Mark Borigini M.D.

Overcoming Pain

Awakening to the Reality of Chronic Fatigue Syndrome

Does your doctor have CFS fatigue?

Posted Nov 18, 2009

It has been twenty years since chronic fatigue syndrome was recognized by major medical organizations as a legitimate medical condition. Still, there are many in the medical profession who doubt its existence.

Thus, the Centers for Disease Control (CDC) is embarking on an effort to increase awareness among medical practitioners, so that they might know how to identify sufferers of chronic fatigue syndrome, allowing for more timely initiation of therapy. It is hoped that earlier intervention can play a crucial role in ameliorating-if not eliminating-the chronic exhaustion and pain that plagues patients.

This is no small task, as it is estimated that only 16% of the 1 million Americans who have chronic fatigue syndrome are diagnosed with chronic fatigue syndrome. It is therefore not surprising that diagnosing chronic fatigue syndrome can be a long and laborious process, as this is one of those "diagnoses of exclusion": that is, the physician must make sure there is no other cause for fatigue and pain. The other causes for fatigue and pain are certainly entities a patient would not want his or her doctor to miss: cancer, neurologic disease, thyroid disorders, depression, and so on. By the time these illnesses are ruled out or rule in, quite a bit of time may have passed, with visits to the lab, the radiology department, and other specialists. Patients must have patience.

So, what characterizes a patient with chronic fatigue syndrome? According to the International Chronic Fatigue Syndrome Study Group, a patient with chronic fatigue syndrome typically experiences unexplained fatigue for at least six months. This is fatigue not made better with rest. This is fatigue that results in a reduction in social interaction and employee productivity. At least four of the following must accompany the fatigue: sore throat, muscle pain, joint pain, headache, and difficulty with memory.

Unfortunately, there is no typical chronic fatigue syndrome patient. Patient complaints can vary from day to day, as symptoms wax and wane. Additionally, many chronic fatigue syndrome patients also suffer from fibromyalgia. And many Gulf War syndrome patients eventually develop chronic fatigue syndrome. Not surprisingly, such overlap issues cause many professionals to feel uncomfortable with chronic fatigue syndrome as a diagnosis in and of itself.

Treatment of chronic fatigue syndrome generally involves treating the symptoms of chronic fatigue syndrome, and nurturing coping behavior in the patients.

The CDC endorses aggressive attempts at maximizing sleep hygiene, through avoiding daytime naps, caffeine and large meals before bedtime. Exercise in moderation is helpful. Anti-depressants can help those patients who also suffer from depression. Anti-inflammatory medications are helpful in taking the edge off the pain. The psychostimulant Provigil can increase energy, but still allows patients to sleep at night.

Alternative remedies such as acupuncture and herbal supplements work for some, and psychological counseling can help with coping mechanisms. Always, working with the patient allows for wellness, improves the patient mood, and it is something we as doctors should know by now makes for better patient outlooks, and outcomes.