Chronic fatigue syndrome

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People with CFS often report a feeling of being unwell and suffering from malaise that can wax and wane.[1] Chronic fatigue and post-exertional malaise[1] are just two symptoms they experience
Roger Cicero was a famous German jazz singer. A few years prior to his death he was diagnosed with CFS. A number of health issues followed which led to an acute case of myocarditis. He died of a sudden stroke at age 45
Emma Blackery is a British singer-songwriter and YouTube vlogger. Emma had symptoms for six years before getting a diagnosis of CFS. The trigger most likely was glandular fever, also known as mononucleosis

Chronic fatigue syndrome (CFS) was a name coined by the Centers for Disease Control (CDC) in response to an outbreak of "chronic flu-like illness" in Incline Village, Lake Tahoe in 1984-1985[2] and several outbreaks and sporadic cases in the United States during the 1980s.

Prior to Incline Village, chronic fatigue syndrome was known as myalgic encephalomyelitis (ME). The "chronic fatigue syndrome" outbreaks of the 1980s and 1990s were likely ME outbreaks, although they differed in some respects from the 1930s-1960s outbreaks. With the development of the CDC's 1988 Holmes criteria,[3] the UK's 1991 Oxford criteria, and the CDC's 1994 Fukuda criteria for CFS,[4] which differed in significant respects from historic descriptions of ME,[5] CFS became a broader diagnosis applied to a far large number of patients,[6][7] which some clinicians and patients regarded as a "wastebasket diagnosis" that included ME along with those suffering from a wide range of undefined or misdiagnosed fatiguing illnesses.[5][8][9][10][11]

There have been media reports of athletes diagnosed with ME or CFS who have recovered in a relatively short period of time after rest, supplementation, and diet changes,[12][13][14] but may have had overtraining syndrome rather than CFS[15][16][17][18][19] and a number of elite athletes have been forced to retire in their 20s or early 30s due to CFS.[20][21][22][23]

Although a diagnosis of CFS is valid and in the US the Fukuda criteria may be used, newer diagnostic criterion such as SEID (ME/CFS), the Canadian Consensus Criteria (ME/CFS), and International Consensus Criteria (ME) offer a more accurate diagnosis of ME/CFS and ME.[24]

Name controversy

The name "chronic fatigue syndrome" is controversial, as many consider it stigmatizing and focusing on a single symptom, chronic fatigue (CF), and despite the fact that post-exertional malaise is regarded as the hallmark symptom rather than chronic fatigue. For decades, patient advocates have been lobbying the CDC to instead use the name myalgic encephalomyelitis (ME).[25] Most patients and patient organizations prefer the name ME, or the hybrid ME/CFS. The names are often used interchangeably or together (ME/CFS).[26]

  • February 2016, Dr Anthony Komaroff, who was part of the CDC group of clinicians who coined the name chronic fatigue syndrome, said: "I think that was a big mistake because the name, in my opinion, and the opinion of a lot of people, it both trivializes and stigmatizes the illness. It makes it seem unimportant, maybe not even real".[28]
  • December 2016, Unger et al. CDC Grand Rounds: Chronic Fatigue Syndrome - Advancing Research and Clinical Education[29]. abstract notes:

Chronic fatigue syndrome (CFS) is a complex and serious illness that is often misunderstood. Experts have noted that the terminology "chronic fatigue syndrome" can trivialize this illness and stigmatize persons who experience its symptoms (1). The name was coined by a group of clinicians convened by CDC in the late 1980s to develop a research case definition for the illness, which, at the time, was called chronic Epstein-Barr virus syndrome. The name CFS was suggested because of the characteristic persistent fatigue experienced by all those affected and the evidence that acute or reactivated Epstein-Barr virus infection was not associated with many cases (2). However, the fatigue in this illness is striking and quite distinct from the common fatigue everyone experiences. A variety of other names have been used, including myalgic encephalomyelitis (ME), ME/CFS, chronic fatigue immune dysfunction, and most recently, systemic exertion intolerance disease (3). The lack of agreement about nomenclature need not be an impediment for advancing critically needed research and education. The term ME/CFS will be used in this article.[29]

  • Jul 2017, the CDC changed its website for Chronic Fatigue Syndrome to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).[26]

The Oxford criteria and Fukuda criteria are used in Australia, South Africa, Canada, and parts of Europe; they use the name CFS. The UK will sometimes use the name chronic fatigue syndrome, CFS/ME, or more recently ME/CFS although they retired the Oxford criteria in late 2021.[30] The United States CDC now uses the acronym ME/CFS.[26]

Disability

Graph comparing the unadjusted quality of life EQ-5D-3L HRQoL score for ME/CFS with other chronic illnesses
ME/CFS patients have the lowest, unadjusted EQ-5D-3L measured HRQoL (quality of life) of 20 conditions, including multiple sclerosis and stroke. Overall, the same results are found after controlling for gender, age, education, and co-morbidity, including mental illness.
Unadjusted average quality of life in CFS compared to different illnesses. Source: PLoS One. 2015; 10(7): e0132421.

Chronic fatigue syndrome is a highly disabling illness, with only around 5% of patients achieving a full recovery. Quality of life, physical and work limitations, and pain are consistently found to be worse in CFS patients than in other chronic illnesses.[31]

Notable studies

Source: Chronic fatigue syndrome: A review (Balachander et al.) 2014.[32]

See also

Generally accepted criteria for diagnosing ME/CFS and ME

Learn more

References

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