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fatigue syndrome (CFS), sometimes called myalgic encephalomyelitis (ME), is a condition that makes you feel so
tired that you can't do all of your normal, daily activities. There are other
symptoms too, but being very tired is the main
one. Some people have severe fatigue and other symptoms for
CFS is not well understood. Most experts now
believe that it is a separate illness with its own set of symptoms. But some
doctors don't believe this.
There are no tests for CFS. Because
of this, many people have trouble accepting their disease or getting their
friends and family to do so. Having people who believe your diagnosis and
support you is very important. Having a doctor you can trust is critical.
Your tiredness is real. It's not "in your head." It is your
body's reaction to a mix of factors.
Doctors don't know what causes
CFS. Sometimes it begins after a viral infection, but there is no proof
of any connection. It's likely that a number of factors or triggers come
together to cause CFS.
Extreme tiredness, or
fatigue, is the main symptom. If you have CFS:
Depression is common with CFS, and it can make your other
There are no tests for CFS.
Doctors can diagnose it only by ruling out other possible causes of your
fatigue. Many other health problems can cause fatigue. Most people with
fatigue have something other than chronic fatigue syndrome.
There is no treatment for CFS
itself, but many of its symptoms can be treated. A good relationship with your
doctor is important. That's 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.
Some trial and error may be needed, because no single combination of
treatments works for everyone.
Home treatment is very important.
You may need to change your daily schedule, learn better sleep habits, and
use regular gentle movement or exercise to fight fatigue. Even at times when you have more energy, keep a low-key pace throughout each day. Rest often.
Living with CFS can be as much a mental health challenge as it is a physical one. Take steps to avoid getting caught
in a cycle of frustration, anger, and depression. Learning to cope with your
symptoms and talking to others who have CFS can help. So can working with a counselor.
Learning about chronic fatigue syndrome (CFS):
Living with chronic fatigue syndrome (CFS):
Health Tools help you make wise health decisions or take action to improve your health.
Doctors don't know what causes
chronic fatigue syndrome (CFS). For many people, CFS symptoms start after a viral illness. In some cases, CFS seems to follow a major physical or emotional trauma or an exposure to toxins. But there is no single known cause of CFS.
Other theories point to the
immune system, glands and hormones, and family history. But again, there's not enough evidence to prove
a solid connection.
Chronic fatigue syndrome (CFS) symptoms usually start suddenly. But for some people, they develop gradually over weeks or months. Symptoms can change in a day, and from day to day. They tend to stop (remission) and then start again (relapse).
There is broad range of CFS symptoms. But there is a core set of symptoms that affect nearly everyone with CFS. These core symptoms are:
A person with CFS also has two or more of these symptoms:
CFS also causes the following symptoms. Different people with CFS have different combinations of:
Having depression along with CFS is common and can make CFS symptoms
causes symptoms that are the same as many other diseases, especially early on. For this reason, it can be diagnosed only after a thorough evaluation has ruled
out other conditions with similar symptoms.
In some cases,
chronic fatigue syndrome (CFS) develops after a flu-like
illness such as
mononucleosis (mono) or after a period of unusual stress. But it may
also occur without warning, even if you have not been sick.
fatigue may come upon you gradually or quite suddenly. Because fatigue can be
vague and can be caused by many things, you might not pay attention to the
problem for several weeks or months. It is hard to say what is normal with CFS. That's
because the diagnosis often is not clear for some time.
Some people find the fatigue, pain, and thinking problems
caused by CFS greatly hamper their lives. But other people are not nearly as
People who have
chronic fatigue syndrome (CFS) are generally 25 to 45
years of age. Women are more likely to have CFS.
CFS is rare in
children. It may occur in teens, especially young teenage girls. Unlike
adults, teens are more likely to develop CFS after having a flu-like illness.
It's important to talk to your
doctor about any symptoms you may have.
Call your doctor if
Watchful waiting refers to a period of time in which you are being
watched by your doctor but are not getting treatment. A month or two of paying close attention to your
sleep habits, getting regular moderate exercise, trying to control stress, and
eating a balanced diet will take care of most cases of fatigue not caused by
CFS or another medical problem. But if your fatigue has not improved after
1 to 2 months of self-care, or if fatigue won't go away and limits your usual
activities, call your doctor.
If you have been diagnosed with CFS,
pay attention to any new symptoms and report them to your
doctor. 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
The following health professionals can evaluate
fatigue and other symptoms:
There are doctors who specialize in the treatment of CFS.
Get a recommendation from your family doctor or a local CFS support group
before you make an appointment with a specialist. It is always wise to start with
your family doctor. You may also be referred to a physiatrist, psychologist, or
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Chronic fatigue syndrome (CFS) is hard to diagnose. It is common to have normal test results when you have CFS. Fatigue is an extremely common
problem, and it can have many other causes. CFS can be diagnosed only by ruling
out other conditions.
First, your doctor will ask you about past health and do a physical exam. Experts have
come up with a specific list of symptoms to decide whether a person has CFS.
Doctors use a variety of tests to rule out other conditions. These tests
These are routine lab tests. Other tests may be done if
your symptoms, history, and physical exam suggest other possible problems.
These other tests may include:
Some doctors may order tests that check your
immune system. These can be expensive and generally
are done only in research settings. Also, it's hard to know what the
findings of these tests mean. That's because so little is known about the immune
system's connection to chronic fatigue syndrome.
Since there is not yet a cure for chronic fatigue syndrome (CFS), the key to living with CFS is treating your symptoms.
Start by listing your worst symptoms—the ones that make it hardest to get through the day. With your doctor, focus first on treating those symptoms. Decide whether a specialist might be helpful for any of them.
The most common CFS symptoms can also be the most treatable.
Good sleep habits can help improve the quality of your sleep. If you also try medicine for sleep, it's best to start on a low dose. Certain antidepressants help with sleep, mood, and chronic pain, so your doctor may suggest trying one.
Different kinds of pain can be treated in different ways. If one treatment doesn't work, you and your doctor can try another until you find what works best for you.
Do all you can to take charge of your fatigue level. Even when you have more energy, keep a low-key pace throughout each day.
Living with CFS can be as much a mental health challenge as it is a physical one. It's easy to get caught
in a cycle of frustration, anger, and depression.
You can expect your symptoms to come and go. For some people, certain things trigger long periods of worse symptoms. Visit your doctor every few months to help
track your symptoms and check for any need to change your treatment.
Get specialized care if you need it. For example:
There are many
unproven remedies, such as special diets or mineral
supplements, that some people recommend for treating CFS. There is no evidence
that any of these are effective.1
Your mind and body are connected and affect each other. Physical illnesses
can be made worse—or better—by your feelings and attitudes, and vice versa. Learn as much as you can about CFS. Then work with your doctor to learn
ways to cope with your symptoms. Get emotional support from your health
professionals as well as from your family and friends.
Chronic fatigue syndrome (CFS) can't be prevented or cured. But treatment can help control or reduce symptoms.
Home treatment is the most important
part of treating
chronic fatigue syndrome (CFS). You
can take steps to control and sometimes relieve your CFS symptoms:
Try to be patient. Keep in mind that daily home treatment
usually helps relieve or control CFS symptoms. Your doctor may suggest
cognitive-behavioral therapy to help you with your home treatment.
Medicines do not cure
chronic fatigue syndrome (CFS). But they can help relieve
Over-the-counter medicines include:
Prescription medicines include:
Some research has studied the
corticosteroids (such as hydrocortisone and
fludrocortisone) to treat chronic fatigue syndrome (CFS). Studies have shown
that these medicines don't work very well to treat CFS. And the side effects
can be serious. Unless corticosteroids can be shown to have a greater benefit
for people with CFS over a longer period of time, the side effects associated
with long-term corticosteroid therapy outweigh the benefits from their use in
often becomes a part of
chronic fatigue syndrome and can make your symptoms worse. Like any medical
illness, depression needs to be treated. If you have CFS and feel depressed,
talk to your doctor and get treatment .
The best treatment for your chronic fatigue syndrome (CFS) is what makes you feel better. Along with daily self-care and the treatment you get from your doctor, you might find that other treatments help too.
There are safe nontraditional
treatments that can relieve
pain and stress, ease muscle tension, help you feel better and healthier, and
improve your outlook and quality of life.
Some popular complementary treatments include:
There are many unproven treatments for CFS. Some of the more popular ones include:
None of these complementary
treatments have been proven effective in treating CFS, but some people have
reported feeling better after using them. If you have CFS and are thinking
about trying a complementary treatment, get the facts before you begin. Consider
these questions with your doctor:
Avoid products that claim to have a "secret" ingredient or that claim
to cure CFS. Currently, there is no cure for CFS. Any benefit reported as a
result of using a product is most likely due to improved symptom management,
chance, or, possibly, the illness running its course.
For more information, see the topic
Reid S, et al. (2011). Chronic fatigue syndrome, search date March 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Other Works Consulted
Bleijenberg G, Van Der Meer JWM (2012). Chronic fatigue syndrome. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 3519–3521. New York: McGraw-Hill.
Engleberg NC (2010). Chronic fatigue syndrome. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., pp. 1897–1904. Philadelphia: Churchill Livingstone Elsevier.
Sadock BJ, Sadock VA (2007). Chronic fatigue syndrome.
Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 652–657. Philadelphia:
Lippincott Williams and Wilkins.
White PD, et al. (2011). Comparison of adaptive pacing therapy, cognitive behaviour
therapy, graded exercise therapy, and specialist medical care
for chronic fatigue syndrome (PACE): A randomised trial. Lancet, 377(9768): 823–826.
Current as of:
March 12, 2014
Anne C. Poinier, MD - Internal Medicine
& Nancy Greenwald, MD - Physical Medicine and Rehabilitation
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