Chronic Fatigue Syndrome

Chronic Fatigue Syndrome

What is chronic fatigue syndrome?

Chronic fatigue syndrome (CFS) is a condition of severe exhaustion that lasts for at least six months and which is not due to a known medical or psychological disorder. The exhaustion persists despite obtaining rest. CFS occurs in 0.46 to 1% of the general population and 80% of those with CFS are women. Gunn, W. J., Connell, D. B., & Randall, B. (2007). Epidemiology of chronic fatigue syndrome: The Centers for Disease Control study. In G. R. Bock & J. Whelan (Eds.), CIBA Foundation Symposium 173 – Chronic Fatigue Syndrome. Chichester, UK:  John Wiley & Sons, Ltd.


Patients with CFS tend to have high rates of additional diagnoses like fibromyalgia syndrome, irritable bowel symptoms, migraine headache, temporomandibular joint disorder (TMJ), gynecological problems, anxiety and depression. Aaron, L. A., Burke, M. M., & Buchwald, D. (2000). Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Archives of Internal Medicine, 160, 221-227. Schur, E. A., Afari, N., Furberg, H., Olarte, M., Goldberg, J., Sullivan, P. F., & Buchwald, D. (2007). Feeling bad in more ways than one: Comorbidity patterns of medically unexplained and psychiatric conditions. Journal of General Internal Medicine, 22, 818-821.


The cause of CFS is not fully known. However, there are known factors that are likely to be involved in the onset and maintenance of CFS. These are problems within the stress response of the endocrine and nervous systems, Demitrack, M. A., & Crofford, L. (1998). Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Annals of the New York Academy of Sciences, 840, 684-697. Tanriverdi, F. Karaca, Z., Unluhizarci, K., & Kelestimur, F. (2007). The hypothalamic-pituitary-adrenal axis dysregulation in chronic fatigue syndrome and fibromyalgia. Stress, 10, 13-25. and particularly in a condition of the nervous system called central sensitization. Meeus, M. & Nijs, J. (2007). Central sensitization: A biopsychosocial explanation of widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clinical Rheumatology, 26, 465-473.  


Is there a cure for chronic fatigue syndrome?

CFS has no cure. It is a chronic condition. Chronic conditions are health conditions that have no cure and which tend to last indefinitely. Healthcare for chronic conditions focuses on the following: 


  • Reducing symptoms

  • Reducing the impact that the condition has on the patient’s life

The goal is to live well despite having the condition.  


Therapies & procedures for chronic fatigue syndrome

Common treatments for CFS are antidepressant medications, anticonvulsant medications, graded physical therapy, and cognitive behavioral therapy.  


Three reviews of research on the effectiveness of all treatments come to the same conclusion: cognitive behavior therapy and graded physical therapy are the most effective treatments for CFS and that medications for CFS are either ineffective or only minimally effective. Reid, S. F. Chalder, F., Cleare, A., Hotopf, M., & Wessely, S. (2008). Chronic fatigue syndrome. Clinical Evidence, 2008, 1101. Chambers, D., Bagnall, A. M., Hempel, S., & Forbes, C. (2006). Interventions for the treatment, management, and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: An updated systematic review. Journal of the Royal Society of Medicine, 99, 506-520. Whiting, P., Bagnall, A. M., Sowden, A. J., et al. (2001). Interventions for the treatment and management of chronic fatigue syndrome: A systematic review. Journal of the American Medical Association, 286, 1360-1368.


Cognitive behavioral therapy (CBT) is a common type of treatment for chronic health conditions. Its emphasis is on reducing symptoms and improving functioning through teaching the patient how to self-manage their condition. Self-management is a catchall phrase for a number of health behaviors and ways of coping which, when done by the patient, can have positive effects on chronic conditions, such as CFS. Sharpe, M., Hawton, K., Simkin, S., Surawy, C., Hackmann, A., Klimes, I., Peto, T., Warrell, D., & Seagrott, V. (1996). Cognitive behavior therapy for chronic fatigue syndrome: A randomized controlled trial. British Medical Journal, 312, 22-26. White, P. D., Goldsmith, K. A., Johnson, A. L., et al. (2011). Comparison of adaptive pacing therapy, cognitive behavior therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): A randomized trial. Lancet, 377, 823-836. Price, J. R., Mitchell, E., Tidy, E., & Hunot, V. (Updated April 2, 2008). Cognitive behavior therapy for chronic fatigue syndrome in adults. In Cochrane Database Reviews, 2008, (3). Retrieved July 13, 2012, from The Cochrane Library, Wiley Interscience. A health psychologist usually provides CBT.  


Physical therapy is generally considered a necessary therapy for CFS. As indicated, it has been shown to be moderately effective in reducing CFS symptoms and in increasing functioning Fulcher, K. Y., White, P. D. (1997). Randomized controlled trial of graded exercise in patients with chronic fatigue syndrome. British Medical Journal, 314, 1647-1665.



Murray J. McAllister, PsyD, is the executive director of the Institute for Chronic Pain. The Institute for Chronic Pain is an educational and public policy think tank. Its purpose is to bring together thought leaders from around the world in the field of chronic pain rehabilitation and provide academic-quality information that is also approachable to all the stakeholders in the field: patients, their families, generalist healthcare providers, third party payers, and public policy analysts. Its aim is to change the culture of how chronic pain is managed through education and consultation efforts that advocate for the use of empirically supported conceptualizations and treatments of chronic pain. He also blogs at the Institute for Chronic Pain Blog.



Last Updated on Sunday, 25 October 2015 23:55

Published on Saturday, 23 June 2012 16:17

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