Disease Description (Causes and Symptoms)
Chronic Fatigue Syndrome (CFS) is a condition in which severe fatigue that cannot be explained by another clear medical cause persists for 6 months or longer and leads to a significant reduction in daily activities (work, studies, social activities, and personal activities). It is characterized by not improving with rest and worsening with mental or physical activity.
Major pathophysiological factors and triggers:
- Although the exact cause is unknown, it is considered multifactorial. Viral infection, immunological abnormalities, abnormalities of the nervous and endocrine systems (stress response), changes in the central nervous system, and psychosocial stress are reported to be involved in combination.
- Important clinical features include severe exhaustion after exertion (worsening after exercise, post-exertional malaise, PEM), poor sleep, impaired cognitive function (memory and concentration problems), muscle and joint pain, sore throat, and tender lymph nodes.
Examples of symptoms:
- Unexplained severe fatigue lasting 6 months or longer
- Impaired memory and concentration, sleep disturbances (not feeling refreshed even after sleeping)
- Generalized pain, loss of appetite, malaise, depression, anxiety, etc.
(Prevalence: Some reports estimate that approximately 2–5% of people who complain of chronic fatigue have CFS.)
Treatment Methods and Precautions
The goals of treatment are symptom relief, functional recovery, and improvement of quality of life; there is currently no curative treatment. Multidisciplinary, symptom-focused treatment is recommended.
Recommended treatment and management
- Cognitive behavioral therapy (CBT): May help with coping with symptoms, planning activities, and improving psychological factors.
- Gradual, individualized physical activity management: Gradual increases in primarily aerobic activity have been useful in studies; however, exercise can worsen symptoms (PEM), so a gradual, individualized plan adapted to the symptom level is essential (guidance by a physical therapist is recommended).
- Recent guidelines emphasize avoiding overly strenuous exercise therapy and adjusting activity based on symptoms.
- Symptom-specific medication: No specific medication treats CFS. Appropriate medication (including antidepressants, sleeping pills, and pain relievers) may be considered for accompanying insomnia, pain, depression, anxiety, and other symptoms.
- Treatment of comorbid conditions: Other diseases that cause fatigue, such as thyroid disease, anemia, infection, and rheumatic disease, should be actively evaluated and treated.
- Education and lifestyle management: Pacing (balancing activity and rest), stress management, sleep hygiene, and energy-conservation strategies (adjusting work and household tasks) are recommended.
Precautions and risk of complications
- Symptoms may worsen when starting exercise (PEM) → Avoid overly strenuous exercise; a gradual, symptom-adapted approach is necessary.
- Some medications (diuretics, beta-blockers, some antipsychotics and antidepressants, pain relievers [including narcotics], anticonvulsants, steroids, antihistamines, etc.) may worsen fatigue, so reviewing current medications is important.
- Depression, social isolation, and loss of employment may occur as a result of reduced functioning.
Outpatient Visit Checklist (Including Preparation Items and Sample Questions)
Preparation items (recommended to bring)
- A list of all medications and supplements currently being taken (including dosage and times of administration)
- Copies of recent test results (blood tests, hormone tests, imaging, etc.)
- A record summarizing when symptoms began and how they have progressed (main symptoms, severity, aggravating factors, response after exercise, etc.)
- A sleep-pattern and activity-level diary (if possible, for 1–2 weeks)
- A record of changes in daily functioning (work, household tasks, and social activities)
Key information to submit and explain to the doctor during the outpatient visit
- When symptoms began and how they have progressed (confirm whether they have persisted for 6 months or longer)
- Activities that worsen symptoms and the time needed to recover (especially after exercise)
- Recent history of infection (e.g., a cold or mono) or stressful events
- Previously diagnosed conditions and treatment history (especially thyroid disease, anemia, rheumatic disease, and psychiatric conditions)
- Sleep quality (daytime sleepiness, snoring, etc.) and symptoms of depression and anxiety
Examples of General Questions to Ask the Doctor
- What are the possible causes of this condition? What additional tests should be performed?
- What treatments (nonmedication and medication) do you recommend to improve my symptoms? What effects and side effects can be expected?
- What gradual plan do you recommend for daily activities and returning to work?
- How can we confirm whether other conditions (such as thyroid disease or anemia) have been ruled out?
Examples of Condition-Specific Questions
- How do we determine whether I can exercise and how much activity is allowed? (Including step-by-step goals when starting exercise and what to do if symptoms worsen)
- How can I promptly distinguish and manage worsening symptoms after exercise (or activity)? (Including pacing and criteria for rest)