A Brief Synopsis of AFP's "Chronic Fatigue Syndrome: Diagnosis and Treatment "

A brief synopsis of:
Chronic Fatigue Syndrome: Diagnosis and Treatment, JOSEPH R. YANCEY, MD, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, SARAH M. THOMAS, MD, Fairchild Air Force Base, Washington
http://www.aafp.org/afp/2012/1015/p741.pdf
Am Fam Physician. 2012 Oct 15;86(8):741-746

     Chronic fatigue syndrome is one of the tougher diseases to deal with as a physician. We don't know what causes it, and don't have any real great way to treat it. It is seen more commonly in women over 40 years old. The CDC has created a list of criteria. The patient will have severe fatigue for at least six months, plus at least four of the following symptoms; a new headache, pain in multiple joints (without swelling or redness), myalgia, malaise after a period of exertion (which lasts at least 24 hours), short-term memory or concentration impairment, sore throat, unrefreshing sleep, and lymph node tenderness.
     The history and physical exam should focus on the patients' most bothersome symptoms. The patient should also be evaluated for depression, which is present in almost half of CFS patients. Lab work (UA,CBC, CMP, Ph, TSH, CRP) is used to rule out other causes of fatigue.  THERE IS NO TEST FOR CFS. There is no need for viral titers. Red flag symptoms including chest pain, focal neurological defects, inflammation, weight loss, lymphadenopathy, or dyspnea,  may indication a serious underlying illness.
     The etiology is confusing and complex. It is either immune, viral, adrenal, genetic, biopsychosocial,  sleep or nutrition based. Or it could be mixed. Research is ongoing.
     There is no great treatment for CFS since all the medications that have been tried in the past don't really do much. Obviously, the physician wants to treat the patient by managing the symptoms. The most common ones are sleep, depression and pain. As far as treatment for the CFS itself, the two evidence based treatments are CBT and graded exercise therapy. CBT helps the patient realize that the fear of the fatigue and malaise can actually perpetuate the symptoms.  The therapy needs to be individualized on a case by case basis by an expert. Graded exercise therapy is done by having the patient slowly work up to a goal of mild exercise of 30 minutes for 5 days a week. Overexertion should be avoided. Many patients choose walking for their exercise. Patients may benefit from regular visits by a physiotherapist. Effects of either of these therapies is moderate at best, with resolution unlikely.