Chronic fatigue syndrome (CFS)

Chronic Fatigue Syndrome (CFS), also known as Systemic Exertion Intolerance Disease (SEID) or Myalgic Encephalomyelitis (ME), is a compounded and debilitating chronic illness. CFS is a complex and long-lasting illness, which causes persistent or recurring fatigue, chronic pain (especially in the muscles and joints) and trouble sleeping for at least six months without any other identifiable cause.

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Causes and symptoms of chronic fatigue syndrome

CFS is likely caused by a variety of factors.

We don't know exactly why people get chronic fatigue syndrome, but believe it is due to a variety of factors, including genetics, environmental influences, lifestyle choices and stress levels. Other causes may include immune system dysfunction, medical treatments like chemotherapy or radiation, major surgery recovery, and viral or bacterial infections.

You may also be experiencing anxiety, depression, chemical sensitivities, or even fibromyalgia. Because these symptoms can overlap and co-exist, CFS can be difficult to diagnose. Your provider will work with you to determine the best combination of treatment, medication and therapy, so you can manage all of your symptoms and feel like yourself again.

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Symptoms of CFS vary from person to person.

Patients with CFS can’t perform normal daily activities because they experience overwhelming and extreme fatigue known as post-exertional malaise, which is not alleviated by resting. The severity of CFS symptoms varies from person to person, sometimes causing inability to work or attend schools, and in some instances leading to severe disabilities.

Aside from severe fatigue, people who suffer from CFS likewise experience a wide range of mental and physical symptoms, including:

  • Brain fog.
  • Chronic pain.
  • Dizziness that worsens with moving from lying down or sitting to standing.
  • Enlarged lymph nodes in your neck or armpits.
  • Extreme exhaustion after physical or mental exercise.
  • Fatigue.
  • Headaches.
  • Problems with memory or concentration.
  • Sore throat.
  • Unexplained muscle or joint pain.
  • Unrefreshing sleep.

Sleep disorders, insomnia, depression, mood swings, anxiety attacks and panic attacks have also been reported by patients with CFS.

Meeting diagnostic criteria.

To meet the Institute of Medicine’s diagnostic criteria for chronic fatigue syndrome, a person would also need to experience at least one of these two symptoms:

  • Difficulties with memory, focus and concentration.
  • Dizziness that worsens with moving from lying down or sitting to standing.

These symptoms must last for at least six months and occur at least half the time at moderate, substantial or severe intensity.

Diagnosing chronic fatigue syndrome

To diagnose CFS, your healthcare provider will ask for your medical history; which includes your physical and mental health. They will perform a physical exam and most-likely order blood tests to measure electrolyte levels and thyroid function. They may also run other medical tests, collect urine samples or order x-rays.

When examining blood samples, elevated levels of proteins like C-reactive protein (CRP), white blood cell and lymphocyte counts, or erythrocyte sedimentation rate (ESR) are a key indicator that a patient may have chronic fatigue syndrome.

If your medical provider suspects you may have CFS, they will refer you to a specialist (a rheumatologist) who can review your medical history, blood tests and urine samples. The rheumatologist will confirm the correct diagnosis.

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Treating chronic fatigue syndrome

Chronic fatigue syndrome has no known cure, but several treatments are available to help alleviate symptoms.


Some problems associated with chronic fatigue syndrome can be improved with either prescription or over-the-counter medications. Examples include prescribed pain and depression medications and blood-pressure medications.

Pharmacist explaining medication to patient


Attending therapy and counseling sessions can be extremely beneficial in the lives of CFS patients. Counseling can help patients learn coping mechanisms for disruptive symptoms, manage depression, build confidence and strengthen family dynamics. And counseling can provide additional support when navigating limitations in both school and work.

Addressing sleep problems

Dealing with sleep deprivation, regardless of the severity, has the potential to make additional symptoms even more difficult to address. Your healthcare provider may encourage you to alter your bedtime routine or limit your caffeine intake to aid in your sleep problems.


Engaging in exercises that are of low, or slowly increasing intensity are most beneficial for CFS patients. High-intensity, aggressive forms of exercise may lead to worsened symptoms, so keeping to a low-intensity exercise regimen will help to improve the long-term health and function of a CFS patient.

Frequently asked questions (FAQs) about chronic fatigue syndrome

Is chronic fatigue syndrome known by other names?

CFS might also be referred to as systemic exertion intolerance disease (SEID) or myalgic encephalomyelitis (ME).

Is chronic fatigue syndrome an autoimmune disease?

Chronic fatigue syndrome may be a variant of an autoimmune disease but is not one in and of itself. Instead, CFS is often spurred by infections and may involve a genetic predisposition.

Are there different classifications of fatigue?

Yes. The three types of fatigue are transient, cumulative and circadian.

  • Transient fatigue is a severe fatigue in response to staying awake for prolonged periods of time within the span of one to two days.
  • Cumulative fatigue is often in response to either a mild, continuous sleep restriction or staying awake for prolonged periods of time over the course of several days.
  • Circadian fatigue typically arises from a lack of sleep occurring during a person’s window of “circadian low” which often falls between 2 and 6 a.m.
Is chronic fatigue syndrome a disability?

The classification of chronic fatigue syndrome as a disability varies from person to person and is dependent on Social Security’s assessment of the severity of each patient’s case, including the effect your CFS limitations may have on your ability to work a full-time job. If they conclude that your chronic fatigue is severe, they will then determine your disability status.

What kinds of complementary or alternative therapies are used to treat CFS?

Sleep, nutrition, and physical exercise. A pattern of proper sleep, nutrition and a daily aerobic exercise routine can help manage chronic fatigue. Behavioral therapy techniques, medications including sleep aids or a referral to a sleep specialist may be recommended to facilitate good sleep. To promote exercising, your health care provider at the Integrative Medicine Center will also create and discuss an individualized graded exercise program with you, using activity management to balance rest and activity to avoid fatigue. We will also make nutritional recommendations to optimize your energy.

Nutritional therapies. Eating healthy foods and foods high in B vitamins are essential. These include whole grains, fruits, vegetables, nuts, seeds, dairy products and green tea. Some of the best energy supplements include not only B vitamins, but vitamin D3 and vitamin E as well. Including Magnesium, Calcium, Zinc as part of the vitamin regime is suggested by nutritionists. Additional supplements such as CoQ10, L-glutamine, fish oil and ginkgo biloba may be beneficial.

Avoiding excessive alcohol, sugar and caffeine is beneficial to help prevent worsening CFS symptoms. Limiting food additives, preservatives, and artificial sweeteners (Aspartame), high fructose corn syrup and refined carbohydrates can also help keep symptoms at bay. Sodium supplements should be avoided.

Cognitive behavioral therapy. To change self-defeating behaviors and enhance self belief, you may be advised to meet with one of the Integrative Medicine Center’s experienced psychologists. The psychologist might integrate stress-reduction techniques such as mindfulness, guided imagery, or meditation to help you manage your outlook and processing of your range of symptoms to manage chronic pain.

Complementary medicine therapies. Patients demonstrating adherence to their individualized sleep, exercise, nutrition and behavioral therapy treatment plans may benefit from additional therapies. Such complementary therapies include massage, acupuncture, nutritional counseling or chiropractic care and should be considered. These supplementary methods paired with effective treatment plans may help to improve your overall quality of life and usual activities.

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Center for Disease Control and Prevention (CDC). Myalgic Encephalomyelitis Chronic Fatigue Syndrome (

National Center for Biotechnology Information (NCBI): National Library of Medicine. Chronic Fatigue Syndrome (