Introduction to CFS

Introduction to CFS

Chronic Fatigue Syndrome (CFS) is a disorder of unknown cause characterized by significant functional disability associated with fatigue, pain and neuropsychological complaints.

A formal case definition was published in the United States in 19881 and revised in 19942, but many believe it to be outdated and inadequate for the 21st century. For over twenty years since the first clear clinical presentation of CFS in the United States by Straus3 and Jones4 and the first USA epidemic of CFS was reported in Lake Tahoe5, the therapeutic domain for CFS has been dominated by pharmaceutical, nutriceutical, herbiceutical, or alternative medical interventions.

After these twenty-plus years, there is no consensus on what optimal therapy looks like and many reasons to believe that this lack of consensus will continue for years to come. With the advent of stem cell therapy in chronic illness, we are entering a new era in medicine where the old therapeutic ideas are being challenged in favor of new ideas about therapies more appropriate for the treatment of complex chronic illness. 6

1994 CDC Case Definition

As published in the Annals of Internal Medicine by Fucuda et al (1994), the CDC case definition requires that two major criteria be met as follows:

Major criteria:

1. A thorough physical and mental status examination must be performed and a battery of laboratory screening tests should be performed to rule out other possible causes of the major symptoms of chronic fatigue syndrome.
2. Unexplained, persistent fatigue that is not due to ongoing exertion, isn’t substantially relieved by rest, is of new onset (not lifelong) and results in a significant reduction in previous levels of activity.

And

At least four of eight minor symptoms be present for six months or more and include:

1. Impaired memory or concentration.
2. Post-exertional malaise (extreme, prolonged exhaustion and sickness following physical or mental activity).
3. Unrefreshing sleep.
4. Muscle pain.
5. Multijoint pain without swelling or redness.
6. Headaches of a new type or severity.
7. Sore throat that is frequent or recurring.
8. Tender cervical or axillary lymph nodes.

And

That certain exclusionary criteria be adhered to as follows:

1. Any active medical condition that may explain the presence of chronic fatigue, such as untreated hypothyroidism, sleep apnea and narcolepsy and iatrogenic conditions such as side effects of medication.
2. Some diagnosable illnesses may relapse or may not have completely resolved during treatment. If the persistence of such a condition could explain the presence of chronic fatigue, and if it cannot be clearly established that the original condition has completely resolved with treatment, such patients should not be classified as having CFS.
   Examples of illnesses that can present such a picture include some types of malignancies and chronic cases of hepatitis B or C virus infection.
3. Any past or current diagnosis of a major depressive disorder with psychotic or melancholic features:
   • bipolar affective disorders
   • schizophrenia of any subtype
   • delusional disorders of any subtype
   • dementias of any subtype
   • anorexia nervosa
   • bulimia nervosa
4. Alcohol or other substance abuse, occurring within two years of the onset of chronic fatigue and any time afterwards.
5. Severe obesity as defined by a body mass index (body mass index = weight in kilograms ÷ height in meters) equal to or greater than 45.