Chronic Fatigue Syndrome/ME
Chronic Fatigue Syndrome (CFS) is often also known as Myalgic Encephalopathy (ME). CFS/ME can affect anyone, including children. However, it is more common in women, and tends to develop between your mid-20s and mid-40s. It is currently estimated that some 250,000 people in Britain are affected by CFS/ME.
What are the signs and symptoms?
CFS/ME effects each individual differently, in some the effects may be minimal but in a large number, lives are changed dramatically. Sufferers often experience severe and debilitating fatigue, disordered sleep, poor memory and concentration, painful joints and muscles, and gastric disturbances. The most common symptom is extreme tiredness and feeling generally unwell. In the young, schooling and higher education can be severely disrupted. In the working population, employment becomes impossible for many. For all, social life and family life become restricted and in some cases severely strained. People can be housebound or confined to bed for months or years. As well as the extreme tiredness, people with CFS/ME may have other symptoms, including:
What causes CFS/ME?
The exact cause of CFS is still unkown, however, there are a numerous theories – e.g. infection may be the trigger, or specific factors could make you prone to developing CFS/ME. Some these include:
Genetics
CFS/ME appears to run in some families, which could be linked to Single Nucleotide Polymorphisms (small genetic changes in DNA that differ between individuals) such as those seen on the TRPM3 gene - which makes a protein involved in cellular calcium signalling and in maintaining physiological homeostasis (a stable state); the TRPA1 gene - a sensor for pain, stretch and environmental irritants ; and the TRPC4 gene - plays a part in the regulation of blood vessels and cell division.
Immune System Problems
Immunological abnormalities are observed in those with CFS/ME often. Decreased Natural Killer cell activity correlates with symptoms severity. CFS/ME sufferers have an abnormal response to exercise, which includes increased production of complement cascade products, increased oxidative stress along with decreased antioxidant response, and increased Interleukin 10, and TLR4, correlates with symptom severity. Increased cytokine levels may account for the increased lactic acid during exercise and decreased ATP production; however, elevated cytokine levels are inconsistent for specific cytokines. One hypothesis for inflammation in CFS/ME proposes that inflammation inhibits serotonin synthesis, which would also link to fatigue and depression-like symptoms. Similarities have also been drawn between CFS/ME and cancer regarding abnormal intracellular immunological signaling, e.g. abnormalities have been observed such as hyperactivity of Ribonuclease L, a protein activated by Interferon, and hyperactivity of Nuclear Factor-Kappa B.
Viral Infections
Some people develop CFS/ME after having a viral infection, e.g. infectious mononucleosis or glandular fever - Epstein-Barr virus (EBV), human herpes virus 6, Enterovirus infection, Rubella/German measles, Candida albicans, Mycoplasma/atypical pneumonia, Ross River virus (a mosquito-borne tropical disease), Human retrovirus infection/HIV.
Unfortunately research has not yet found an association between CFS/ME and one single type of viral infection. No one infection or pathogen causes CFS/ME and it may be triggered by a variety of illnesses or conditions. For example Epstein-Barr virus and Ross River virus lead to post-infective symptoms that meet the criteria for CFS/ME in approximately 10-12% of cases. People who had severe symptoms upon becoming infected are more likely than those with mild symptoms to develop CFS symptoms later. However, there are a variety of different factors that can cause people to develop CFS.
Bacterial Infections
Chronic bacterial infections can be a common feature of CFS/ME, many sufferers have Mycoplasmal infections. Mycoplasmas arecommonlyfound in the oral cavity, urinary tract and gut flora, but some species can cause chronic illnesses when they manage to get into the blood stream and colonise organs and tissues. Mycoplasmas also have a complex relationship with the immune system. They are extremely effective at evading host immune responses, and often act synergistically with other infections e.g. Human Herpes Virus-6 (HHV-6) and C. pneumoniae. Mycoplasmas also contribute to rheumatoid arthritis, systemic lupus erythematosis, demyelinating and axonal neuropathies, and HIV-AIDS.
Lyme disease
Prognosis
Most sufferers fall into one of four groups:
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What are the signs and symptoms?
CFS/ME effects each individual differently, in some the effects may be minimal but in a large number, lives are changed dramatically. Sufferers often experience severe and debilitating fatigue, disordered sleep, poor memory and concentration, painful joints and muscles, and gastric disturbances. The most common symptom is extreme tiredness and feeling generally unwell. In the young, schooling and higher education can be severely disrupted. In the working population, employment becomes impossible for many. For all, social life and family life become restricted and in some cases severely strained. People can be housebound or confined to bed for months or years. As well as the extreme tiredness, people with CFS/ME may have other symptoms, including:
- joint or muscle pain
- sleep problems
- flu-like symptoms
- a sore throat or sore glands that aren't swollen
- headaches
- trouble thinking clearly, concentrating
or remembering - feeling dizzy or nauseous
- rapid or irregular heartbeats (palpitations)
What causes CFS/ME?
The exact cause of CFS is still unkown, however, there are a numerous theories – e.g. infection may be the trigger, or specific factors could make you prone to developing CFS/ME. Some these include:
- genetics
- immune system problems
- viral infections
- bacterial infections
- endocrine (hormone) imbalance
- mental health issues, such as anxiety/stress, depression and emotional trauma
Genetics
CFS/ME appears to run in some families, which could be linked to Single Nucleotide Polymorphisms (small genetic changes in DNA that differ between individuals) such as those seen on the TRPM3 gene - which makes a protein involved in cellular calcium signalling and in maintaining physiological homeostasis (a stable state); the TRPA1 gene - a sensor for pain, stretch and environmental irritants ; and the TRPC4 gene - plays a part in the regulation of blood vessels and cell division.
Immune System Problems
Immunological abnormalities are observed in those with CFS/ME often. Decreased Natural Killer cell activity correlates with symptoms severity. CFS/ME sufferers have an abnormal response to exercise, which includes increased production of complement cascade products, increased oxidative stress along with decreased antioxidant response, and increased Interleukin 10, and TLR4, correlates with symptom severity. Increased cytokine levels may account for the increased lactic acid during exercise and decreased ATP production; however, elevated cytokine levels are inconsistent for specific cytokines. One hypothesis for inflammation in CFS/ME proposes that inflammation inhibits serotonin synthesis, which would also link to fatigue and depression-like symptoms. Similarities have also been drawn between CFS/ME and cancer regarding abnormal intracellular immunological signaling, e.g. abnormalities have been observed such as hyperactivity of Ribonuclease L, a protein activated by Interferon, and hyperactivity of Nuclear Factor-Kappa B.
Viral Infections
Some people develop CFS/ME after having a viral infection, e.g. infectious mononucleosis or glandular fever - Epstein-Barr virus (EBV), human herpes virus 6, Enterovirus infection, Rubella/German measles, Candida albicans, Mycoplasma/atypical pneumonia, Ross River virus (a mosquito-borne tropical disease), Human retrovirus infection/HIV.
Unfortunately research has not yet found an association between CFS/ME and one single type of viral infection. No one infection or pathogen causes CFS/ME and it may be triggered by a variety of illnesses or conditions. For example Epstein-Barr virus and Ross River virus lead to post-infective symptoms that meet the criteria for CFS/ME in approximately 10-12% of cases. People who had severe symptoms upon becoming infected are more likely than those with mild symptoms to develop CFS symptoms later. However, there are a variety of different factors that can cause people to develop CFS.
Bacterial Infections
Chronic bacterial infections can be a common feature of CFS/ME, many sufferers have Mycoplasmal infections. Mycoplasmas arecommonlyfound in the oral cavity, urinary tract and gut flora, but some species can cause chronic illnesses when they manage to get into the blood stream and colonise organs and tissues. Mycoplasmas also have a complex relationship with the immune system. They are extremely effective at evading host immune responses, and often act synergistically with other infections e.g. Human Herpes Virus-6 (HHV-6) and C. pneumoniae. Mycoplasmas also contribute to rheumatoid arthritis, systemic lupus erythematosis, demyelinating and axonal neuropathies, and HIV-AIDS.
Lyme disease
Prognosis
Most sufferers fall into one of four groups:
- Those who manage to return to completely normal health, even though this can take a lengthy amount of time. Only a fairly small percentage fall into this category.
- Majority, tend to follow a fluctuating pattern with good and bad periods of health; Relapses or exacerbations are often precipitated by infections, stressful events, operations or temperature extremes.
- A substantial minority, who remain severely affected and often require a large amount of practical and social support.
- A few, who show continuous deterioration, this is unusual in ME/CFS - a detailed medical assessment is necessary to rule out other potential diagnoses.
Fibromyalgia
Fibromyalgia is a chronic (long-term) condition that causes widespread pain and tenderness over much the body. This pain may be felt throughout the body, but is often worse in particular areas, such as the neck or back, elbows or knees . The pain is often continuous, although it can get better or more severe at different times; it can feel like an ache, burning sensation or a sharp stabbing pain. Even the slightest touch can be painful, and if you hurt yourself the pain often continues for much longer than it normally would.
People with fibromyalgia also often suffer:
Other symptoms sufferers sometimes experience include:
The exact cause is unknown; there are numerous factors involved. One of key theory is that people with fibromyalgia have developed changes in the way the central nervous system (CNS) processes pain messages from the body. This may be due to changes to chemicals in the nervous system (neurotransmitters). People with fibromyalgia have especially low levels of the neurotransmitters serotonin, noradrenaline and dopamine in their brains. Low levels of these neurotransmitters is a key factor in the cause, because they are important in regulating:
Disturbed sleep patterns may also be a cause rather than a symptom. People who sleep badly can also have higher levels of pain, suggesting that these sleep problems contribute to the other symptoms of fibromyalgia.
Genetics may also play a small role in development, some people are more likely than others to develop the condition because of their genes - many people develop fibromyalgia after some sort of trigger e.g. a stressful event, including physical stress or psychological (emotional) stress. Potential triggers include:
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People with fibromyalgia also often suffer:
- increased sensitivity to pain
- muscle/joint stiffness - most severe after being in the same position for prolonged periods – e.g. getting out of bed in the morning.
- fatigue (extreme tiredness) - ranges from a mild, tired feeling to sudden and severe fatigue/exhaustion that can drain all of your energy
- difficulty sleeping - Non-restorative sleep; often wake up tired, even when you've had plenty of sleep
- "fibro-fog" - problems with mental processes such as, problems with memory and concentration, and/or slowed or confused speech
- headaches - range from mild headaches to severe migraines,
- sensitivity to certain foods, fumes/smoke and bright lights.
- irritable bowel syndrome (IBS) – abdominal pain and bloating, as well as diarrhoea and/or constipation
Other symptoms sufferers sometimes experience include:
- anxiety
- depression - may be caused by suffering from fibromyalgia or linked to levels of the hormones and neurotransmitters involved the condition
- dizziness and clumsiness
- tingling, numbness, prickling or burning sensations in hands and/or feet (pins and needles - paraesthesia)
- feeling too hot or too cold – this is because of inability to regulate body temperature properly
- restless legs syndrome (an overwhelming urge to move your legs)
- irritable bladder - feeling an urgent need to urinate, especially at night
- unusually painful periods in women
The exact cause is unknown; there are numerous factors involved. One of key theory is that people with fibromyalgia have developed changes in the way the central nervous system (CNS) processes pain messages from the body. This may be due to changes to chemicals in the nervous system (neurotransmitters). People with fibromyalgia have especially low levels of the neurotransmitters serotonin, noradrenaline and dopamine in their brains. Low levels of these neurotransmitters is a key factor in the cause, because they are important in regulating:
- mood
- appetite
- sleep
- behaviour
- response to stressful situations
Disturbed sleep patterns may also be a cause rather than a symptom. People who sleep badly can also have higher levels of pain, suggesting that these sleep problems contribute to the other symptoms of fibromyalgia.
Genetics may also play a small role in development, some people are more likely than others to develop the condition because of their genes - many people develop fibromyalgia after some sort of trigger e.g. a stressful event, including physical stress or psychological (emotional) stress. Potential triggers include:
- an injury
- an operation
- a viral infection
- giving birth
- death of a loved one
- breakdown of a relationship
- an abusive relationship
