Chronic Fatigue Syndrome (CFS)
Incidence of CFS:
Findings indicated that CFS occurs in about 0.42% (95% confidence interval,
0.29%-0.56%) of this random community-based sample. The highest levels of
CFS were consistently found among women, minority groups, and persons
with lower levels of education and occupational status. Chronic fatigue
syndrome is a common chronic health condition, especially for women, occurring
across ethnic groups. Earlier findings suggesting that CFS is a syndrome
primarily affecting white, middle-class patients were not supported by our
Intern Med. Oct.11, 1999;159:2129-2137 - Leonard A.
Classify as CFS if both of the following criteria are met:
CDC Definition of CDC
Clinically evaluated, unexplained chronic fatigue cases can be classified
as chronic fatigue syndrome if the patient meets both the following criteria:
Clinically evaluated, unexplained persistent or relapsing chronic fatigue
that is of new or definite onset (i.e., not lifelong), is not the result
of ongoing exertion, is not substantially alleviated by rest, and results
in substantial reduction in previous levels of occupational, educational,
social, or personal activities ; and
Four or more of the following symptoms are concurrently present for 6 months
Substantial impairment in short-term memory or concentration that impairs
Tender cervical or axillary lymph nodes
Multijoint pain without swelling or rednes
New headaches of a new type, pattern, or severity
Post exertional malaise lasting more than 24 hours
A note on the use of laboratory tests in the diagnosis
A minimum battery of laboratory screening tests should be performed.
Routinely performing other screening tests for all patients has no known
value. However, further tests may be indicated on an individual basis
to confirm or exclude another diagnosis, such as multiple sclerosis.
In these cases, additional tests should be done according to accepted clinical
In clinical practice, no tests can be recommended for the specific purpose
of diagnosing chronic fatigue syndrome. Tests should be directed toward
confirming or excluding other possible clinical conditions.
Examples of specific tests that do not confirm or exclude the diagnosis
of chronic fatigue syndrome include serologic tests for Epstein-Barr
virus, enteroviruses, retroviruses, human herpesvirus 6, and Candida albicans;
tests of immunologic function, including cell population and function studies;
and imaging studies, including magnetic resonance imaging scans and radionuclide
scans (such as single-photon emission computed tomography and positron emission
Treatment of CFS:
CFS Rx Guidelines
Psychotherapy and Supportive Counseling
Experimental Drugs and Treatment
Dietary Supplements and Herbal Preparations
Low-dose Tricyclic Agents: Tricyclic agents are sometimes prescribed
for CFS patients to improve sleep and to relieve mild, generalized pain.
Examples include doxepin (Adapin, Sinequan), amitriptyline (Elavil, Etrafon,
Limbitrol, Triavil), desipramine (Norpramin), and nortriptyline (Pamelor).
Some adverse reactions include dry mouth, drowsiness, weight gain, and elevated
Antidepressants: Antidepressants have been used to treat depression
in CFS patients, although non-depressed CFS patients receiving treatment
with serotonin reuptake inhibitors have been found by some physicians to
benefit from this treatment as well or better than depressed patients.
Examples of antidepressants used to treat CFS include serotonin reuptake
inhibitors such as fluoxetine (Prozac), sertraline (Zoloft),
and paroxetine (Paxil); venlafaxine (Effexor); trazodone
(Desyrel); and bupropion (Wellbutrin). A number of mild adverse
reactions, varying with the specific drug, may be experienced.
Anxiolytic agents: Anxiolytic agents are used to treat panic disorder
in CFS patients. Examples include alprazolam (Xanax), clonazepam ( Klonopin),
and lorazepam (Ativan). Common adverse reactions include sedation, amnesia,
and withdrawal symptoms (insomnia, abdominal and muscle cramps, vomiting,
sweating, tremors, and convulsions).
Nonsteroidal Anti-inflammatory Drugs: These drugs may be used to relieve
pain and fever in CFS patients. Some are available as over-the-counter
medications. Examples include naproxen (Aleve, Anaprox, Naprosen), ibuprofen
(Advil, Bayer Select, Motrin, Nuprin), and piroxicam (Feldene). These medications
are generally safe when used as directed, but can cause a variety of adverse
effects, including kidney damage, gastrointestinal bleeding, abdominal pain,
nausea, and vomiting.
Antimicrobials: An infectious cause for CFS has not been identified,
and antimicrobial agents are not commonly prescribed for CFS, unless of course
the patient has been diagnosed with a concurrent infection..
A controlled trial of the antiviral drug acyclovir found no
benefit in patients with CFS.
Antiallergy Therapy: Some CFS patients have histories of allergy,
and these symptoms may flare periodically. Non-sedating antihistamines may
be helpful for CFS patients. Examples include astemizole (Hismanal) and
loratadine (Claritin). Some of the more common adverse reactions associated
with their use include drowsiness, fatigue, and headache. Sedating antihistimines
can also be of benefit to patients at bedtime.
Antihypotensive Therapy: Fludrocortisone (Florinef) has sometimes
been prescribed for CFS patients who have had a positive tilt table test.
Florinef is currently being tested in controlled studies for its efficacy
in the treatment of CFS patients. Beta blockers such as atenolol (Tenormin)
have also been prescribed for patients with a positive tilt table test.
Increased salt and water intake is also recommended for these patients.
Adverse reactions include elevated blood pressure and fluid retention.
Low dose Hydrocortisone Rx (Letters)
1998;280:1061 - McKenzie R)
May 26, 1999, 281:1887)
- National Chronic Fatigue Syndrome & Fibromyalgia
- Centers for Disease Control & Prevention CFS
Conn's Current Therapy 1998
Ann Intern Med 1994;121:953 The Chronic Fatigue Syndrome - Fukuda K, etc.
Chronic Fatigue Syndrome (JAMA May 23/30, 2001;285:2557
Benjamin H Natelson)
April 2002 - Chronic Fatigue Syndrome - Patient Note