Chronic fatigue

Chronic fatigue is a disease that has not yet been identified in the generally accepted classifier - ICD. The term "chronic fatigue syndrome" has long been known to clinicians, its criteria are also described. However, chronic fatigue is not registered in a separate nosological unit, and its symptoms are almost 100% coincident with neurasthenia, which in ICD-10 has its own code and code number - F48.048.0.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Causes of the chronic fatigue

For the first time the chronic fatigue of an incomprehensible etiology was described by the fragile nurse F. Nightingale. The girl went through the entire Crimean war without receiving a single serious wound, saving thousands of lives of wounded soldiers. Three terrible military years have knocked down the health of an indefatigable and fearless nurse so much that after returning home, she was bedridden. No pathology, intelligible reason for explaining the immobility Florence doctors have not found. So, in 1858, the term "chronic fatigue syndrome" or chronic fatigue appeared. It is interesting that, being immobilized, the girl retained mental activity and continued her statistical research on the mortality from wounds received in the war, and also wrote works on the reform of military hospitals. The chronic fatigue itself began to be studied more closely only a hundred years later, when Europe and some US states were struck by a strange epidemic, similar in symptoms to chronic fatigue. Only in the 80s of the last century chronic fatigue was included in the list of unexplained diseases and started more serious scientific research of this phenomenon. Among the recent outbreaks of chronic fatigue, we can note massive diseases of strong, trained and resistant to any impact - both physical and psychological, of special forces. This happened in the 90 years of the XX century after the famous military operation on the Persian Gulf - "Desert Storm". Hundreds of participants in hostilities, without obvious and understandable reasons, contracted severe forms of depression, some were bedridden against a background of absolutely normal physical activity, and attempts were also made to commit suicide. It was not necessary to write down the causes of this epidemic for laziness or idleness, as hundreds of people showed similar symptoms and signs.

Chronic fatigue can affect people regardless of age, gender and social status. According to statistics, CFS is found in 40 patients out of 100,000 with a diagnosis of neurasthenia. Chronic fatigue is not manifested by pathology of organs, biochemical changes in blood and a decrease in immunity. And the radiograph and ultrasound examination, most likely will not reveal appreciable deviations from the norms.

As a rule, a general diagnosis is given to those suffering from such an affliction - VSD (vegetative-vascular dystonia) or neurovegetative dystonia. Any therapy, typical for the supervision of neuroses or VSD, eventually turns out to be ineffective. Then the question arises about the confirmation of the diagnosis of chronic fatigue. If the period of specification of the diagnosis lasts a long time, there may be a significant deterioration in the patient's health, up to mental disorders and cognitive functions of the brain. These obvious symptoms are already clearly identified on the electroencephalogram and CT (computer tomogram).

[11], [12], [13], [14]

Risk factors

Today chronic fatigue is a disease of careerists and perfectionists, unlike the last century, when such a syndrome was considered a sign of laziness, and the condition itself was called "a joint disease." Statistics argue that chronic fatigue chooses the most energetic and active people, regardless of age. As a rule, these are people who have higher education, age boundaries from 20 to 55 years. Women are more often ill, apparently as a result of polyfunctional loads, both external - social and domestic - and mental - emotional. However, chronic fatigue is observed in individuals who are not associated with an active lifestyle. Thus, the etiology of CFS remains a mystery, despite several recent, popular in the medical world versions. This is the theory of viral etiology and the infectious version, which, however, has not yet been confirmed statistically. Also, some clinicians use the theory of general immune depletion as a basis. While doctors argue and debate about the causes and diagnostic criteria, the chronic fatigue syndrome - chronic fatigue, continues to endanger humanity, hitting more and more people.

[15], [16], [17], [18], [19], [20], [21], [22], [23], [24]

Symptoms of the chronic fatigue

As a rule, in order to confirm the diagnosis of chronic fatigue, you need to record at least two symptoms from the core group and eight from a group of small signs.

The main symptoms are: 

• Sudden weakness, lasting more than three months and turning into a chronic one. Not controlled by adaptagens and stimulants (they can only exacerbate the condition, causing exhaustion); 
• Rapid progression and increase in total fatigue, exhaustion of forces; 
• General decrease in working activity during half a year (more than twice); 
• Absence of basic pathologies and causes, etiologically explaining such a condition as chronic fatigue and apathy.

Small symptoms: 

• Severe chronic fatigue after habitual physical and mental stress; 
• Tremor of extremities, fever at normal body temperature; 
• Chronic pain in the throat, lump; 
• Swelling of the lymph nodes, often - painful sensations in this area; 
• Muscle asthenia, weakness; 
• Muscle pain, myalgia; 
• Insomnia or drowsiness (sleep disturbance); 
• Headaches of unclear etiology; 
• Intermittent joint pain; 
• Depressive state; 
• Cognitive disorders - memory impairment, attention.
• Neuropsychic disorders - photophobia, lack of sensitivity to smells and others.

The main, basic symptom is chronic fatigue, lasting more than six months with a general healthy state of the body. Also, depletion is clearly defined, which is diagnosed using applied techniques (Schulte table). Often the initial diagnosis sounds like hypo or hyperaesthesia. Independently a person can not cope with this serious illness, no matter how he tried to activate his body with the help of cigarettes, coffee, medicinal stimulants. There is also a decrease in body weight, and vice versa - obesity, as a compensatory factor.

[25], [26], [27], [28], [29]

Treatment of the chronic fatigue

Chronic fatigue does not lend itself to any method that presupposes monotherapy. Treatment should be carried out in a complex and long period. With all the combination of the symptoms of chronic fatigue and typical signs, the therapeutic strategy is always individual. Nevertheless, the prescription of psychotropic medications in minimum doses, selective serotonin reuptake inhibitors, tricyclic antidepressants is considered standard. Support in the form of a complex of vitamins and microelements is considered auxiliary, but necessary. In addition, a positive result provides an application in the treatment of polyunsaturated fatty acids, immunotherapy. Glucocorticoids and L-DOPA can be prescribed in short courses. When pain symptoms are prescribed analgesics and non-steroidal anti-inflammatory drugs. Course psychotherapy, physiotherapy fix the initial results and are mandatory components in the complex treatment of chronic fatigue syndrome. Chronic fatigue is treated for a long time, but modern medicine hopes to find really effective methods of its supervision after the true causes of the spread of this disease will be determined.