Thursday, March 28

Chronic fatigue syndrome: what to do when the fatigue does not go away

Chronic fatigue syndrome can be explained from its name: it is a disorder that generates in those who suffer from it a feeling of intense and persistent tirednesswhich has no apparent cause, does not decrease with rest and is maintained for at least six months.

As a consequence, the person has difficulties or cannot directly carry out activities that they previously carried out normally, such as working or playing sports. In fact, fatigue gets worse with exertionnot only physical but also mental.

That is not the only symptom. They also produce a cognitive impairment, which includes lack of concentration and loss of memory and mental agility. The person has trouble sleeping and, when he does, the sleep is of low quality and therefore not restful.

In addition, they often present headaches, sore throat and dizziness, especially when you stop lying down or sitting and stand up. All these effects significantly impair the quality of life, to such an extent that -in the most serious cases- some people go to the extreme of not being able to get out of bed.

A complex and controversial entity

It is estimated that this problem as it reaches about 0.5% of the population. Therefore, the number of people with this disease in Spain would rise above 230,000.

according to a study carried out by scientists from Barcelona, ​​the syndrome “preferably affects young women”: the average age of onset of symptoms is 35 years. The National Library of Medicine of the United States (BNM), for its part, points out that it is more common in people between 40 and 60 years of age.

Chronic fatigue syndrome is also known as myalgic encephalomyelitis and it has received other names since the 19th century, the best known of which is neurasthenia. This is how a Article published in 2019 by Íñigo Murga and José-Vicente Lafuente, experts from the University of the Basque Country.

In 2015, the US National Academy of Medicine proposed a disease redefinition. Includes a name change: to be renamed systemic exercise intolerance disease. This has not yet been agreed upon by the international scientific community or by the World Health Organization.

The various names and the proposed redefinition portray a reality: this syndrome is “an entity complex and controversial”, according to Murga and Lafuente. For various reasons, among which are the lack of knowledge of its causes and the difficulties in its diagnosis and treatment.

Causes and triggers

Although the causes of chronic fatigue syndrome are not known for sure, experts believe that there may be a genetic predisposition towards the disorder. And that this would be triggered by the action of factors such as the following:

  • viral infections. Certain cases of chronic fatigue syndrome begin after infections caused by viruses such as Epstein-Barr, Q fever or the one of the human herpes 6according to the BNM and the mayo clinicAlso from the USA. They clarify, however, that “a conclusive relationship has not yet been found.”
  • Immune system problems. Some changes in the immune system of people with the syndrome suggest that this could be another key to its appearance. But in this case there is not enough evidence to affirm it either.
  • Hormonal imbalances. Another characteristic of some people with the syndrome is having “abnormal blood levels of hormones that are produced in the hypothalamus, pituitary gland, or adrenal glands,” explains the Mayo Clinic. There is also a lack of confirming evidence on this point.
  • Traumatic episode. An injury, surgery or high levels of physical or mental stress could be triggering factors, as they have occurred in some cases before the onset of symptoms.
  • Cell behavior. The BNM specifies that in people with the syndrome “the way in which the cells within the body obtain energy is different.” But, as with the previous possible factors, it is not clear how that would be related to the development of the disease.

Diagnostic difficulties

The diagnosis of this syndrome, as mentioned, is difficult. First of all, because -as a document from the University Hospital of Barcelona points out- those who suffer from chronic fatigue syndrome “may have a completely healthy appearance”.

In addition, there is no test to confirm the presence of the syndrome. For this reason, the diagnosis has to be clinical: that is, made only through the analysis of its signs and symptoms.

The problem is that these symptoms, adds the mayo clinicoften resemble those of many other diseasessuch as sleep disorders, mental health problems (such as anxiety or depression) or other diseases: diabetes, anemia, hypothyroidism, etc.

Therefore, the diagnosis must be made by exclusion. That is, it consists of eliminating all other possibilities. One of the consequences of this difficulty is that it takes too long. According to the work of scientists from Barcelona, ​​the average time between the appearance of the first symptoms and the diagnosis was nine years.

Treatment, seeking to alleviate symptoms

At the moment there is no known cure for chronic fatigue syndrome. The treatment consists of symptom relief to improve the quality of life of the patient. The experts from the University Hospital of Barcelona point out that it should be multidisciplinary, personalized and continuous.

no drug, so far, has shown a significant improvement in relation to fatigue. Those that are recommended are those that can alleviate or eliminate other symptoms, such as pain, contractures, insomnia, depression, or neurocognitive conditions. Of course, the doctor must indicate what corresponds in each case.

As for non-pharmacological measures, emotional support from close people is key. Psychological therapy can also be an important help. On the other hand, physical activity it can also be positive.

But how to do it if such activity gives such pronounced fatigue? The aforementioned document details that “aerobic physical exercise in short and tailored guidelines each person improves the global symptomatology of the syndrome”.

And he adds that “the most recommended activities are walking in short and intermittent periods of 15-20 minutes of marching and alternate resting and doing a gentle activity in a heated pool (32°C), especially if it is a pool without chlorine”.

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