For a diagnosis of Chronic Fatigue Syndrome (CFS) to be made, the patient must have at least three of the following symptoms for several months:

• Extreme fatigue generally not improved by rest
• Post-exertion malaise
• Fibromyalgia
• Muscle weakness
• Impaired memory and concentration
• Insomnia
• Ongoing sore throat and tender lymph nodes
• Joint pain without inflammation
• Chronic headaches
• Dizziness.

Other symptoms associated with chronic fatigue are: Irritable Bowel Syndrome, multiple food intolerances and chemical sensitivities. A small number of patients have cold intolerance; Restless Leg Syndrome and Irritable Bladder Syndrome.

Chronic tiredness without any other of the above symptoms should not be diagnosed as CFS. There are other causes of tiredness, which should be investigated, such as weight loss; fever; persistent malaise; night pain; pain in a particular area and neurological signs.

Fibromyalgia

CFS patients frequently have fibromyalgia. Symptoms include:

• Generalised muscle pain in all four quadrants with tender points
• Paraesthesia (pins and needles)
• Skin sensitivity
• Temporo-mandibular joint syndrome. (TMJ)

Although fibromyalgia is a separate syndrome from CFS, it is included here because it is commonly associated with CFS.

To adequately treat CFS we need to find out if your CFS has a single cause, or two or more causes. This may require some tests, as finding out specific causes  helps to give you the best treatment plan.

The causations of CFS can be loosely divided into the categories listed below.

We exclude emotional or psychological aspects because it is a mistake to assume that CFS can be reduced to “stress”. Many CFS patients have doubted their own perceptions and the reality of their disease because of the sceptical attitudes of their health practitioners. If conventional medical tests fail to return evidence of abnormal pathology, practitioners unaware of CFS and insensitive to its implications, can dismiss the patient as hysterical. Our experience is that CFS patients are not hysterical and their disease is real. Patients with chronic disease whose illness is dismissed as “all in the head” can soon become depressed or anxious because their disease receives no acknowledgement. Once CFS has been correctly diagnosed and treated, these emotional states improve.

Causes of CFS

1. Post viral  – eg never well since glandular fever.

2. Heavy metal toxicity

3. Multiple chemical exposures

4. Untreated or undiagnosed chronic infection, (eg Lyme disease)

5. A combination of several, or all of the above.

A majority of cases of CFS are complex and require complex treatment. To understand this well, we need patients to provide a detailed time line of all of the health events in their life, whether or not medical treatment was sought at the time. This timeline starts in the in-utero stage of the lifespan and continues up to the present day. These events may include:

• Viruses
• Emotional shocks
• Injuries
• Chemical and heavy metal exposures
• Reactions to medications, including vaccinations
• Other drug side effects (eg long term use of the oral contraceptive pill, antibiotics, cortisone, etc.)
• Illicit drug use

How soon does CFS respond to treatment?

We have found that uncomplicated post-viral fatigue is the most straight forward type of CFS in terms of treatment outcomes. Patients who have more than one causative factor require a far more detailed treatment plan.