Chronic Fatigue

Fatigue is probably the most common complaint my patients present with.  Discovering why my patients are tired has always been an area of great interest to me. There are many different levels of fatigue from mild to severe.  For one person it might be just not having quite the level of energy they wish they had, while at the other end of the spectrum is the exhausted patient who is becomes practically bedridden after only minor activity.

Assessment and Treatment of Fatigue Disorders

After treating CFS to conditions for over 30 years, and has become apparent that most fatigue conditions are multifactorial and often complex.  There is no "magic bullet" or universal treatment for these conditions. The majority of the time the cause or causes of fatigue can be discovered and treated.  My basic approach is to find the cause and eliminate it or discover the deficiency and replace it.

Chronic fatigue conditions can manifest in different organ systems:

• Immune system-immune deficiency or hypersensitivity or a combination of both
• Central nervous system-brain and especially autonomic nervous system
• Endocrine system-deficiency, autoimmunity, impairments
• Cellular energy disruptions-especially mitochondrial dysfuncti0ns

Allergic Fatigue-Although not commonly recognized, fatigue is one of the most common manifestations of allergy.  (Just ask the moderately severe hayfever sufferer how they feel when their pollen allergies are acting up).

Allergy evaluation is an important part of our diagnostic evaluation of patients with fatigue, even though many of these patients have no suspicion that allergy could be causing their problems. This would include inhalants such as dust, mold, pollen, etc. and especially foods.

Be aware that allergies are inflammatory reactions, which can cause generalized inflammation and fatigue.  This is similar to catching the flu when we feel tired and achy all over. These flu-like symptoms are not caused by the virus, but rather by our immune system reacting producing cytokines/inflammatory mediators to kill the foreign invader.   This is analogous to an allergic reaction and why chronic allergies can result in chronic fatigue.

Chronic Fatigue Syndrome-CDC Criteria

The symptoms of chronic fatigue cannot be objectively measured.  That is the reason why the CDC developed criteria to establish the diagnosis of Chronic Fatigue Syndrome, a systemic disorder comprising a complex set of symptoms, which vary in duration, incidence and severity.  The most common characteristic is prolonged fatigue lasting 6 months or more resulting in substantial reduction in the patient's previous ability to participate in occupational, educational, social, and personal activities.

According to the CDC guidelines on CFS, the major characteristics are that the fatigue:

• Is persistent or relapsing in nature and of at least six months duration.
• Should not be lifelong.
• Cannot be explained by other physical or mental conditions.
• Results in substantial reduction of occupational, educational, social and personal activities compared to the patient's condition prior to the onset of this present condition.
• Should not be the result of ongoing exertion and is not relieved by rest.

The current CDC definition also requires at least four or more of the following symptoms:

• Impairment of short-term memory or concentration  severe enough to cause substantial reduction in previous levels of occupational, educational, social, and personal activities.
• Sore throat
• Tender lymph glands
• Muscle pain
• Joint pain involving more than one joint
• Headaches of a new type, pattern, or severity
• Unrefreshing sleep
• Fatigue lasting more than 24 hours after exertion