DEAR DOCTOR K:
I have CFS. What is the latest information about the condition, particularly treatments?
For readers who are not familiar with the condition, CFS stands for chronic fatigue syndrome. Fatigue is a universal human experience. In our increasingly pressured and fast-paced lives, many people feel tired a lot of the time. In fact, fatigue is one of the most common reasons people visit their doctor. Yet very few people with fatigue are suffering from CFS. It is relatively uncommon, affecting about 4 to 8 out of every thousand adults in the U.S., and a small fraction of teenagers and younger children.
People with CFS experience ongoing, severe, debilitating fatigue that is not relieved by rest. Other symptoms include: Impaired memory or concentration, sore throat, swollen glands, muscle pain, pain in multiple joints, headaches, and exhaustion following physical activity.
We don’t know what causes CFS. People with CFS are more likely than healthy people — and people with other fatigue-causing diseases — to have various abnormalities.
Many have chronic activation of different parts of the immune system. Many have problems with their cells making enough energy. Many have biochemical abnormalities called oxidative and nitrosative stress.
Then there are problems involving the brain that have been found, thanks to brain imaging techniques (MRI, SPECT and PET). Brain hormones often respond differently to challenges. Electrical brain wave studies often show differences. The autonomic nervous system, the part of the brain that controls basic body functions — such as heart rate, blood pressure and body temperature — often does not work properly. But the abnormalities are not seen in all patients with CFS, and they come and go. What is causing these abnormalities remains uncertain.
A combination of the following strategies may help manage your symptoms:
- Set priorities. Make a list of things you want to have more energy to do. Eliminate as many nonessential activities as you can. But be careful to guard against becoming too passive.
- Exercise. Begin an exercise program in which you gradually increase your activity level. This can effectively reduce the severity of your symptoms.
- Cognitive behavioral therapy (CBT). CBT is a type of psychotherapy. It helps you identify and change negative thoughts and behaviors. CBT can reduce symptoms.
- Tricyclic antidepressants. Low doses of this type of antidepressant may improve the quality of your sleep, reduce pain, and increase energy.
- Other medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol) can help relieve headaches, joint pain and muscle pain. Fish oil capsules (3,000 mg per day) may also help reduce CFS symptoms.
There are also several experimental treatments in development. These include drugs to treat abnormalities of the autonomic nervous system, to quiet activated parts of the immune system, and antiviral drugs (for people with certain active viral infections).
I am impressed by the progress made in understanding CFS over the past 25 years. It was made possible by research conducted and supported by the National Institutes of Health, Centers for Disease Control and Prevention, and private foundations. Still, we have a lot more to learn.