Chronic Fatigue Syndrome: The fibromyalgic approach

Abstract

Chronic fatigue syndrome (CFS) is a chronic illness characterised by at least six months of debilitating fatigue and associated non-specific symptoms. Depression is seen in many of the patients, although the features often differ from other patients with depression. Many efforts have been made to identify a chronic virus infection as cause of the syndrome - however, no unequivocal evidence exists for persistent virus infection. The prominence of muscle pain led many to conclude that CFS is a muscle disorder, but various studies have disproved this hypothesis. A hypothalamic dysfunction, particularly involving 5-hydroxy tryptamine metabolism, is postulated. A study was undertaken to determine the prevalence of the fibromyalgia syndrome (FMS) and major depression in patients who fulfill the CDC criteria for CFS. It was found that CFS has a high prevalence among young patients and is frequently a long standing problem. Doctors should be aware of the high prevalence of depression in these patients. None of the FMS patients were previously correctly diagnosed, confirming an alarming lack of knowledge of this common condition among doctors. Trigger points cause referred pain in many different anatomical areas - these patients undergo numerous unnecessary investigations and procedures. This could have been managed at primary care level with the emphasis on compassionate holistic care. Hie recognition of FMS in CFS patients has important economic implications. CFS, FMS and major depression probably share a similar neurochemical background, although there are clinical and therapeutic differences.