Chronic fatigue syndrome

Chronic fatigue syndrome is a disease characterized by excessive, disabling fatigue that persists for at least 6 months and is accompanied by numerous joint, infectious and neuropsychiatric symptoms.

Chronic fatigue syndrome is defined as prolonged, severe, incapacitating fatigue without obvious muscle weakness. There are no associated disorders that could explain the fatigue. Depression, anxiety, and other psychological diagnoses are usually absent. Treatment is rest and psychological support, often with antidepressants.

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Epidemiology

There are several variations of this definition of chronic fatigue syndrome (CFS), and the heterogeneity of patients who meet the criteria for this definition is considerable. Prevalence cannot be precisely determined; it ranges from 7 to 38/100,000 persons. Prevalence may vary due to differences in diagnostic evaluation, physician-patient relationship, social acceptability, risk of exposure to an infectious or toxic substance, or case ascertainment and definition. Chronic fatigue syndrome is more common in women. Office-based studies have shown that the incidence is higher among people of color. However, community surveys indicate higher prevalence among people of color, blacks, Hispanics, and American Indians.

Approximately every fifth patient (10-25%) seeking medical help complains of prolonged fatigue. Usually, the feeling of fatigue is a transient symptom that disappears spontaneously or with the treatment of the underlying disease. However, in some patients, this complaint begins to persist and has a negative impact on the general health. When fatigue cannot be explained by any disease, it is assumed that it is associated with chronic fatigue syndrome, the diagnosis of which can be made only after excluding other somatic and mental disorders.

The prevalence of chronic fatigue syndrome in the adult population, according to some data, can reach 3%. Approximately 80% of all cases of chronic fatigue syndrome remain undiagnosed. Children and adolescents get chronic fatigue syndrome much less often than adults. The peak incidence of chronic fatigue syndrome occurs in the active age (40-59 years). Women in all age categories are more susceptible to chronic fatigue syndrome (60-85% of all cases).

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Causes chronic fatigue syndrome

Initially, the infectious theory of chronic fatigue syndrome development (viral infection) was favored, but further studies revealed a wide variety of changes in many areas, including brain structure and function, neuroendocrine response, sleep structure, immune system, and psychological profile. Currently, the most common model of chronic fatigue syndrome pathogenesis is the stress-dependent model, although it cannot explain all the pathological changes characteristic of this syndrome. Based on this, most researchers postulate that chronic fatigue syndrome is a heterogeneous syndrome based on various pathophysiological abnormalities. Some of them may predispose to the development of chronic fatigue syndrome, others directly cause the development of the disease, and others determine its progression. Risk factors for chronic fatigue syndrome include female gender, genetic predisposition, certain personality traits or behavior style, etc.

Read also: Top 10 Causes of Fatigue

Stress-dependent hypothesis

• The premorbid history of patients with chronic fatigue syndrome usually includes indications of a large number of stressful life events, infectious diseases and surgeries. The manifestation or exacerbation of chronic fatigue syndrome and comorbid conditions in adults is often associated with stress or conflict situations.
• Childhood mental trauma (child abuse, cruel treatment, neglect, etc.) is considered an important risk factor for the development of chronic fatigue syndrome. High reactivity to adverse psychosocial factors is characteristic of the entire spectrum of disorders associated with childhood mental trauma. Stress in early life during the critical period of increased brain plasticity constantly affects the brain regions involved in cognitive-emotional processes and regulating the endocrine, autonomic and immune systems. There is experimental and clinical evidence that psychotraumatic events experienced at a young age lead to long-term disruption of the hypothalamic-pituitary-adrenal system and a more pronounced reaction to stress. However, childhood mental trauma is not present in the anamnesis of all patients with chronic fatigue syndrome. It is likely that this mechanism can play a leading role in the pathogenesis of only a certain group of patients with chronic fatigue syndrome.
• Comprehensive studies of the neuroendocrine status in chronic fatigue syndrome have revealed significant changes in the activity of the hypothalamic-pituitary-adrenal system, which confirms the disturbance of the physiological response to stress. Hypocorticism, which probably has a central origin, is detected in one third of patients with chronic fatigue syndrome. It is also noteworthy that a mutation that disrupts the production of a protein necessary for the transport of cortisol in the blood was found in families of patients with chronic fatigue syndrome. In women (but not in men) suffering from chronic fatigue syndrome, the morning peak of cortisol is reduced compared with healthy women. These sex differences in the circadian rhythm of cortisol production may explain the higher risk of developing chronic fatigue syndrome in women. Low cortisol levels lead to immune mediator disinhibition and determine the stress response of the suprasegmental parts of the autonomic nervous system, which in turn causes fatigue, pain phenomena, cognitive impairment, and affective symptoms. Intake of serotonin agonists in patients with chronic fatigue syndrome leads to a greater increase in plasma prolactin levels compared to healthy individuals. In patients suffering from major depression, the pattern of neuroendocrine disorders is reversed (hypercorticism, serotonin-mediated suppression of prolactin). In contrast, depletion of morning cortisol levels is noted in individuals suffering from chronic pain and various emotional disorders. Currently, dysfunction of the hypothalamic-pituitary-adrenal axis, the hormonal response to stress, and the specific neurotransmitter effects of serotonin are the most reproducible changes found in patients with chronic fatigue syndrome.
• Patients with chronic fatigue syndrome are characterized by a distorted perception of natural bodily sensations as painful symptoms. They also typically have increased sensitivity to physical stress (low threshold for changes in heart rate, blood pressure, etc.). A similar pattern of impaired perception can be observed in relation to stress-related bodily sensations. It is believed that perceptual disturbances, regardless of the etiology of chronic fatigue syndrome, are the basis for the appearance and persistence of symptoms and their painful interpretation.

CNS disorders. Some symptoms of chronic fatigue syndrome (fatigue, impaired concentration and memory, headache) suggest the pathogenetic possibility of CNS dysfunction. In some cases, MRI reveals nonspecific changes in the subcortical white matter of the brain, which, however, are not associated with cognitive impairment. Regional cerebral perfusion disorders (usually hypoperfusion) are typical according to SPECT scanning. In general, all changes identified to date have no clinical significance.

Vegetative dysfunction. DH Streeten, GH Anderson (1992) suggested that one of the causes of chronic fatigue may be a failure to maintain blood pressure in the upright position. Perhaps a separate subgroup of patients with chronic fatigue syndrome have orthostatic intolerance [the latter is understood as symptoms of cerebral hypoperfusion, such as weakness, lipothymia, blurred vision, occurring in the upright position and associated with sympathetic activation (tachycardia, nausea, tremor) and an objective increase in heart rate by more than 30 bpm]. Postural tachycardia associated with orthostatic intolerance is quite often observed in individuals with chronic fatigue syndrome. Symptoms characteristic of postural tachycardia (dizziness, palpitations, pulsation, decreased tolerance to physical and mental stress, lipothymia, chest pain, gastrointestinal symptoms, anxiety disorders, etc.) are also observed in many patients with chronic fatigue syndrome. The pathogenesis of postural tachycardia syndrome remains unclear, but the role of baroreceptor dysfunction, increased sensitivity of alpha- and beta-adrenergic receptors, pathological changes in the venous system, norepinephrine metabolism disorders, etc. are suggested. In general, in some patients, chronic fatigue syndrome may indeed be pathogenetically caused by autonomic dysfunction, manifesting orthostatic intolerance.

Infections. Epstein-Barr virus, herpes virus type 6, Coxsackie virus group B, T-cell lymphotropic virus type II, hepatitis C virus, enteroviruses, retroviruses, etc. were previously considered as possible etiologic agents of chronic fatigue syndrome. Further studies have not yielded reliable evidence of the infectious nature of chronic fatigue syndrome. In addition, therapy aimed at suppressing viral infection does not improve the course of the disease. Nevertheless, a heterogeneous group of infectious agents continues to be considered as a factor contributing to the manifestation or chronic course of chronic fatigue syndrome.

Immune system disorders. Despite numerous studies, only minor deviations in the immune status have been identified in patients with chronic fatigue syndrome. First of all, they concern an increase in the expression of active markers on the surface of T-lymphocytes, as well as an increase in the concentration of various autoimmune antibodies. Summarizing these results, it can be stated that mild activation of the immune system is typical for patients with chronic fatigue syndrome, but it remains unknown whether these changes have any pathogenetic significance.

Mental disorders. Since there is no convincing evidence of a somatic cause for chronic fatigue syndrome, many researchers postulate that it is a primary mental illness. Others believe that chronic fatigue syndrome is a manifestation of other mental illnesses, in particular, somatization disorder, hypochondria, major or atypical depression. Indeed, patients with chronic fatigue syndrome have a higher incidence of affective disorders than in the general population or among individuals with chronic somatic illnesses. In most cases, mood disorders or anxiety precede the manifestation of chronic fatigue syndrome. On the other hand, the high prevalence of affective disorders in chronic fatigue syndrome may be a consequence of an emotional response to disabling fatigue, immune changes, and CNS disorders. There are other objections to identifying chronic fatigue syndrome with mental illnesses. Firstly, although some manifestations of chronic fatigue syndrome are close to non-specific mental symptoms, many others, such as pharyngitis, lymphadenopathy, arthralgia, are not typical for mental disorders. Secondly, anxiety-depressive disorders are associated with central activation of the hypothalamic-pituitary-adrenal system (moderate hypercorticism), on the contrary, in chronic fatigue syndrome, central inhibition of this system is more often observed.

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Symptoms chronic fatigue syndrome

Subjectively, patients may formulate the main complaint differently (“I feel completely exhausted”, “I constantly lack energy”, “I am completely exhausted”, “I am exhausted”, “normal loads exhaust me”, etc.). When actively questioning, it is important to differentiate actual increased fatigue from muscle weakness or a feeling of despondency.

Most patients rate their premorbid physical condition as excellent or good. The feeling of extreme fatigue appears suddenly and is usually associated with flu-like symptoms. The disease may be preceded by respiratory infections, such as bronchitis or vaccination. Less often, the disease has a gradual onset, and sometimes begins insidiously over many months. Once the disease has begun, patients notice that physical or mental effort leads to an increase in the feeling of fatigue. Many patients find that even minimal physical effort leads to significant fatigue and an increase in other symptoms. Long-term rest or abstinence from physical activity can reduce the severity of many symptoms of the disease.

The frequently observed pain syndrome is characterized by diffuseness, uncertainty, and a tendency for pain sensations to migrate. In addition to muscle and joint pain, patients complain of headaches, sore throats, tender lymph nodes, and abdominal pain (often associated with a comorbid condition - irritable bowel syndrome). Chest pain is also typical for this category of patients, some of whom complain of "painful" tachycardia. Some patients complain of pain in unusual places [eyes, bones, skin (pain at the slightest touch to the skin), perineum, and genitals].

Changes in the immune system include tender lymph nodes, recurrent episodes of sore throat, recurrent flu-like symptoms, general malaise, hypersensitivity to previously well-tolerated foods and/or medications.

In addition to the 8 main symptoms that have the status of diagnostic criteria, patients may have many other disorders, the frequency of which varies widely. Most often, patients with chronic fatigue syndrome note a decrease in appetite up to anorexia or an increase in appetite, weight fluctuations, nausea, sweating, dizziness, poor tolerance of alcohol and drugs affecting the central nervous system. The prevalence of autonomic dysfunction in patients with chronic fatigue syndrome has not been studied; however, autonomic disorders have been described both in individual clinical observations and in epidemiological studies. The most common symptoms are orthostatic hypotension and tachycardia, episodes of sweating, pallor, sluggish pupillary reactions, constipation, frequent urination, and respiratory disorders (a feeling of shortness of breath, obstruction in the airways, or pain when breathing).

Approximately 85% of patients complain of impaired concentration, weakening of memory, however, routine neuropsychological examination usually does not reveal any memory function disorders. However, in-depth examination often reveals minor but unmistakable memory and information assimilation disorders. In general, patients with chronic fatigue syndrome have normal cognitive and intellectual abilities.

Sleep disorders are represented by difficulties in falling asleep, interrupted night sleep, daytime sleepiness, while the results of polysomnography are quite variable. Most often, "alpha intrusion" (imposition) during slow sleep and a decrease in the duration of stage IV sleep are described. However, these findings are unstable and do not have diagnostic value, in addition, sleep disorders do not correlate with the severity of the disease. In general, fatigue should be clinically distinguished from drowsiness and it should be taken into account that drowsiness can both accompany chronic fatigue syndrome and be a symptom of other diseases that exclude the diagnosis of chronic fatigue (for example, sleep apnea syndrome).

Almost all patients with chronic fatigue syndrome develop social maladjustment. About a third of patients cannot work and another third prefer part-time professional employment. The average duration of the disease is 5-7 years, but symptoms can persist for more than 20 years. The disease often progresses in waves, with periods of exacerbation (worsening) alternating with periods of relatively good health. Most patients experience partial or complete remissions, but the disease often recurs.

Additional symptoms seen in patients with chronic fatigue syndrome

• Irritable bowel syndrome (abdominal pain, nausea, diarrhea, or bloating).
• Chills and sweating at night.
• A feeling of fog, emptiness in the head.
• Chest pain.
• Difficulty breathing.
• Chronic cough.
• Visual disturbances (blurred vision, intolerance to bright light, eye pain, dry eyes).
• Food allergies, hypersensitivity to alcohol, odors, chemicals, medications, noise.
• Difficulty maintaining an upright position (orthostatic instability, irregular heartbeat, dizziness, unsteadiness, fainting).
• Psychological problems (depression, irritability, mood swings, anxiety, panic attacks).
• Pain in the lower half of the face.
• Increase or decrease in body weight

The feeling of excessive fatigue, as well as chronic fatigue syndrome itself, is comorbid with many functional diseases, such as fibromyalgia, irritable bowel syndrome, post-traumatic stress disorder, dysfunction of the temporomandibular joint, chronic pelvic pain, etc.

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Diagnostic criteria

Chronic fatigue syndrome has been described many times under various names; the search for a term that would most fully reflect the essence of the disease continues to this day. The following terms were most often used in the literature: "benign myalgic encephalomyelitis" (1956), "myalgic encephalopathy", "chronic mononucleosis" (chronic infection with the Epstein-Barr virus) (1985), "chronic fatigue syndrome" (1988), "postviral fatigue syndrome". In ICD-9 (1975), chronic fatigue syndrome was not mentioned, but there was a term "benign myalgic encephalomyelitis" (323.9). In ICD-10 (1992), a new category was introduced - postviral fatigue syndrome (G93).

The term and definition of chronic fatigue syndrome were first presented by US scientists in 1988, who suggested a viral etiology of the syndrome. The Epstein-Barr virus was considered the main causative agent. In 1994, the definition of chronic fatigue syndrome was revised and in its updated version it acquired international status. According to the 1994 definition, the diagnosis requires persistence (or remittance) of unexplained fatigue that is not relieved by rest and significantly limits daily activity for at least 6 months. In addition, 4 or more of the following 8 symptoms must be present.

• Impaired memory or concentration.
• Pharyngitis.
• Pain when palpating the cervical or axillary lymph nodes.
• Muscle pain or stiffness.
• Joint pain (without redness or swelling).
• A new headache or a change in its characteristics (type, severity).
• Sleep that does not bring a feeling of restoration (freshness, vigor).
• Worsening fatigue to the point of exhaustion after physical or mental exertion, lasting more than 24 hours.

In 2003, the International Chronic Fatigue Syndrome Study Group recommended the use of standardized scales to assess the core symptoms of chronic fatigue syndrome (impaired daily functioning, fatigue, and associated symptom complex).

Conditions that exclude the diagnosis of chronic fatigue syndrome are the following:

• The presence of any current somatic diseases that can explain the persistence of chronic fatigue, such as severe anemia, hypothyroidism, sleep apnea syndrome, narcolepsy, cancer, chronic hepatitis B or C, uncontrolled diabetes mellitus, heart failure and other severe cardiovascular diseases, chronic renal failure, inflammatory and dysimmune diseases, diseases of the nervous system, severe obesity, etc., as well as taking medications whose side effects include a feeling of general weakness.
• Mental illness (including history).
  • Major depression with psychotic or melancholic symptoms.
  • Bipolar affective disorder.
  • Psychotic conditions (schizophrenia).
  • Dementia.
  • Anorexia nervosa or bulimia.
• Drug or alcohol abuse within 2 years before the onset of fatigue and for some time after.
• Severe obesity (body mass index of 45 or more).

The new definition also specifies diseases and conditions that do not exclude the diagnosis of chronic fatigue syndrome:

• Disease conditions that are diagnosed based solely on clinical criteria and that cannot be confirmed by laboratory tests.
  • Fibromyalgia.
  • Anxiety disorders.
  • Somatoform disorders.
  • Non-melancholic depression.
  • Neurasthenia.
• Diseases associated with chronic fatigue, but the successful treatment of which led to an improvement in all symptoms (the adequacy of therapy must be verified). For example, the success of replacement therapy for hypothyroidism must be verified by a normal level of thyroid hormones, the adequacy of treatment for bronchial asthma - by assessing respiratory function, etc.
• Diseases associated with chronic fatigue and caused by a specific pathogen, such as Lyme disease, syphilis, if they were adequately treated before the onset of chronic fatigue symptoms.
• Isolated and unexplained paraclinical abnormalities (laboratory changes, neuroimaging findings) that are insufficient to firmly confirm or exclude a disease. For example, these findings may include elevated antinuclear antibody titers in the absence of additional laboratory or clinical evidence to reliably diagnose a connective tissue disease.

Unexplained chronic fatigue that does not fully meet the diagnostic criteria may be classified as idiopathic chronic fatigue.

In 2007, the UK National Institute for Health and Care Excellence (NICE) published less stringent criteria for chronic fatigue syndrome, which are recommended for use by different professionals.

• The presence of new, persistent or recurrent fatigue (more than 4 months in adults and 3 months in children) that:
  • cannot be explained by any other disease;
  • significantly limits activity levels;
  • characterized by malaise or worsening fatigue after any effort (physical or mental) followed by extremely slow recovery (at least 24 hours, but usually several days).
• The presence of one or more symptoms from the following list: sleep disturbance, muscle or joint pain of polysegmental localization without signs of inflammation, headache, tenderness of the lymph nodes without their pathological enlargement, pharyngitis, cognitive dysfunction, worsening of symptoms with physical or mental stress, general malaise, dizziness and/or nausea, palpitations in the absence of organic heart pathology.

At the same time, it is recommended to reconsider the diagnosis if the following symptoms are absent: malaise or fatigue after physical or mental effort, cognitive difficulties, sleep disorders, chronic pain.

The NICE criteria for chronic fatigue syndrome have been subject to considerable criticism from experts, so most researchers and clinicians continue to use the 1994 international criteria.

Along with chronic fatigue syndrome, secondary forms of this syndrome are also distinguished in a number of neurological diseases. Chronic fatigue is observed in multiple sclerosis, Parkinson's disease, motor neuron diseases, chronic cerebral ischemia, strokes, post-poliomyelitis syndrome, etc. The basis of secondary forms of chronic fatigue is direct damage to the central nervous system and the impact of other factors indirectly related to the main disease, for example, depression that arose as a reaction to a neurological disease.

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Diagnostics chronic fatigue syndrome

There are no specific paraclinical tests to confirm the clinical diagnosis of chronic fatigue syndrome. At the same time, examination is mandatory to exclude diseases, one of the manifestations of which may be chronic fatigue. Clinical assessment of patients with the leading complaint of chronic fatigue includes the following activities.

• A detailed medical history, including medications the patient is using that may be causing fatigue.
• A comprehensive examination of the patient's somatic and neurological status. Superficial palpation of the somatic muscles in 70% of patients with chronic fatigue syndrome with gentle pressure reveals painful points localized in various muscles, often their location corresponds to that in fibromyalgia.
• Screening study of cognitive and mental status.
• Conducting a set of screening laboratory tests:
  • general blood test (including leukocyte count and ESR determination);
  • biochemical blood test (calcium and other electrolytes, glucose, protein, albumin, globulin, creatinine, ALT and AST, alkaline phosphatase);
  • thyroid function assessments (thyroid hormones);
  • urine analysis (protein, glucose, cellular composition).

Additional studies usually include determination of C-reactive protein (an inflammation marker), rheumatoid factor, and CPK activity (a muscle enzyme). Determination of ferritin is advisable in children and adolescents, as well as in adults if other tests confirm iron deficiency. Specific tests confirming infectious diseases (Lyme disease, viral hepatitis, HIV, mononucleosis, toxoplasmosis, cytomegalovirus infection), as well as a serological panel of tests for Epstein-Barr viruses, enteroviruses, retroviruses, herpes viruses type 6 and Candida albicans are performed only if there is a history of an infectious disease. On the contrary, MRI of the brain and examination of the cardiovascular system are considered routine methods if chronic fatigue syndrome is suspected. Polysomnography should be performed to exclude sleep apnea.

In addition, it is advisable to use special questionnaires that help assess the severity of the disease and monitor its progress. The following are most often used.

• The Multidimensional Fatigue Inventory (MFI) assesses general fatigue, physical fatigue, mental fatigue, and motivation and activity reduction. Fatigue is defined as severe if the general fatigue scale score is 13 points or more (or the activity reduction scale score is 10 points or more).
• The SF-36 quality of life questionnaire (Medical outcomes survey short form-36) for assessing functional activity impairments in 8 categories (physical activity limitation, limitation of usual role activity due to health problems, limitation of usual role activity due to emotional problems, physical pain, general health assessment, vitality assessment, social functioning, and general mental health). The ideal norm is 100 points. Patients with chronic fatigue syndrome are characterized by a decrease in functional activity (70 points or less), social functioning (75 points or less), and a decrease in the emotional scale (65 points or less).
• The CDC Symptom Inventory is a tool for identifying and assessing the duration and severity of fatigue-related symptom complexes (in a minimized form, it represents a summary assessment of the severity of the 8 symptoms that are criteria for chronic fatigue syndrome).
• If necessary, the McGill Pain Score and Sleep Answer Questionnaire are also used.

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Differential diagnosis

Chronic fatigue syndrome is a diagnosis of exclusion, which means that its establishment requires a thorough differential diagnosis to exclude many serious and even life-threatening diseases (chronic heart disease, anemia, thyroid pathology, tumors, chronic infections, endocrine diseases, connective tissue diseases, inflammatory bowel disease, mental disorders, etc.).

In addition, it should be remembered that the feeling of fatigue can be a side effect of some medications (muscle relaxants, analgesics, beta-blockers, benzodiazepines, antihistamines and anti-inflammatory drugs, interferon beta).

Treatment chronic fatigue syndrome

Since the causes and pathogenesis of chronic fatigue syndrome are still unknown, there are no well-founded therapeutic recommendations. Controlled studies have been conducted on the effectiveness of certain medications, food supplements, behavioral therapy, physical training, etc. In most cases, the results were negative or unconvincing. The most encouraging results were obtained with respect to complex non-drug treatment.

Drug treatment of chronic fatigue syndrome

There are isolated studies showing some positive effect of intravenous immunoglobulin (compared to placebo), but the effectiveness of this method of therapy cannot yet be considered proven. Most other drugs (glucocorticoids, interferons, antiviral agents, etc.) have proven ineffective in relation to both the feeling of fatigue itself and other symptoms of chronic fatigue syndrome.

Antidepressants are widely used in clinical practice, allowing to successfully relieve some symptoms of chronic fatigue syndrome (improving sleep and reducing pain, positively affecting comorbid conditions, in particular fibromyalgia). Some open studies have established a positive effect of reversible MAO inhibitors, especially in patients with clinically significant vegetative symptoms. However, it should be taken into account that most patients with chronic fatigue syndrome poorly tolerate drugs that affect the central nervous system, so therapy should be started with low doses. Preference should be given to antidepressants with a favorable tolerability spectrum. In addition, official herbal preparations with significantly fewer side effects can be considered as an alternative therapy in people who have had a negative experience of using antidepressants. Most official complex herbal preparations are based on valerian. Controlled randomized studies demonstrate that the effects of valerian on sleep include improved sleep quality, increased sleep time, and decreased time to fall asleep. The hypnotic effect of valerian on sleep is more pronounced in individuals with insomnia than in healthy individuals. These properties allow valerian to be used in individuals with chronic fatigue syndrome, the core of the clinical picture of which is insomnia. More often, not a simple valerian extract is used, but complex herbal preparations (novo-passit), in which a harmonious combination of herbal extracts provides a complex psychotropic (sedative, tranquilizing, mild antidepressant) and "organotropic" (antispasmodic, analgesic, antiallergic, vegetative-stabilizing) effect.

There is evidence that some patients have experienced a positive effect when prescribed amphetamine and its analogues, as well as modafinil.

In addition, paracetamol or other NSAIDs are used, which are especially indicated for patients with musculoskeletal disorders (muscle pain or stiffness).

Sleep disorders may sometimes require the use of sleeping pills. As a rule, you should start with antihistamines (doxylamine) and only if there is no effect, prescribe prescription sleeping pills in minimal doses.

Some patients use alternative treatments - vitamins in large doses, herbal medicine, special diets, etc. The effectiveness of these measures has not been proven.

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Non-drug treatment of chronic fatigue syndrome

Cognitive behavioral therapy is widely used to address abnormal perception and distorted interpretation of bodily sensations (i.e., factors that play a significant role in maintaining the symptoms of chronic fatigue syndrome). Cognitive behavioral therapy can also be useful in teaching the patient more effective coping strategies, which in turn can lead to increased adaptive capabilities. Controlled studies have shown that 70% of patients report a positive effect. A combination of a graded exercise program with cognitive behavioral therapy may be helpful.

Deep breathing techniques, muscle relaxation techniques, massage, kinesiotherapy, and yoga are considered as additional interventions (mainly to eliminate comorbid anxiety).

Forecast

Long-term observation of patients with chronic fatigue syndrome has shown that improvement occurs in approximately 17-64% of cases, while deterioration occurs in 10-20%. The probability of complete recovery does not exceed 10%. 8-30% of patients return to their previous professional activities in full. Old age, long duration of the disease, severe fatigue, and comorbid mental illnesses are risk factors for an unfavorable prognosis. On the contrary, complete recovery is more common in children and adolescents.