s: chronic fatigue syndrome, pain, sleep

Chronic fatigue syndrome or Myalgic encephalomyelitis “ CFS”

Are you tired all the time ? 

Have you heard before about Chronic fatigue syndrome or Myalgic encephalomyelitis “ CFS”? 

If you have this syndrome, of course you wondered about these questions.. 

  • Which specialist should I go to ?
  • Is it correlated with other conditions?
  • Is it progressive? 
  • Can this condition qualify a person for mobility aids or disability payments?!

Don’t worry, In this article you will find the answer to your questions.. 


Fatigue is different from being tired, when you get tired, you know that if you can just get some sleep you will feel better, but fatigue is still there when you wake up, it stays with you all the day. 

  • Fatigue is lack of energy, a feeling of mental, emotional, and physical exhaustion. 

What is CFS: 

It’s a physiological, chronic, and multisystem disorder that debilitates long term illness with a wide range of symptoms, especially extreme fatigue,  that affects 1% of the population.

**Multi system disease that cause dysfunction of:

  • Neurological system 
  • Immune system 
  • Energy metabolism system
  • Endocrine system 

Facts to know about CFS:

  • Affects women three to four times more than mens.
  • Affects adults more than children. 
  • This illness is called ( Chronic fatigue syndrome) , due to the long-term persistence of fatigue. 
  • The severity of symptoms vary between individuals. 
  • Main cause of disease is still Unknown. 

Causes of chronic fatigue syndrome:

May begin suddenly or gradually. If suddenly, it may follow gastrointestinal or respiratory conditions, or any other acute infection, other cases may develop after a physical or emotional trauma such as serious accidents, or surgery.

Main cause is UNKNOWN. But it maybe arise due to: 

  1. Infection source. Viral (glandular fever) , Bacterial ( Pneumonia) 
  2. Dysfunction in the Immune or adrenal system.
  3. Hormone imbalance. 
  4. Genetic.
  5. Childhood trauma.

Risk factors: 

  • Gender: female twice suspected than males. 
  • Age: most common 30-60. 
  • Biological illness. 
  • Psychological factor. 

Signs and Symptoms of CFS:

Presentation varying from normal lives to being bedridden as: 

25% housebound at some point, while 75% are unable to work. 

  1. Unexplained Fatigue: Px can’t perform the normal tasks. 
  2. Post exertional malaise: worsening of symptoms in the 48 hours after physical or mental activity. 
  3. Sleep disturbance.
  • Un-refreshing.
  • Excessive daytime sleepiness.
  • Insomnia at night.
Sleep disturbance.
  1. Orthostatic intolerance.
  2. Loss of memory.
  3. Cognitive dysfunction .
  • Lack of concentration.
  • Decrease short term memory.
  • Decrease processing speed.
  • Decrease multi-skilling abilities.
Cognitive dysfunction
Cognitive dysfunction
  1. Autonomic Dysfunction: Headache, nausea, sweating, dizziness. 
  2. Extreme exhaustion.
  3. Exercise intolerance.
  4. Anxiety or depression.
  5. Others: GI upset, sore throat , chronic myalgia, unexplained muscle pain.
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Why do the symptoms come and go? 

Usually the symptoms are most  severe at the first or two years, then the symptoms stabilize and then can persist chronically.

Which specialist should I go to ?

Doctors may refer the patient to a specialist such as, Neurologist, Rheumatologist, Sleep specialist, or Psychologist for accurate diagnosis. 

Differential Diagnosis: 

  • Hypothyroidism.
  • Anemia.
  • Multiple sclerosis “MS”
  • Celiac disease.
  • Bipolar disorder.
  • Cancer. 
  • Fibromyalgia.
  • Dementia.

Diagnosis and Examination:

  • There is No specific Test.
  • No specific blood test. 
  • Investigation just done to rule out other conditions. 
  • Diagnosis based on the symptoms. 

A diagnosis for CFS/ ME requires at least these three symptoms: 

  1. Post exertional malaise.
  2. Sleep disorder.
  3. Impairment in the ability to engage in pre illness levels in educational, social, personal, or occupational activities, that persistence for more than 6 months and it is accomplished with fatigue. 

Treatment and management:

Although there is No specific cure or therapy. Multidisciplinary team MDT work on: 

  • Focus on improving the quality of life. 
  • Cognitive behavioral therapy. “How Thinking affect feelings” 
  • Physical therapy and exercises. 
  • Rintatolimod:  double standard medication. 
  • Energy management. 
  • Person should rest for longer than usual after activities or exercises. 
  • Medication to relieve symptoms of “ pain, and sleeping disorder”
  • Modify lifestyle. 

Although some patients with chronic fatigue syndrome CFS improve over time with specific treatment, many patients with this syndrome will need to adapt with their daily routine for a long period of time.

How can Physical Therapy help CFS? 

Physiotherapy can be one of the best choice to help CFS

  • Help to balance the nervous system.
  • Improve body function.
  • Improve the energy level of the body.
  • Stretching exercise to reduce tension.
  • Manipulation therapy: to relieve stress and tightness of the muscle.
  • Reclined exercise. 
  • Improve quality of life.
  • Patient education .
  • Balance exercise.
  • Aerobic exercise, treadmill, stationary bicycle,walking , and running to increase heart capacity.


People with chronic fatigue syndrome CFS are more than (just tired).They have persistent fatigue and exhaustion all day.

Once they do physical or mental activities, it may make their symptoms get worse.


  • Snyder, K. (n.d.). Feeling tired? physical therapy can fight fatigue. Feeling Tired? Physical Therapy Can Fight Fatigue: Posture Perfect: Chiropractors. Retrieved January 3, 2023, from https://www.postureperfectwellnesscenter.com/blog/physical-therapy-fatigue
  • SHFAustralia. (2020, March 10). Chronic fatigue syndrome and sleep. The Sleep Health Foundation. Retrieved January 3, 2023, from https://www.sleephealthfoundation.org.au/chronic-fatigue-syndrome-and-sleep.html
  • Suzanne D. Vernon, P. D. (2009, September 16). Chronic fatigue syndrome. healthywomen. Retrieved January 3, 2023, from https://www.healthywomen.org/amp/chronic-fatigue-syndrome-2646344359
  • Demystifying Medicine McMaster. (2018, April 2). What is chronic fatigue syndrome? YouTube. Retrieved January 3, 2023, from https://youtu.be/5XEMqDa92RA
  • Rhesus Medicine. (2022, May 2). Myalgic encephalomyelitis (chronic fatigue syndrome): Includes criteria & treatment. YouTube. Retrieved January 3, 2023, from https://youtu.be/7ai-YHjiaEs

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