Chronic Fatigue Syndrome - Causes, Symptoms and Treatment

The chronic fatigue syndrome is a controversial and difficult to explain, and it is very frustrating to deal not only with patients but also with physicians, because its causes have not yet been definitively established, the diagnosis is difficult to make and the current treatment is not very effective.

Chronic fatigue syndrome
Chronic fatigue syndrome

Although it does not reduce the life expectancy of the affected patient, the chronic fatigue syndrome can be considered a serious illness due to the great decrease in the quality of life that it can cause.

It is important to know that there are differences between chronic fatigue syndrome and frequent fatigue. In fact, only 10% of patients who complain of chronic fatigue actually have criteria for the diagnosis of chronic fatigue syndrome.


In addition to the chronic fatigue that gives the disease its name, patients with this syndrome also usually present the following symptoms:
  • 1. Difficulty concentrating and "weak memory"
  • 2. Sore throat
  • 3. Muscle pain
  • 4. Joint pain
  • 5. Headache
  • 6. Difficulties in sleeping
  • 7. Lymph nodes discretely enlarged and painful
  • 8. Exhaustion after physical or mental effort, even after 24 hours of rest

These are the classic symptoms, however, several others can occur such as dizziness, diarrhea, allergies, etc.

It is important to note that physical examination is usually normal. The patient complains of pain, but no lesion is found, he complains of fever, but the thermometer never shows it, painful lymph nodes are normal at biopsy, and electromyography can not prove muscle weakness.

This inability to document patient complaints often leads to a misunderstanding that they are pretending to have a disease. However, as in fibromyalgia, chronic fatigue syndrome should be viewed as a real disease, avoiding stigmatization of patients.


Despite all efforts, the causes of chronic fatigue syndrome have not yet been elucidated. Some diseases and infections, especially of the respiratory tract, seem to precipitate the disease, but the mechanism in which this occurs and why it only happens in some people is still a mystery. It is known, however, that the disease is more common in young people and middle-aged adults than in children and the elderly, and twice as common in women as in men.

Among the diseases that may precipitate the chronic fatigue syndrome, we mention:
  • Viral infections, especially of the respiratory tract
  • Depression
  • Anemia due to iron deficiency
  • Hormonal changes
  • Autoimmune causes
  • Chronic low blood pressure
  • Fibromyalgia

For many years it was believed that there was a very strong relationship between mononucleosis and syndrome, however, the latest evidence shows that this relationship is not so important.


Chronic Fatigue Syndrome is a diagnosis of exclusion, that is, one must be sure that fatigue and symptoms are not caused by any other identifiable disease. Cardiac, pulmonary, hepatic and renal diseases, in addition to dozens of other problems, such as morbid obesity, drug use, sleep apnea, anorexia, etc., can cause fatigue and should always be discarded.

Even if the patient has no identifiable cause for his fatigue, it is still necessary for the diagnosis of the syndrome that the fatigue has been present in the last six months and is associated with at least 4 of the 8 symptoms described above.


There is no cure for chronic fatigue syndrome and treatment is not always satisfactory. Of all the treatments already tried, those that really provide clinical improvement are psychotherapy and regular physical exercises.

The latter can be very difficult since at the beginning the symptoms seem to worsen. However, exercise should be started with very, very light loads, with slow and progressive increase as the patient tolerates. In the long run, practicing exercise greatly improves the quality of life.

There is no specific drug or diet treatment that is proven to improve the symptoms of chronic fatigue syndrome.

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