We often feel overtired and have an extreme lack of energy and a strong desire to sleep it all off. But how long does this tiredness last? Well, if this bone-crushing fatigue persists for months, then it might be a mysterious condition known as Chronic fatigue syndrome also known as myalgic encephalomyelitis, myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS. This deep and extreme exhaustion affects women twice to four times as often as men, according to numerous studies. However, what causes this unknown condition that typically affects women between the ages of 25 to 45 years is still not known. Health experts maintain that it can affect adolescents and children as well.
The Center for Disease Control (CDC) in the U.S. estimates that 836,000 to 2.5 million Americans suffer from CFS, however, the majority of them are undiagnosed. Reportedly, the United States loses between US$9 to 25 billion each year in reduced productivity and medical expenses due to CFS. However, statistics on this condition in India are sparse.
What is Chronic fatigue syndrome (CFS)?
Chronic fatigue syndrome (CFS) is a complicated disorder that is characterised by extreme fatigue that lasts for at least six months and that can’t be fully explained by any underlying medical condition. According to doctors, fatigue worsens with physical or mental activity in people who suffer from this condition, but it doesn’t improve with rest. Most recently, the condition is termed systemic exertional intolerance disease (SEID).
According to doctors and health experts, there’s no single test to diagnose chronic fatigue syndrome. There is a need to conduct a variety of medical tests to rule out other health problems that have similar symptoms. Additionally, treatment for chronic fatigue syndrome focuses on improving symptoms. Due to this lack of tests, doctors often have a hard time describing this disease.
“Chronic Fatigue Syndrome is a condition in which there is profound fatigue that is unexplained by any medical condition. The duration lasts for at least six months and usually, there is a lot of pain in the body. The patient who suffers from chronic fatigue syndrome does not have very refreshing sleep, is always tired and as such, there is no medical condition or underlying disease that explains signs of fatigue,” Dr. Ankita Baidya, Consultant – Infectious Disease, HCMCT Manipal Hospital, Dwarka told Financial Express.com.
Decades ago this complex condition was dismissed as a “psychological disorder” and patients were sent to psychological wards for treatment. Now, doctors and health experts across the world are now recognising this condition as a serious long-term illness.
Possible cause of Chronic fatigue syndrome (CFS)
Dr. Ajay Agarwal – Director & HOD, Internal Medicine, Fortis Hospital Noida told Financial Express.com that the exact cause of Chronic fatigue syndrome is still not known but various hypotheses are that it can be precipitated by viral infection herpes zoster, Epstein bar virus, and stress-induced. Meanwhile, Dr. Ankita Baidya informed that in the majority of the CFS cases, there is a history of viral infection.
“Post-COVID, we have seen a lot of patients complaining of chronic fatigue syndrome. Immune system imbalance, poor immunity can sometimes result in triggering this condition. Hormonal imbalances are the third reason why we can see the prevalence of this condition but usually, the levels of these hormones are not in the range that we need to medically treat them,” Dr. Baidya said.
She also emphasised that it has been observed that with different hormonal imbalances especially with the pituitary gland or hypothalamus, there has been an association with chronic fatigue syndrome and sometimes physical or mental stress can also lead to this condition.
This complex condition hits the people who are usually young leaving as many as 75 percent of them unable to work and 25 percent completely bedridden. In 2009, a study, published in the journal JAMA Psychiatry, established a link between childhood trauma and CFS risk. Recently, several studies have highlighted that COVID-19 or post-COVID complications may also lead to CFS.
Symptoms of Chronic fatigue syndrome (CFS)?
Those who are suffering from this mysterious condition can have a hard time doing very basic physical acts. According to doctors, as the name suggests, chronic fatigue syndrome usually has the most common symptom of fatigue, especially after physical or mental exercise. When a person suffers from chronic fatigue syndrome he/she feels very tired and exhausted symptoms persist for more than six months. There are also symptoms like memory issues and brain fog, headaches, sore throat, enlarged lymph nodes in the neck and armpits, and muscle and joint pains. There are difficulties in focus and also dizziness while getting up from lying down or sitting.
Moreover, the diseases which cause similar symptoms like anaemia, diabetes, and thyroid diseases are ruled out by the doctor before labeling a person as CFS. Some diseases like fibromyalgia, irritable bowel syndrome, depression, and sleep disorders may coexist with CFS.
Moreover, CFS can lead to a range of sleep disorders when a person may feel very sleepy but be unable to sleep or not feel refreshed after sleeping. They may experience issues like:
1. intense and vivid dreaming
2. restless legs
3. nighttime muscle spasms
4. sleep apnea
A person suffering from CFS can also experience conditions like:
1. tenderness in the lymph nodes, especially the neck or armpits
2. gastrointestinal problems
3. chills and night sweats
4. allergies to food
5. sensitive to light, touch, heat, or cold
6. muscle weakness
7. shortness of breath
8. irregular heartbeat
9. irritability and mood changesTrusted Source
10. anxiety or panic attacks
11. numbness, tingling, and burning in the hands, feet, and face
12. a low grade fever
13. vision problems
“An important sign is that if you feel very fatigued, very weak, even after sleeping, you are not refreshed and you are still having a weakness. Another sign can be the unwillingness to do many things, and not having the energy to do things. Sometimes, if you have any dizziness, muscle pain, or muscle aches. So, consult your doctor for chronic fatigue syndrome or any other medical condition that has to be taken care of,” Dr. Baidya told Financial Express.com.
Chronic fatigue syndrome (CFS) in India
According to a study published in the British Medical Journal, as chronic fatigue was commonly reported by women in this community study from India, the strongest associations with chronic fatigue were for psychosocial factors which point towards poor mental health and gender disadvantage.
According to experts, due to a lack of awareness and insufficient research, the diagnosis of CFS in India is quite difficult. Several researchers pointed out that medical school textbooks around the globe have little or no descriptions of this condition.
However, experts emphasise that although there is insufficient data about how many people actually suffer from CFS in the country, a lot of people are affected by the CFS and they don’t know what to do about the persistent exhaustion.
Diagnosis and treatment of Chronic fatigue syndrome (CFS) in India
As there is a lack of specific tests for diagnosing CFS, patients are often forced to remain untreated and live with pain for years. There are instances in which a doctor has witnessed only 4-5 cases of CFS in a decade in India.
Generally, a diagnosis is made after taking a complete history, examination, and investigations of the affected person which rule out other medical or psychological conditions which may mimic CFS. According to doctors and health experts, there is no specific cure or treatment for CFS. However, symptoms that are most problematic are addressed first.
“Two things are important in the diagnosis of CFS. One is this important symptom of chronic fatigue. The second is that sleep does not relieve the symptom of fatigue and it is unrefreshing, different body aches and pain is there that are not explained by any other health condition. Sometimes a dizziness vomiting sensation, sometimes giving a typical history of viral infection. After this, they developed chronic fatigue syndrome. So, all these actually guide us towards that the patient might be having chronic fatigue syndrome,” Dr. Baidya told Financial Express.com.
She also pointed out that by ordering certain lab tests to rule out any mental disorder, any laboratory abnormalities, or any other health condition that is actually resulting in fatigue has to be ruled out and then labeled as chronic fatigue syndrome.
“So, the treatment is usually important. One is psychological counseling. The second is by giving adequate health supplements. Vitamin supplements like different antioxidants like vitamin E, and vitamin D sometimes help to overcome the weakness and improve overall well-being. A good, healthy diet and regular physical exercise, yoga, and meditation can also help the patient to come out of the chronic fatigue syndrome slowly and gradually, she added. Moreover, as the causes of CFS are still unknown there is no way to prevent it.
Does COVID-19 lead to chronic fatigue?
Dr. Baidya also highlighted that Chronic fatigue syndrome can affect anybody, in any age group or gender, but usually, it is more commonly seen in females and middle-aged adults.
“We had seen a lot of cases during COVID-19, especially after the third wave, where the patient developed chronic fatigue syndrome as a major complaint after recovery,” she said.
According to a study published in Molecular Psychiatry, after getting infected with COVID-19, a majority of individuals complain about continuing breathlessness and fatigue even months after the onset of the disease.
Doctors across the globe have reported that Chronic fatigue is one of the most commonly reported symptoms among those with long COVID, and experts claim that the increasing number of people dealing with fatigue due to COVID-19 “could have a significant social impact.”
Scientists all over the world who are investigating potential health concerns after COVID-19 have found similarities between long COVID and CFS. A 2021 study published in The Lancet journal revealed that after six months with long COVID participants showed common symptoms like fatigue, cognitive dysfunction, and post-exertional malaise (PEM).
At present, there is no cure for CFS but researchers are hopeful that extensive research into long COVID may provide some crucial insights for people living with CFS/ME.