Diagnosing And Treating CFS
Diagnosing CFS is difficult because its symptoms are vague and the disorder often mimics other syndromes or diseases, such as influenza or other viral infections (Aaron 2000; Borish 1998; Bruno 1998; Demitrack 1994). Illnesses that may mimic CFS include hypoglycemia, hypothyroidism, depression, environmental illness, food allergies, eating disorders, sleep apnea, autoimmune disease, infections, mononucleosis, and cancer.
A CFS diagnosis can be made only when the patient has suffered from persistent, unexplained fatigue for at least six months. In addition to fatigue, four of the following symptoms must be present (CDC 2005b):
- Unrefreshing sleep
- Cognitive impairment, especially short-term memory or concentration
- Sore throat
- Tender lymph nodes
- Aching or stiff muscles
- Multi-joint pain without swelling or redness
- Headaches of a new type, pattern, or severity
- Post-exertion malaise lasting more than 24 hours
- Persistent feeling of illness for at least 24 hours after exercise
A number of other symptoms have been reported by CFS patients, including abdominal pain, alcohol intolerance, bloating, chest pain, chronic cough, diarrhea, dizziness, dry eyes or mouth, earache, irregular heartbeat, jaw pain, morning stiffness, nausea, night sweats, shortness of breath, skin sensation, tingling sensations, and weight loss (CDC 2005c).
Chronic fatigue syndrome tends to arise suddenly in otherwise active individuals. In a typical disease course, an otherwise ordinary flu-like illness or some other stressor will leave behind unbearable exhaustion and symptoms of CFS. This condition is frequently mistaken for a recurrence of the infection, sending the patient back to the doctor for more tests. Repeated tests will reveal no characteristic abnormalities, yet symptoms worsen, eventually resulting in sleep disturbances and depression. Many patients with CFS feel their concerns are initially dismissed by physicians, friends, and family, which may contribute to a sense of isolation.
Once diagnosed, the symptoms may fluctuate, but CFS is not a progressive disease. Instead, most patients tend to get better by degrees, and some will fully recover (Kasper 2005).
There is no single laboratory test to confirm CFS. Instead, physicians should perform a wide variety of blood and cognitive testing in an effort to rule out other diseases. Recent research into CFS suggests that there may be several subclasses of the disease, based on differences in disabilities, socio-demographic factors, viral status, and other biomarkers, and thus different modes of diagnosis and treatment may be appropriate (Jason 2005).