Introduction

Despite an always increasing medical and technical knowledge, Chronic Fatigue Syndrome (CFS) remains an elusive health problem. Once known as "the disease of many names" it is now generally recognized as CFS (Chronic Fatigue Syndrome). Unfortunately, there is no simple test for CFS and diagnosis still relies on clinical evaluation by a competent health care provider. No single cause for CFS is known and it is generally accepted that CFS develops through the exposure of many convergent factors.

In the US, it is estimated that ½ million to 2 million people suffer from CFS (0.2 - 0.7% of the population). While CFS potentially affects people of all ages, including children, it is more common that onset occurs in the early thirties (Dowsett, 1990, Shepherd, 1999). CFS afflicts women twice as much as men (ho-Yen, 1991).

Definition

According to the American Center for Disease Control, Chronic Fatigue Syndrom (CFS) is defined by "the presence of unexplained persistent fatigue that is not relieved by rest and that results in a substantial reduction in occupational, social and personal activities".

Symptoms

The CDC states that at least four of the following symptoms must have been present for a minimum of six consecutive months with a history of previous wellbeing to allow diagnosis of CFS.

• Short-term memory loss
• Difficulties concentrating
• Sore throat
• Tender neck or armpit lymph nodes
• Muscle pain or weakness
• Migratory painful joints without swelling or redness
• Headache
• Lost or depressed vision
• Visual intolerance to light
• Unusual irritability
• Un-refreshing sleep
• Post-extortional malaise lasting more than 24 hours

Most patients treated for Chronic Fatigue Syndrome do not have symptoms severe enough to be classified as CFS according to the CDC. This does not mean these patients are not suffering; their symptoms may just vary enough to fall outside these general parameters. Severe Fatigue in any of its forms or diagnoses needs to be approached seriously and with compassion.

The factors leading to fatigue

Many factors are recognized to contribute to fatigue and CFS. While immune imbalances, oxidative stress (the accumulation of free radicals and their effects inside the cells), genetic and psychological factors are often mentioned, neurohormonal factors seem to be one of the major components involved. A high incidence of abnormalities in the HPA (Hypothalamus, Pituitary, Adrenal) axis of people suffering from CFS is reported. The HPA axis plays a major role in the body's response to stress and refers to the interaction of the hypothalamus, pituitary and adrenal glands. This very complex system in our bodies manages, amongst other things, how energy reserves are mobilized and used. Even slight imbalances may jeopardize this fragile feed-back loop.

A key element in this cycle is the adrenal gland. CFS has been associated with smaller adrenal glands (Scott, 1999). Mild signs of adrenal failure as well as reduced levels of the related hormones are seen in almost half of the people suffering from CFS. Lower levels of CRH (corticotrophin releasing hormone) and cortisol for example, are known to result in extreme fatigue, myalgias, mood and sleep disturbances and other symptoms generally associated with Chronic Fatigue Syndrome.