Chronic fatigue syndrome (Myalgic encephalomyelitis)

Dr. Nabi Darya Vali (AIIMS)MBBS

May 13, 2020

June 04, 2022

Chronic fatigue syndrome
Chronic fatigue syndrome

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a medical condition characterized by extreme fatigue which cannot be attributed to an underlying illness or condition. Another name for this condition is systemic exertion intolerance disease (Seid), and it can worsen with physical or mental activity. The condition is diagnosed after the symptoms persist for six months or more.

While there isn't any established reason behind the occurrence of this disease, there are several theories about the potential causes of CFS. Common theories behind the causes of CFS include viral infections, psychological stress as well as a combination of other factors.

Women are 1.5 to two times more likely to be affected by this disease than men. And while CFS has been seen in children, it is more common between the ages of 40 and 50.

CFS is known to cause significant morbidity around the world, with the United States reporting at least a million cases. A "Systematic review and meta-analysis of the prevalence of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)" published in the Journal of Translational Medicine in February 2020 showed that 0.89% of the world's population has CFS. Another study, "Chronic fatigue in developing countries: population based survey of women in India", showed that factors such as sexual violence by the husband and poor mental health are linked with CFS in Indian women. 

Although there is no known cure for this condition yet, symptomatic management and conservative treatment methods are used to relieve the symptoms. Another difficulty while living with the disease is that its symptoms do not go away with rest.

While there isn't a single test to diagnose CFS, a variety of tests are usually performed to arrive at the right clinical conclusion. However, a 2019 study done by a team at Stanford University developed a technique that could measure the electrical responses of cells through a blood test.

Symptoms of chronic fatigue syndrome

Some of the common signs and symptoms of chronic fatigue syndrome or myalgic encephalomyelitis include:

  • Extreme fatigue that does not go away with rest
  • Post-exertional malaise: severe tiredness, dizziness, headache, difficulty concentrating after doing small tasks. Sometimes, these symptoms can take days or weeks to go away.
  • Joint and muscle pain
  • Sleep problems/insomnia
  • Tender lymph nodes
  • Sore throat
  • Headache
  • Gastrointestinal issues
  • Loss of memory
  • Difficulty in concentrating or brain fog

Chronic fatigue syndrome also shares many symptoms with another medical condition called fibromyalgia (FM): both have quite a few similarities in terms of their clinical presentation, and can co-occur in a person at the same time.

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Causes of chronic fatigue syndrome

While the exact causes of CFS are not known, doctors and health experts have put the onset of this condition down to the following factors:

  • Viral infections: Doctors say that some cases of CFS develop because of viral infections, but which viruses are behind the condition is not fully established. Members of the herpesvirus family including the Epstein-Barr virus (EBV) and human herpesvirus 6, the measles-causing rubella virus and the mouse leukemia virus are thought to be linked to this condition.
  • Weakened immune system: Immunodeficiency disorders can prevent your body from defending itself against bacteria, viruses or parasites. Those with a weak immune system are more susceptible to this condition.
  • Hormonal imbalances: People with CFS can also have abnormal hormone levels in the different glands of the body. However, how these abnormal levels of hormones affect a person is still not known.
  • Stress: High levels of stress are also said to be a contributing factor towards chronic fatigue syndrome in the person.

Some doctors and researchers have also theorized that CFS could be the result of different medical conditions rather than a singular cause or factor. Others opine that CFS could also be genetic, passed down from generation to generation.

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Diagnosis of chronic fatigue syndrome

In the absence of a definitive test, the diagnosis of chronic fatigue syndrome (CFS) is not straightforward. A number of symptoms of CFS are also found in other illnesses, which too makes it harder to arrive at the correct diagnosis.

The doctor may ask routine questions about your and your family's medical history to rule out other causes or conditions. A thorough physical examination will be performed besides taking a look at your blood and urine samples and performing some other tests.

It is important for the doctor to know about the persistence of fatigue in the patient's body after physical or mental activity, which is considered to be one of the primary factors behind this condition, and whether or not adequate amounts of rest was able to alleviate the fatigue. A number of heart or lung ailments can also result in fatigue, which must be ruled out.

Depression, anxiety or other mental health problems will also be looked at, which may have been contributing to the resulting fatigue in the body.

Treatment of chronic fatigue syndrome

While chronic fatigue syndrome (CFS) doesn't have a cure yet, its symptoms can be managed by healthcare practitioners. Certain prescription medications are used to alleviate the symptoms, especially if they are related to muscle or joint pain, lack of sleep or mental health issues.

A combination of therapeutic practices is also used to treat the symptoms of CFS. These may include counselling sessions with a trained therapist, as well as an exercise programme called graded exercise therapy (GET).

Treatment methods have resulted in partial recovery among patients, and children or younger patients have a higher likelihood of making a recovery. But there would be times when the symptoms could become better or worse.

People with CFS are also recommended to make significant lifestyle changes to reduce the symptoms, such as:

  • Regulating the intake of caffeine
  • Following a proper sleep cycle and avoiding naps during the day
  • Practising light exercises such as tai chi as well as yoga are also considered to relieve the symptoms or pain associated with CFS.
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Research to find the root causes of chronic fatigue syndrome is ongoing. Scientists are also trying to find a cure for the debilitating disease in the long-term, but this condition remains a complex one with no exact line of treatment or cure, with a low recovery rate.

Making lifestyle changes, regular rehabilitation as well as proper management of the symptoms are important while living with a condition like CFS.


  1. National Health Service [Internet]. UK; Chronic fatigue syndrome (CFS/ME)
  2. National Health Portal [Internet] India; World Chronic Fatigue Syndrome Awareness Day
  3. Centers for Disease Control and Prevention [internet], Atlanta (GA): US Department of Health and Human Services; What is ME/CFS?
  4. Patel V et al. Chronic fatigue in developing countries: population based survey of women in India BMJ. 2005 May 21; 330(7501): 1190. PMID: 15870118
  5. Jason, LA et al. Myalgic Encephalomyelitis: Symptoms and Biomarkers Curr Neuropharmacol. 2015 Sep; 13(5): 701–734. PMID: 26411464.
  6. National Institutes of Health; [Internet]. U.S. National Library of Medicine. Blood test may detect myalgic encephalomyelitis/chronic fatigue syndrome

Doctors for Chronic fatigue syndrome (Myalgic encephalomyelitis)

Dr. Vinayak Jatale Dr. Vinayak Jatale Neurology
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Dr. Muthukani S Dr. Muthukani S Neurology
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Medicines for Chronic fatigue syndrome (Myalgic encephalomyelitis)

Medicines listed below are available for Chronic fatigue syndrome (Myalgic encephalomyelitis). Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

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