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Chronic Fatigue Syndrome (CFS, “Myalgic Encephalitis”)

Lady not sleeping

Chronic fatigue is a very common symptom, and one which we often get asked about as GP’s. It often seems like chronic fatigue is a normal state of being, between late childhood (when exam pressure starts to come on), all the way through to retirement! So, what is “normal” fatigue, and when does it become an illness?

As a doctor, I have certainly had a number of patients who seem to have developed this particular group of symptoms that fit with the diagnosis of CFS. They can be patients from all walks of life that were completely fine previously. These symptoms often include:

  • An unusual amount of tiredness especially after exercise
  • Headaches
  • Muscle and joint pains
  • Sore throats, flu-like illnesses
  • Lymph gland swelling
  • Loss of memory and poor concentration
  • Low mood and loss of enjoyment in normally pleasurable activities
  • Loss of motivation
  • Poor sleep
  • Greater than 6 months duration

Quite often there has been a trigger, such as a viral illness like glandular fever, an unrelated medical illness or operation, or a period of high stress or workload. The problems can be minor or very debilitating.

There is no known obvious cause, and no test that comes up positive for Chronic Fatigue Syndrome – it’s a diagnosis of exclusion – i.e. trying to rule out other causes. That can be easy with some physical health problems, such as thyroid problems, diabetes or iron deficiency, but there is also a strong relationship with mood problems such as depression, and that can be difficult to disentangle. Not least because the symptom of chronic fatigue can actually make you feel depressed and anxious as a consequence.

Some doctors don’t “believe” in Chronic Fatigue Syndrome being a genuine medical illness, perhaps because it is so variable in how it presents. Sometimes there is a suspicion that sufferers are using the label of “chronic fatigue syndrome” as a way of avoiding work or study, or it’s “attention seeking” behaviour and that they should just “toughen up”. We take a more open-minded approach at Azure Medical and aim to treat the person as an individual, rather than treating just a disease or a symptom. We aim to work with you, to support you through a management plan and long term recovery. CFS must be regarded as a “real” biomedical condition.

Treatment for CFS is difficult. There are no easy fixes. Sometimes the condition will last for years. Here are things that can help:

  • A graduated exercise program, preferably supervised by an exercise physiologist, to slowly boost your exercise capacity, help to preserve your physical fitness and muscle strength, as well as boosting the mood from exercise-induced release of natural endorphins.
  • Antidepressant medications, if we feel depression could be a part of the problem – either as the cause, or a secondary consequence. These are usually Serotonin Specific Reuptake Inhibitors (SSRI’s, medications that boost the levels of serotonin – the “happiness hormone” -in the brain).
  • Counselling with a psychologist, especially Cognitive Behavioural Therapy
  • Advice on diet, sleep hygiene and other aspects of a healthy lifestyle

Every commercially available “cure” for CFS needs to be treated with great caution, as there is no proof that they work.

Perhaps chronic fatigue is a symptom that has been troubling you, or you have found it’s been difficult to get treated genuinely and compassionately. Let us see how we can help by booking with one of our friendly and professional doctors at Azure Medical.

Richard Newton

Dr Richard Newton grew up in Warwickshire, England and went to University in Southampton, qualifying in medicine in 1991. Richard’s medical career has taken him around the world in a wide range of roles, from a ship’s Medical Officer on a frigate during the Balkans War, to rural General Practice on King Island, Tasmania. Richard has completed further Professional Development in Laser and Cosmetic Medicine, Skin Cancer Management, Sports Medicine and Internal Medicine.

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