It's all three types together. Marinaccio says her fatigue spills over into her social and family life, and she worries it may affect her relationships. She has often found herself physically unable to pick up the phone when a friend calls, and then cannot summon the mental energy to return the call. I don't want to be that person who is moody and cranky all the time.
Her fatigue is chronic but unpredictable in its intensity. Some days she can go to the supermarket to shop. Other days, she doesn't even have the energy to make a sandwich.
People who have CFS describe the second core symptom, post-exertional malaise—a serious exacerbation of symptoms after mental, emotional, or physical exertion that may last anywhere from 24 hours to months—as a "crash" or "collapse. Each person has a different fatigue threshold. For Marinaccio, a walk around the block is like running miles for an ordinary person; if she pushes herself beyond that point, she is affected for days. Besides, "this symptom is variable, and [physicians] have to learn to ask the right questions.
Sabin says he regularly encourages his patients to do as much as they can but reminds them that overexertion may be counterproductive. Each person has to identify his or her own threshold and be active up to that point. Some evidence suggests that those who exert up to their threshold can improve, he says, and the threshold may even increase over time. No matter how many hours they sleep, people with CFS universally report feeling unrested when they wake up.
As with many symptoms of CFS, the intensity may vary.
Fresh evidence points to a cause and possible treatments for chronic fatigue syndrome
Initially, Marinaccio says she had difficulty staying asleep because her legs and arms felt achy. She would toss and turn, trying to stretch out. These days she sleeps soundly, but she feels no less tired or achy when she wakes up. As the day goes on, her symptoms lessen, and she feels most energetic in the evenings. The IOM panel noted that many people who have CFS report that they can't process information as quickly as they used to, and that they lack focus and are more forgetful.
This dulling of mental faculties can be as debilitating as the physical fatigue, but it is equally difficult to measure clinically, she says. And neurocognitive testing for the symptoms may not be covered by insurance. Marinaccio, who used to love to read and discuss books, now can only concentrate long enough to listen to audio books in short bursts. Because of this, she has had to put her doctorate on hold for now. The report also found that many people with CFS feel lightheaded or faint or have heart palpitations or other cardiac symptoms when they stand up or after standing for a long time.
Once they sit or lie down, the symptoms diminish. This condition, called orthostatic intolerance, is normally diagnosed and treated by cardiologists—another example, Dr. Levine says, of how CFS cuts across medical specialties. Sabin says the IOM's proposed diagnostic criteria is "a simplification [of the condition], perhaps," but one that clarifies the core symptoms and makes it easier to diagnose. He also thinks the report will draw attention to CFS, and he is happy that it confirms that the syndrome causes real suffering and should not be dismissed by doctors.
Levine says there is still debate about whether other common symptoms of CFS, such as viral infections, muscle and joint pain, and swollen lymph glands, should be included as part of the diagnostic criteria. Otherwise, she thinks the panel's proposed criteria are a good start. Berger adds that he believes too many people whose only symptom is fatigue are diagnosed with CFS. He thinks that physicians should apply the new diagnostic criteria for CFS strictly, and if their patients don't satisfy them in full, they should look elsewhere for underlying causes. Since chronic fatigue was first reported in the s, researchers have put forward theories about its cause, but no single virus or environmental trigger has been proven and no single mechanism has been found.
A outbreak in a hospital in Los Angeles was thought to be a mutation of the poliovirus. An outbreak in in London's Royal Free hospital, which affected many staff members, was considered highly contagious. Another episode in the s near Lake Tahoe was thought to be a chronic form of the Epstein-Barr virus. Recently, many viruses and infectious agents have been studied as potential causes or triggers for the condition, including the human herpesvirus 6, Candida albicans a fungus that causes yeast infections , and bornaviruses a family of viruses found in farm animals and birds that affect neurons.
However, none has been shown to be the single or most likely cause of CFS. Berger, who doesn't believe a single agent is likely to be behind all cases of CFS and is not convinced that a chronic or lingering infection gives rise to the symptoms. The lack of a proven cause or mechanism adds to the amorphous quality of the condition.
After an exhaustive analysis of the medical literature, the IOM committee could not come to any conclusions about what causes CFS, how it works within the body, or how to treat it. The literature offered no consensus on the process or natural progression of the syndrome. Chronic fatigue syndrome morphs over time, says Dr. However, Dr.
Levine thinks researchers are getting closer to finding these biomarkers.
But, Dr. Levine cautions, "it's so complex, we're only scratching the outer surface.
Chronic fatigue syndrome: New evidence of immune role
It's going to take a while. Sabin agrees. Because there is no recognized treatment for CFS, doctors can only treat individual symptoms like pain, difficulty sleeping, and opportunistic infections. Marinaccio still takes medications for acid reflux and irritable bowel syndrome, but her doctor is slowly weaning her off them. Return to footnote 3 referrer. Return to footnote 4 referrer. PloS one. Return to footnote 5 referrer. Quality of life in chronic fatigue syndrome.
Return to footnote 6 referrer. Health-related quality of life in patients with chronic fatigue syndrome: an international study. Journal of Psychosomatic Research. Return to footnote 7 referrer.
Public Health Agency of Canada. Return to footnote 8 referrer. Psychological medicine. Return to footnote 9 referrer. Arch Gen Psychiatry.
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Return to footnote 10 referrer. Evidence for a heritable predisposition to chronic fatigue syndrome. BMC Neurol. Return to footnote 11 referrer. Salit IE. Precipitating factors for the chronic fatigue syndrome. Journal of psychiatric research. Return to footnote 12 referrer. You will not receive a reply. Skip to main content Skip to "About government".
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