Chronic Fatigue

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Definition

Is a chronic condition that causes significant fatigue. 

Prevalence

National Institute of Clinical Excellence (NICE) guidelines reports that 2 –4 in 1000 are affected. Women are affected 2-4 times more frequently then men.1It usually develops in early 20 - 40s. Children can also be affected, especially in mid teens. Most cases are mild or moderate, but up to 25% severe.

Causes

Many different potential aetiologies for CFS/ME – including neurological, endocrine, immunological, genetic, psychiatric and infectious – have been investigated, but the diverse nature of the symptoms can not yet be fully explained

Symptoms and Signs

Fatigue with all of the following features:

  • new or had a specific onset
  • persistent and/or recurrent
  • unexplained by other conditions
  • has resulted in a substantial reduction in activity level
  • characterised by post-exertional malaise and/or fatigue

Additional symptoms

  • Headaches
  • Mood disturbances
  • Muscle and joint aches
  • Sleeping problems
  • Cognitive dysfunction –‘brain fog’
  • Painful lymph nodes w/o pathological enlargement
  • Sore throat
  • Dizziness and/or nausea
  • Palpitations1

 A person's symptoms may fluctuate in intensity and severity, and there is also great variability in the symptoms different people experience.

  • Mild: able to self- care, but may need days off work to rest. 
  • Moderate: may have reduced mobility, and symptoms can vary. May also have disturbed sleep patterns, and need to sleep in the afternoon.
  • Severe: able to carry out minimal daily tasks, such as brushing teeth, but with significantly reduced mobility and difficulty with cognitive function.

Investigations

National Institute of Clinical Excellence (NICE) guidelines recommend a set of screening blood tests (e.g. including full blood count, liver, kidney, thyroid function etc.) and more specific ones if indicated by the history (e.g. HIV serology).Further functional tests may be indicated depending on the history. These may include Acumen mitochondrial function, bowel function and nutritional status tests etc.2,3

How is CFS/ME managed?

Many patients benefit from a combination of activity management, gradual exercise therapy and cognitive behavioural therapy. Some people also find mindfulness and other mind-body therapies helpful.

Some people benefit from medications such as amitriptyline, a tricyclic antidepressant, even if their mood is stable. The other medications are prescribed to manage the symptoms (painkillers for headaches, anti-sickness for nausea etc.)

What complementary and alternative therapies shall I try?

  • Acupuncture. The insertion of fine metal needles into the acupuncture points stimulates sensory nerves under the skin and in the muscles of the body. This in turn regulates body functions to restore health. 
  • Homeopathy is a natural system of medicines based on the belief that the body can cure itself. Accurately selected remedies from plants and minerals are given to stimulate the healing process. Two studies looked at the effect of homeopathy on chronic fatigue syndrome. Both studies reported beneficial effects of homeopathy on symptom improvement.4,5
  • Hypnotherapy can reduce stress by calming the body down and places the body and mind into a state of deep relaxation and stimulate repair mechanisms.
  • Integrated medicine. The doctors combine conventional treatments with a combination of herbal and homeopathic remedies, nutritional supplements, diet and psychological techniques depending on the individual circumstances.
  • Massage therapy
  • Nutritional therapy. It is important to have a balanced, varied nutrient-dense diet when suffering from a chronic condition. Nutritional therapist will be able advise on an individualised nutritional plan.
  • Osteopathy emphasizes manual readjustments, release of the muscles and connective tissues.
  • Reiki and reflexology.These therapies aim to stimulate and restore the natural balance of the body and place it in a position to restore or boost it’s own natural healing system.

What practitioners can I see about this condition?

Follow up

After you initial consultation, we recommend that you have regular check-ups to monitor your symptoms and response to interventions. The practitioner will advise on appropriate follow up arrangements for your individual situation. 

Multidisciplinary approach

Depending on your needs, your care may be shared with other practitioners at the natural practice or elsewhere. Whenever you permit us, we will write to your GP to ensure they are aware of our recommendations and follow up arrangements. 

Further information:

ME association 

References

  1. Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management, 2018.
  2. Jones D.S. et al The textbook of functional medicine 3rd ed, Gig Harbour, WA: Institute for Functional Medicine, 2010.
  3. Anthony, H et al Environmental Medicine in clinical practice, Southampton: BSAENM publications, 1997.
  4. Weatherley-Jones E, Nicholl JP, Thomas KJ, Parry GJ, McKendrick MW, Green ST, Stanley PJ, Lynch SP. A randomised, controlled, triple-blind trial of the efficacy of homeopathic treatment for chronic fatigue syndrome. J Psychosom Res. 2004;56(2):189–197.
  5. Awdry R. Homeopathy may help ME. Int J Alternat Complement Med.