Understanding the Complexity of Chronic Fatigue Syndrome

MIDDLETOWN — According to the Centers for Disease Control and Prevention, 2.5 million Americans have been diagnosed with myalgic encephalomyelitis or chronic fatigue syndrome. For the many people who suffer from this disease, there is no cure. Treatment begins by addressing the most disabling symptoms.

This column will look at the complexity of the condition making CFS difficult to diagnose, as many symptoms overlap with other illnesses and diseases.

The National Academy of Medicine’s 2015 Diagnostic Criteria documents the three main symptoms of CFS: fatigue, unrefreshing sleep, and post-exertional malaise, which occurs after physical or mental exertion. PEM is the exacerbation of CFS symptoms.


All three of the above must be present and the level of severity must be moderate to severe at least 50% of the time. In addition, a person must experience one of the following symptoms: worsening of symptoms after standing or sitting, or “brain fog” – memory and concentration difficulties that worsen when tired or stressed.

According to the Mayo Clinic, additional symptoms of CFS can include headache, sore throat, enlarged lymph nodes in the neck or armpits, unexplained muscle or joint pain, or dizziness when standing.

Extreme fatigue is defined by the United States Institute of Medicine as new and not permanent; severe enough that a person can no longer participate in activities they did before the onset or illness; not improved by rest, and include post-exercise malaise, which may take days or weeks to recover.

Many medical conditions can trigger symptoms of CFS, including sleep disturbances, anemia, diabetes, cancer, many autoimmune diseases, hormonal imbalances, such as an overactive or underactive thyroid; depression and anxiety.

Unfortunately, there is no one test or procedure to diagnose CFS. The causes of CFS can arise suddenly from a viral infection, surgery, injury, or emotional trauma. Following the coronavirus pandemic, many COVID long-haulers are showing symptoms of CFS.

If you think you have symptoms of CFS, it is recommended that you make an appointment with your doctor. Be sure to list all symptoms, being as specific as possible about their onset, severity, and impact on your quality of life.

Also share any updated medical and personal information with your doctor. Blood work as well as additional diagnostic tests may be needed to rule out other medical conditions. Your doctor may refer you to a specialist if they are concerned that the symptoms are related to a specific medical condition.

If other medical conditions are ruled out, managing the most debilitating symptoms is key to feeling better. This may include over-the-counter medications to manage pain or prescriptions to treat anxiety and depression. However, counseling, support groups or exercises may also be part of the individual care plan.

Laura Falt is Director of Business Development for National Health Care Associates, CT North. She represents the company’s seven qualified nurses, including Water’s Edge Center for Health & Rehabilitation in Middletown. Email him at [email protected]

Sharon D. Cole