Chronic Fatigue Syndrome" have, in contrast to those with M.E., a psychosomatic disorder or problems. Part of the problem of the extremely broad criteria of some CFS definitions is that they can incorporate both those whose fatigue is primarily related to depression and emotional stressors in their lives, and those who have fatigue and other physical symptoms which are caused by undiagnosed physical disorders or diseases. Thus the definition CFS is, as Dr Byron Hyde has written, unhelpful to those with M.E., and unhelpful to those who have been diagnosed with 'CFS'. Dr Hyde advocates that the concept of 'CFS' should be abandoned, as in practice it leads to stigmatizing those with physically-caused illnesses as psychosomatic or hypochondriacs, and is often used as an excuse not to conduct proper testing and treatment of the genuinely ill (by doctors who assume the diagnosis of 'CFS' means that there is no point in conducting more than rudimentary physical tests).

Chapter 3: Therapeutical approaches to Chronic Fatigue Syndrome

This section is not yet finished. Any help on this section is welcome

From Highlights from Dr. Kenny De Meirleir's Lecture:

Some psychiatrists advocate that no tests or lab work be done on ME/CFS patients because testing will reinforce delusion of physically illness. Given the wealth of confirmed biochemical abnormalities, such rationale is ludicrous. Dr. De Meirleir stressed that tests must be done in order to eliminate the cause. A "clean-up" of all the consequences of the problem must also be undertaken. Therapies and the orders of treatment vary according to the patient's unique test profile. Treatment includes:
1. Restoring immune competence
2. Removing microorganisms
3. Restoring hormonal balance
4. Restoring intestinal flora
5. Decreasing prostaglandins and protein kinase activity
6. Removing heavy metals and toxic chemicals

Chapter 4: Biological approaches to Chronic Fatigue Syndrome

This section is not yet finished. Any help on this section is welcome

Dr. De Meirleir is a world renowned researcher and professor of Physiology and Internal Medicin at Free University of Brussels in Belgium. In Highlights from Dr Kenny De Meirleir's Lecture[14] Van de Sande states that numerous infectious agents can trigger ME/CFS. Infectious agents that invade cells release RNA (ribonucleic acid) or DNA (deoxyribonucleic acid) when they reproduce. Normally when a virus infects a cell, an enzyme called RNase L (Ribonulease L) is activated and cuts the RNA of the infectious agent so it cannot replicate itself and cuts the RNA of the infected cell, which triggers the cell's death and removal. Then the RNase L molecule "switches off" and remains inactive so that it doesn't damage healthy cells.

Abnormality in RNase L molecule in ME/CFS Patients
The normal weight of the RNase L molecule is 80 kilo Daltons (kDa). In ME/CFS patients the RNase L molecule is being cut and weighs 37 kDa. The low molecular weight (LMW) of the RNase L molecule can discriminate ME/CFS Patients from healthy people and other illnessses such as fibromyalgia, multiple sclerosis, cancer, AIDS and depression. The Center for Disease Control (USA) sent 100 blood samples to Dr. De Meirleir who was able to identify with an accuracy of 99%, using the test for LMW RNase L, which blood samples came from ME/CFS patients. {|- style="color: red" |NEEDS REFERENCE|}

Abnormal RNase L molecule causes chronic dysfunction of the immune system
The damaged RNase L molecule is not able to kill infectious agents and it keeps damaged cells alive. The body is unable to "switch off" these abnormal RNase L fragments and they also continue to cut the RNA of normal cells. Destructive RNase L fragments are six times more active than normal and consume approximately 70% of the cells' energy (ATP). Un-"switched off" Rnase L fragments destroy normal protein synthesis, enzyme production and other vital cellular functions. They inhibit respiratory muscles and cause hyperventilation, metabolic alkalosis, sleep diturbances and fatigue. Furthermore there is sodium retention, low magnesium levels and dramatically low levels of potassium. Natural killer cells, which protect against viruses and intracellular infections, are also being damaged. Thus, the immune system is in a state of chronic dysfunction.

Chapter [one of the lasts]: Philosophical Reflections on Therapeutical approaches

This section is not yet finished. Any help on this section is welcome

Van de Sande points out that these findings confirm an organic origin of ME/CFS and validate diagnosis of ME/CFS.
This idea of there being an organic origin (instead of a mental) suggest a sepparation between mental and physical phenomena which, as we would like to argue in this wikibook, might be a false view and we would like to argue that there is no difference between mental and physical phenomenon. Instead of trying to find treatments on medical or mental bases we should work towards a holistic approach. Problem only is that "mental" phenomenon work as complex non-linear systems for which we can't easily point out which physical constitutions causes which mental phenomenon and vice versa. With reviewing some recent developments in the research on Embodiment we would like to get a better idea how the mental and the physical interact.

Bibliography

Bibliography:

Cromby, Between constructionism and Neuroscience, the societal Co-constructionism and Neuroscience, Theory and Psychology, Vol 14(6), 2004.
Cromby, Embodied Subjectivity in Chronic Fatigue Syndrome: a phenomenological analysis, (in press).
Hermans, The Dialogical Self as a society of Mind, Theory and psychology, Vol 12(2), 2002.
Lewis, The dialocial brain: Contributions of emotional neurobiology to understanding the dialogical self', Theory and psychology, Vol 12(2), 2002.
Lysaker & Lysaker, Narrative structure in Psychosis: Schizophrenia and Disruptions in the Dialogical Self, Theory and psychology, Vol. 12(2), 2002.
Franssen & Van Geelen, Silence and the dialogical self: Considerations on Polyphony and Authorship, ??, University Utrecht/University Medical Center, 2006.
Varela & Thompson, Radical embodiment: neural dynamics and consciousness, TRENDS in cognitive sciences, Vol. 5 No. 10 October 2001.


--rik 17:15, 2 December 2006 (UTC)

Footnotes

  1. ^  Sande, van de, M., Highlights from Dr. Kenny De Meirleir's Lecture, Calgary, Alberta, april 2, 2006.
  2. ^  Chambers, D, Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review, D Chambers, AM Bagnall, S Hempel and C Forbes is published in the October 2006 issue of the Journal of the Royal Society of Medicine.
  3. ^  Suhadolnik, R., "Clinical and Biochemical Characteristics Dfiferentiating Chronic Fatigue Syndrome from Major Depression and Healthy Control Populations: Relation to Dysfunction in the RNase L Pathway" in Journal of Chronic Fatigue Syndrome, Vol. 12(1), 2004.

Citable sentences

Up to date as of December 21, 2010

Here are sentences from other pages on Chronic fatigue syndrome, which are similar to those in the above article.








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