Chronic Fatigue Syndrome

The syndrome of chronic fatigue is a disease characterized by excessive, disabling fatigue, which lasts at least 6 months and is accompanied by numerous articular, infectious and neuropsychiatric symptoms.

The syndrome of chronic fatigue is defined as prolonged, severe, disabling fatigue without obvious muscle weakness. Concomitant disorders that could explain fatigue are absent. As a rule, depression, anxiety and other psychological diagnoses are absent. The treatment is rest and psychological support; often with the use of antidepressants.

[1], [2], [3], [4], [5], [6]

Epidemiology

This definition of chronic fatigue syndrome (CFS) has several options, and the heterogeneity of patients who meet the criteria for this definition is significant. It is impossible to pinpoint the prevalence; it ranges from 7 to 38/100 000 people. Prevalence can vary due to differences in the diagnostic assessment, the relationship between the doctor and the patient, social acceptability, the risk of exposure to an infectious or toxic substance, or the detection of a case and definition. The syndrome of chronic fatigue is more common in women. Studies based on the office showed that the frequency is higher among people with white skin color. However, surveys of different communities indicate a higher prevalence among people with black skin color, Hispanic Latin Americans and American Indians.

Approximately one in five patients (10-25%) seeking medical help complain of prolonged fatigue. Usually the feeling of fatigue is a transient symptom that disappears spontaneously or when treating the underlying disease. Nevertheless, in some patients this complaint begins to persist and adversely affect the overall health. When fatigue can not be explained by any disease, it is assumed that it is associated with a syndrome of chronic fatigue, the diagnosis of which can be made only after the exclusion of other somatic and psychiatric disorders.

The prevalence of the syndrome of chronic fatigue 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 develop chronic fatigue syndrome much less often than adults. The peak incidence of the syndrome of chronic fatigue accounts for the active age (40-59 years). Women in all age categories are more prone to chronic fatigue syndrome (60-85% of all cases).

[7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18],

Causes of the chronic fatigue syndrome

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

See also: Top 10 causes of fatigue

Stress-dependent hypothesis

• In the premorbid history of patients with chronic fatigue syndrome, there are usually indications of a large number of stressful life events, transmitted infectious diseases and surgical interventions. The manifestation or exacerbation of the syndrome of chronic fatigue and comorbid conditions in adults is often associated with stress or conflict situations.
• Mental traumas in childhood (child abuse, abuse, neglect, etc.) are considered an important risk factor for the development of chronic fatigue syndrome. High reactivity to unfavorable psychosocial factors is characteristic of the whole spectrum of disorders associated with mental trauma in childhood. Stress in the early period of life during the critical period of increased plasticity of the brain constantly affects the regions of the brain involved in cognitive-emotional processes and regulating the endocrine, vegetative and immune systems. There are experimental and clinical data that the psychotraumatic events suffered at a young age lead to a prolonged disruption of the hypothalamic-pituitary-adrenal system and a more pronounced response to stress. However, childhood psychotrauma is present in the history of not all patients with chronic fatigue syndrome. Probably, this mechanism can play a leading role in the pathogenesis of only a certain group of patients with chronic fatigue syndrome.
• Comprehensive studies of non-neuroendocrine status in chronic fatigue syndrome revealed significant changes in the activity of the hypothalamic-pituitary-adrenal system, which confirms a violation of the physiological response to stress. A third of patients with chronic fatigue syndrome are diagnosed with hypocorticism, which probably has a central origin. Deserves attention and the detection in families of patients with chronic fatigue syndrome, a mutation that violates the production of protein, necessary for the transport of cortisol in the blood. In women (but not in men), suffering from chronic fatigue syndrome, the morning peak of cortisol is lower compared to healthy women. These sex differences in the circadian rhythm of cortisol production may explain a higher risk of chronic fatigue syndrome in women. A low level of cortisol leads to disinhibition of immune mediators and determines the response to stress in the supragmentary parts of the autonomic nervous system, which in turn causes fatigue, pain, cognitive impairment and affective symptoms. The admission of serotonin agonists in patients with chronic fatigue syndrome leads to a greater increase in plasma prolactin levels compared to healthy individuals. In patients with major depression, the pattern of neuroendocrine disorders is inverse (hypercorticism, serotonin-mediated suppression of prolactin). On the contrary, depletion of the morning cortisol level was noted in persons suffering from chronic pain and various emotional disorders. Currently, the dysfunction of the hypothalamic-pituitary-adrenal system, hormonal response to stress and features of neurotransmitter effects of serotonin are the most reproducible changes observed in patients with chronic fatigue syndrome.
• Patients with chronic fatigue syndrome are characterized by a distorted perception of natural bodily sensations as painful symptoms. For them, too, the increased sensitivity to physical exertion (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 disorders, regardless of the etiology of the chronic fatigue syndrome, are the basis for the appearance and preservation of symptoms and their painful interpretation.

Violations from the CNS. Some symptoms of chronic fatigue syndrome (fatigue, impaired concentration and memory, headache) suggest a 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. Typical regional violations of brain perfusion (usually hypoperfusion) according to SPECT-scan data. In general, all the 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 violation of maintaining blood pressure in an upright position. Perhaps a separate subgroup of patients with chronic fatigue syndrome has orthostatic intolerance [under the latter understand the symptoms of cerebral hypoperfusion, such as weakness, lipotomy, blurred vision, arising in the vertical position and associated with sympathetic activation (tachycardia, nausea, tremor) and an objective increase in heart rate more than on 30 in mines]. Postural tachycardia associated with orthostatic intolerance is often observed in individuals with chronic fatigue syndrome. Symptoms typical for postural tachycardia (dizziness, palpitations, pulsations, tolerance to physical and mental stress, lipotomy, chest pain, gastrointestinal symptoms, anxiety disorders, etc.) are also noted in many patients with chronic fatigue syndrome. The pathogenesis of the syndrome of postural tachycardia remains unclear, suggest the role of baroreceptor dysfunction, increased sensitivity of alpha and beta adrenoreceptors, pathological changes in the venous system, disruption of noradrenaline metabolism, etc. In general, in some patients the syndrome of chronic fatigue can indeed be pathogenetically caused by autonomic dysfunction , manifesting orthostatic intolerance.

Infections. As potential etiologic agents of the syndrome of chronic fatigue, the Epstein-Barr virus, the herpesvirus type 6, the Coxsacki group B virus, the T-cell-lymphotropic virus type II, the hepatitis C virus, the enteroviruses, retroviruses, etc. Were previously considered . In further studies, reliable evidence of the infectious nature of the syndrome of chronic fatigue was not obtained. In addition, therapy aimed at suppressing viral infection does not improve the course of the disease. Nevertheless, the heterogeneous group of infectious agents continues to be seen as a factor contributing to the manifestation or chronic course of the chronic fatigue syndrome.

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

Mental disorders. Since there is no convincing evidence of the somatic conditionality of chronic fatigue syndrome, many researchers postulate that this is a primary mental illness. Others believe that chronic fatigue syndrome is one of the manifestations of other mental illnesses, in particular somatized disorder, hypochondria, large or atypical depression. Indeed, in patients with chronic fatigue syndrome, the frequency of affective disorders is higher than in the general population or among persons with chronic physical 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 the syndrome of chronic fatigue can be the result of an emotional response to disabling fatigue, immune changes, violations of the central nervous system. There are other objections to identifying the syndrome of chronic fatigue with mental illnesses. First, although some manifestations of chronic fatigue syndrome and are close to nonspecific mental symptoms, but many others, such as pharyngitis, lymphadenopathy, arthalgia, are not typical of mental disorders. Secondly, anxiety-depressive disorders are associated with central activation of the hypothalamic-pituitary-adrenal system (mild hypercorticism), on the contrary, in the syndrome of chronic fatigue, central inhibition of this system is more often observed.

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Symptoms of the chronic fatigue syndrome

Subjectively, patients can differently formulate the main complaint ("I feel completely exhausted", "I constantly lack energy," "I am completely exhausted," "I am exhausted," "ordinary stress leads me to exhaustion," etc. .). With active interrogation, it is important to differentiate the actual increased fatigue from muscle weakness or a sense of despondency.

Most patients assess their premorbid physical condition as excellent or good. The feeling of extreme fatigue appears suddenly and is usually combined with influenza-like symptoms. The disease can be preceded by respiratory infections, such as bronchitis or vaccination. Less often the disease has a gradual onset, and sometimes begins gradually for many months. After the onset of the disease, patients notice that physical or mental efforts lead to an aggravation of the feeling of fatigue. Many patients believe that even a minimal physical effort leads to considerable fatigue and increased other symptoms. Long rest or refusal of physical activity can reduce the severity of many symptoms of the disease.

Often the observed pain syndrome is characterized by diffuseness, uncertainty, the tendency to migrate painful sensations. In addition to pain in muscles and joints, patients complain of headache, sore throat, tenderness of lymph nodes, abdominal pain (often associated with a comorbid condition - irritable bowel syndrome). Pain in the chest is also typical for this category of patients, some of them complain of a "painful" tachycardia. Individual 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 soreness of the lymph nodes, repeated episodes of sore throat, recurrent flu-like symptoms, general malaise, excessive sensitivity to food and / or medications that were previously tolerated normally.

In addition to the eight 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 report a decrease in appetite right up to anorexia or its increase, body 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, nevertheless, vegetative disorders are described both in individual clinical observations and in epidemiological studies. Orthostatic hypotension and tachycardia, episodes of sweating, pallor, flaccid pupillary reactions, constipation, rapid urination, respiratory disorders (sensation of lack of air, obstruction in the respiratory tract or pain in breathing) are most often observed.

Approximately 85% of patients complain of impaired concentration, memory loss, but routine neuropsychological examination of impairments of mnestic function usually does not reveal. However, in-depth research often reveals minor, but undoubted violations of memory and digestibility of information. In general, patients with chronic fatigue syndrome have normal cognitive and intellectual capabilities.

Sleep disorders are represented by difficulties in falling asleep, intermittent night sleep, daytime sleepiness, while polysomnography results are highly variable. Most often describe "alpha intrusion" (imposition) during a slow sleep and a decrease in the duration of the IV stage of sleep. However, these findings are not perfect and do not have diagnostic value, in addition, sleep disturbances do not correlate with the severity of the disease. In general, it is clinically important to distinguish fatigue from drowsiness and to consider that drowsiness can both accompany the 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 disadaptation. Approximately one third of patients can not work and another third prefer partial professional employment. The average duration of the disease is 5-7 years, but the symptoms can persist for more than 20 years. Often the disease proceeds wavy, periods of exacerbation (deterioration) alternate with periods of relatively good health. In most patients, partial or complete remissions are observed, but the disease often recurs.

Additional symptoms found in patients with chronic fatigue syndrome

• Irritable bowel syndrome (abdominal pain, nausea, diarrhea, or bloating).
• Chills and sweating at night.
• Feeling of fog, emptiness in the head.
• Chest pain.
• Labored breathing.
• Chronic cough.
• Visual disturbances (blurred vision, intolerance to bright light, pain in the eyes, dry eyes).
• Allergy to food, increased sensitivity to alcohol, smells, chemicals, drugs, noise.
• Difficulties in maintaining a vertical position (orthostatic instability, irregular heartbeat, dizziness, instability, 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 the actual chronic fatigue syndrome, is comorbid in many functional diseases, such as fibromyalgia, irritable bowel syndrome, posttraumatic stress disorder, dysfunction of the mandibular joint, chronic pelvic pain, etc.

[21], [22], [23], [24], [25], [26]

Diagnostic criteria

The syndrome of chronic fatigue was repeatedly described under various names; Search for the term that most fully reflects the essence of the disease. Continue to this day. In the literature, the following terms were most commonly used: "benign myalgic encephalomyelitis" (1956), "myalgic encephalopathy", "chronic mononucleosis" (chronic infection with the Epstein-Barr virus) (1985), "chronic fatigue syndrome" (1988), "post-virus syndrome fatigue ". In ICD-9 (1975) chronic fatigue syndrome was not mentioned, but was the term "benign myalgic encephalomyelitis" (323.9). ICD-10 (1992) introduced a new category - post-virus fatigue syndrome (G93).

For the first time, the term and definition of chronic fatigue syndrome were presented by US scientists in 1988, suggesting the viral etiology of the syndrome. As the main causative agent, the Epstein-Barr virus was considered. In1994 the revision of the definition of chronic fatigue syndrome was carried out and in the updated version it acquired the status of an international one. According to the 1994 definition, it is necessary to persist (or remit) unexplained fatigue, which is not facilitated by rest, and to a significant extent restricts daily activity for at least 6 months. In addition, 4 or more of the following 8 symptoms are necessary.

• Impaired memory or concentration of attention.
• Pharyngitis.
• Soreness in palpation of cervical or axillary lymph nodes.
• Tenderness or stiffness of muscles.
• Soreness of the joints (without redness or swelling).
• A new headache or a change in its characteristics (type, severity).
• Sleep, not bringing a sense of recovery (freshness, vivacity).
• The aggravation of fatigue until exhaustion after a physical or mental effort lasting more than 24 hours.

In 2003, the International Group on the Study of Chronic Fatigue Syndrome recommended using standardized scales to assess the main symptoms of chronic fatigue syndrome (a violation of daily activity, fatigue and accompanying symptomatic complex).

Conditions that exclude the diagnosis of chronic fatigue syndrome are as follows:

• The presence of any current somatic diseases that may explain the persistence of chronic fatigue, such as severe anemia, hypothyroidism, sleep apnea syndrome, narcolepsy, oncological diseases, chronic hepatitis B or C, uncontrolled diabetes mellitus, heart failure and other serious cardiovascular diseases , chronic renal failure, inflammatory and dysimmune diseases, diseases of the nervous system, severe obesity, etc., as well as medication, side effects which include a feeling of general weakness.
• Mental illness (including in history).
  • Major depression with psychotic or melancholy symptoms.
  • Bipolar affective disorder.
  • Psychotic states (schizophrenia).
  • Dementia.
  • Anorexia nervosa or bulimia.
• Abuse of drugs or alcohol for 2 years before the onset of fatigue and for some time after.
• Heavy obesity (body mass index of 45 or more).

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

• Painful conditions, diagnosis of which is carried out on the basis of only clinical criteria and which can not be confirmed by laboratory tests.
  • Fibromyalgia.
  • Anxiety disorders.
  • Somatoform disorders.
  • Non-malochial depression.
  • Neurasthenia.
• Diseases associated with chronic fatigue, but successful treatment of which led to the improvement of all symptoms (adequacy of therapy should be verified). For example, the success of hypothyroidism substitution therapy should be verified by the normal level of thyroid hormones, the adequacy of the treatment of bronchial asthma - the evaluation of respiratory function, etc.
• Diseases associated with chronic fatigue and caused by a specific pathogen, such as Lyme disease, syphilis, if their adequate treatment was performed before the onset of symptoms of chronic fatigue.
• Isolated and unexplained paraclinical abnormalities (changes in laboratory parameters, neuroimaging findings), which are not enough to strictly confirm or exclude any disease. For example, these findings may include increasing the titres of antinuclear antibodies in the absence of additional laboratory or clinical evidence to reliably diagnose connective tissue disease.

Unexplained chronic fatigue, which does not fully satisfy the diagnostic criteria, can be regarded as idiopathic chronic fatigue.

In 2007, the National Institute of Health of Great Britain (NICE) published less stringent criteria for chronic fatigue syndrome, recommended for use by various specialists.

• The presence of newly emerged, persistent or recurrent fatigue (over 4 months in adults and 3 months in children), which:
  • can not be explained by any other disease;
  • significantly limits the level of activity;
  • is characterized by malaise or aggravation of fatigue after any effort (physical or mental) followed by extremely slow recovery (for at least 24 hours but usually for several days).
• The presence of one or more symptoms from the following list: sleep disorder, muscle or joint pain, polysegmental location without signs of inflammation, headache, lymph node pain without their pathological increase, pharyngitis, cognitive dysfunction, worsening of symptoms with physical or mental stress, general malaise, dizziness and / or nausea, palpitations in the absence of an organic pathology of the heart.

At the same time, it is recommended to revise 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 heavily criticized by experts, so most researchers and clinicians continue to use the 1994 international criteria

Along with the syndrome of chronic fatigue, secondary forms of this syndrome are also isolated in a number of neurological diseases. Chronic fatigue is observed in multiple sclerosis, Parkinson's disease, motor neurone, chronic cerebral ischemia, stroke, post-poliomyelitis syndrome, etc. The secondary forms of chronic fatigue are caused by direct CNS damage and other factors indirectly related to the underlying disease, for example, depression that has arisen as a reaction to a neurological disease.

[27], [28], [29], [30], [31], [32]

Diagnostics of the chronic fatigue syndrome

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

• Detailed history of the disease, including medications used by the patient, which can cause fatigue.
• Exhaustive examination of the patient's somatic and neurological status. Superficial palpation of somatic muscles in 70% of patients with chronic fatigue syndrome with mild pressing reveals painful points localized in different muscles, often their location corresponds to that of fibromyalgia.
• Screening study of cognitive and mental status.
• Conducting a set of screening laboratory tests:
  • a general blood test (including the leukocyte formula and the definition of ESR);
  • biochemical blood analysis (calcium and other electrolytes, glucose, protein, albumin, globulin, creatinine, ALT and ACT, alkaline phosphatase);
  • evaluation of thyroid function (thyroid hormones);
  • urine analysis (protein, glucose, cellular composition).

Additional studies usually include the determination of C-reactive protein (markers of inflammation), rheumatoid factor, activity of CK (muscle enzyme). The 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 test panel for Epstein-Barr viruses, enteroviruses, retroviruses, herpes viruses of the 6th type and Candida albicans are conducted only at the presence in the anamnesis of indications for an infectious disease. On the contrary, MRI of the brain, the study of the cardiovascular system is referred to routine methods for suspected chronic fatigue syndrome. To exclude sleep apnea, polysomnography should be performed.

In addition, it is advisable to use special questionnaires that help assess the severity of the disease and monitor its course. Most often apply the following.

• The multidimensional Fatigue Inventory (MFI) estimates total fatigue, physical fatigue, mental fatigue, reduction of motivation and activity. Fatigue is defined as severe if the assessment on the scale of total fatigue is 13 points or more (or on a scale of activity reduction - 10 points or more).
• Quality of life questionnaire SF-36 (Medical outcomes survey short form-36) for assessing functional impairment in 8 categories (restriction of physical activity, restriction of normal role activity due to health problems, restriction of normal role-playing activity due to emotional problems, bodily pain, general health assessment, viability assessment, social functioning and general mental health). The ideal rate is 100 points. For patients with chronic fatigue syndrome, 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) are characteristic.
• The CDC Symptom Inventory (CDC Symptom Inventory) for identifying and assessing the duration and severity of the concomitant fatigue of the symptom complex (in a minimized form is a summary of the severity of the 8 symptom criteria of the chronic fatigue syndrome).
• If necessary, the McGill Pain Score questionnaire and the Sleep Answer Questionnaire are also used.

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Differential diagnosis

The syndrome of chronic fatigue is the diagnosis of exclusion, that is, for its formulation, careful differential diagnosis is necessary to eliminate many serious and even life-threatening diseases (chronic heart diseases, anemia, thyroid pathology, tumors, chronic infections, endocrine diseases, connective tissue diseases, inflammatory diseases intestines, mental disorders, etc.).

In addition, it should be remembered that a feeling of fatigue can be a side effect of certain medications (muscle relaxants, analgesics, beta-adrenoblockers, benzodiazepines, antihistamines and anti-inflammatories, interferon beta).

Treatment of the chronic fatigue syndrome

Since the causes and pathogenesis of the syndrome of chronic fatigue are not known to date, there are no valid therapeutic recommendations. Controlled studies of the effectiveness of certain drugs, food additives, behavioral therapy, physical training, etc. In most cases, the results were negative or unconvincing. The most encouraging results were obtained for complex non-drug treatment.

Drug Treatment of Chronic Fatigue Syndrome

There are single studies showing some positive effect of intravenous immunoglobulin (compared with placebo), but the effectiveness of this method of therapy can not yet be considered proven. Most other drugs (glucocorticoids, interferons, antiviral agents, etc.) were ineffective with respect to both the actual fatigue and other symptoms of chronic fatigue syndrome.

In clinical practice, antidepressants are widely used to successfully kill some symptoms of chronic fatigue syndrome (improve sleep and reduce pain, positively affect comorbid conditions, in particular, fibromyalgia). In some open studies, the positive effect of reversible MAO inhibitors has been established, especially in patients with clinically significant vegetative symptoms. However, it should be borne in mind that most patients with chronic fatigue syndrome do not tolerate drugs acting on the central nervous system, so therapy should be started with low doses. Preference should be given to antidepressants with a favorable spectrum of tolerability. In addition, officinal herbal preparations with significantly fewer side effects can be considered as an alternative therapy in people who have a negative experience of using antidepressants. The basis of most of the official complex phytopreparations is valerian. Controlled, randomized studies demonstrate that the effects of valerian on sleep include improving sleep quality, prolonging sleep time, and reducing the time to fall asleep. The hypnotic effect of valerian on sleep is more obvious in people with insomnia than in healthy individuals. These properties allow the use of valerian in individuals with chronic fatigue syndrome, the core of the clinical picture of which are dissomnic manifestations. More common is not a simple extract of valerian, but complex herbal preparations (novopassit), in which a harmonious combination of extracts of medicinal plants provides complex psychotropic (sedative, tranquilizing, mild antidepressant) and "organotropic" (antispasmodic, analgesic, anti-allergic, vegetostabilizing) action.

There is evidence that some patients have a positive effect on the appointment of 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 (tenderness or stiffness of the muscles).

In cases of sleep disorders, it may sometimes be necessary to use sleeping pills. Typically, you should start with antihistamines (doxylamine) and only in the absence of the effect of prescribe prescription sleeping pills in minimum doses.

Some patients use alternative treatment - vitamins in large doses, phytotherapy, special diets, etc. The effectiveness of these measures is not proven.

[37], [38], [39], [40]

Non-drug treatment of chronic fatigue syndrome

Widely used cognitive behavioral therapy designed to eliminate pathological perception and distorted interpretation of bodily sensations (ie, factors that play a significant role in maintaining the symptoms of chronic fatigue syndrome). Cognitive behavioral therapy can also be useful for teaching patients more effective coping strategies, which in turn can lead to increased adaptive capacity. In controlled studies, it has been established that 70% of patients report a positive effect. A combination of the program of stepped physical exercises with cognitive behavioral therapy can be useful.

The technique of deep breathing, muscle relaxation techniques, massage, kinesiotherapy, yoga are considered as additional effects (mainly for the elimination of comorbid anxiety).

Forecast

Long-term follow-up of patients with chronic fatigue syndrome found that improvement occurs in approximately 17-64% of cases, impairment - in 10-20%. The probability of complete cure does not exceed 10%. Return to previous professional occupations in full 8-30% of cases. Elderly age, longer duration of the disease, severe fatigue, comorbid mental illness - risk factors for unfavorable prognosis. On the contrary, children and adolescents are more likely to recover completely.

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