Chronic Fatigue Syndrome - symptoms, diagnosis and treatment for CFS
Chronic Fatigue Syndrome - its most frequent symptoms and causes. Find out how you can use neurofeedback in the treatment of CFS.
Chronic fatigue syndrome is also called, in the specialist literature, myalgic encephalomyelitis, or systemic exertion intolerance disease. It affects mainly women between 40 and 60 years old, and treatment aims to relieve the associated symptoms.
What is Chronic Fatigue Syndrome (CFS)?
Chronic fatigue syndrome (CFS) is a complex condition characterised by severe and persistent fatigue over a period longer than 6 months, which cannot be explained by another medical pathology. Besides the state of chronic exhaustion, CFS can also show itself through sleep disturbances, memory and cognition difficulties, dizziness or malaise after exertion.
This condition often lowers patients’ quality of life, making daily activities harder and causing numerous psychological disturbances.
The causes of CFS
Despite the many studies carried out, the precise causes of CFS are still not fully understood, and diagnosis and treatment remain significant challenges for health professionals.
There are a number of possible explanations and triggers for this condition, among them:
- Viral infections: in patients with CFS an increased titre of antiviral antibodies has been observed, especially Epstein-Barr, cytomegalovirus, human herpesvirus 6 and also COVID-19. One of the manifestations of long COVID is a state of prolonged fatigue and exhaustion.
- Hormonal imbalance: this involves suboptimal functioning of the hypothalamic-pituitary-adrenal axis, without structural changes in these organs.
- Psychological factors: stressful life events such as trauma of any kind (emotional losses, worrying diagnoses and so on) can affect the immune and hormonal systems, contributing to the onset and worsening of persistent fatigue symptoms. These factors have a stronger impact in people with a type A personality, according to the Friedman and Rosenman theory. These people are perfectionist, competitive and achievement-focused, which leads to a stressful lifestyle with an increased risk of coronary or psychological conditions (depression, anxiety, and so on).
- Weakened immune system: although it is unclear whether a weakened immune system can lead to CFS, deficient functioning of it has been observed in patients with chronic exhaustion.
Frequent symptoms of chronic fatigue syndrome
There are several types of fatigue, depending on how long the patient experiences the symptoms. Recent fatigue means manifestations lasting less than a month; prolonged fatigue is characterised by extended symptoms, over a month. As for chronic fatigue syndrome, it involves specific symptoms experienced over the long term (more than six months).
Chronic fatigue is not the result of any kind of effort made by the person in question and is not substantially relieved by rest. It generally has a sudden onset, and the symptoms experienced as a result of CFS affect the patient’s ability to manage everyday life properly.
Among the most frequent symptoms of CFS are:
- General malaise and exhaustion after physical or mental effort of low intensity
- Cognitive decline: this can show itself on several levels, from impaired short-term memory to attention and concentration disturbances, difficulty making decisions, difficulty organising, the feeling of brain fog, and so on.
- Unrefreshing sleep
- Dizziness when standing up and orthostatic intolerance that improves when the patient lies down
- Muscle and joint pain, without local inflammation
- Tenderness of the lymph nodes
- Gastrointestinal symptoms
- Headaches
- Changes in mood, including states of anxiety or panic attacks
- Muscle weakness
Diagnosing Chronic Fatigue Syndrome
Chronic fatigue syndrome is diagnosed by ruling out other conditions that can present in a similar way. Following the medical history and various laboratory tests or imaging investigations, other possible causes of the state of exhaustion are excluded (anaemia, autoimmune diseases, endocrine conditions, neurological diseases, and so on).
Among the investigations a doctor may recommend when chronic fatigue syndrome is suspected are:
- Complete blood count
- Muscle enzymes
- Thyroid function testing
- Testing the level of electrolytes in the body
- Tests to analyse liver and kidney function
- Polysomnography
- Exercise testing
- Brain CT or MRI
The treatment of Chronic Fatigue Syndrome
The treatment of CFS aims to manage the symptoms, because at present there is no specific treatment that completely cures this condition. The patient’s care team may include doctors, physical therapists, psychologists and other professionals specialised in caring for patients with chronic illnesses.
The main symptoms targeted for relief are:
- Relieving the depressive states often experienced by patients with CFS - because of the strong negative impact that chronic exhaustion has on everyday life, many patients with chronic fatigue are affected by depression;
- Orthostatic intolerance - treating it is necessary in order to remove the feeling of faintness that young patients generally experience; this is done with the help of medicines that regulate blood pressure and heart rate, when needed;
- For treating pain, medicines based on ibuprofen may be recommended.
Changes in lifestyle
- A healthy and balanced diet, to provide all the nutrients needed for the body to function well
- Avoiding alcohol consumption and giving up smoking
- Proper sleep hygiene, to reduce the consequences caused by the lack of quality rest (this can be achieved by consulting a sleep specialist, giving up drinks high in caffeine, and so on)
Physical exercise
Light or moderate physical activity can relieve the symptoms specific to CFS. This may involve a gradual increase in the level of physical activity, in order to avoid post-exertional malaise.
Psychological counselling
Whether we are talking about cognitive behavioural therapy or other forms of therapy, psychological counselling is necessary in order to help the patient properly manage the limitations imposed by their condition, as well as to relieve states of depression or anxiety
It is important to underline that treatment can vary from one patient to another, and that the therapeutic approach has to be personalised for each case.
Neurofeedback treatment in chronic fatigue
Given the complex nature of myalgic encephalomyelitis and of the associated chronic fatigue, traditional treatments are not always effective. Neurofeedback, a non-invasive brain training technique, has proved effective as a complementary approach for patients with CFS.
Through training with neurofeedback, people dealing with a state of chronic fatigue can learn to regulate brain activity, which could help relieve symptoms such as fatigue, sleep disturbances and cognitive problems. By training the brain to self-regulate, neurofeedback can reduce the severity of these symptoms.
Patients who follow brain training therapy report that they have noticed a number of significant changes:
- Improved energy levels
- Reduced fatigue
- Better sleep quality
- Improved cognitive functions
Because of these positive effects, neurofeedback can be part of a comprehensive treatment plan for ME, given the multifaceted nature of this condition.
Chronic fatigue syndrome remains a medical enigma, and research continues in order to reveal its precise mechanisms and to develop more effective treatments. Until then, an integrated approach that includes symptom management, psychological support and adaptation to the individual needs of the patient is the key to proper care for this debilitating condition.
It is essential that health professionals stay informed about the most recent findings and technologies, so that they can offer the support needed by patients dealing with CFS, thereby improving their quality of life.
References
- Hammond DC (2022). Treatment of chronic fatigue with neurofeedback and self-hypnosis. NeuroRehabilitation, [online] 16(4). Available from: https://pubmed.ncbi.nlm.nih.gov/11790917/ .
- James, L.C. and Folen, R.A. (1996). EEG Biofeedback as a Treatment for Chronic Fatigue Syndrome: A Controlled Case Report. Behavioral Medicine, [online] 22(2), pp. 77-81. https://pubmed.ncbi.nlm.nih.gov/8879459/ doi:https://doi.org/10.1080/08964289.1996.9933767.
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