Creating Waves of Awareness
A Study on
CHRONIC FATIGUE SYNDROME
(CFS) and its Homeopathic approach
By Dr. Jagat Manik, MD (Hom)
Chronic fatigue syndrome (CFS) is the current name for a disorder characterized by debilitating fatigue and several associated physical, constitutional, and neuropsychological complaints. This syndrome is not new; in the past, patients diagnosed with conditions such as the vapors, neurasthenia, effort syndrome, chronic brucellosis, epidemic neuromyasthenia, myalgic encephalomyelitis, hypoglycemia, multiple chemical sensitivity syndrome, chronic candidiasis, chronic mononucleosis, chronic Epstein-Barr virus infection, and postviral fatigue
syndrome may have had what is now called CFS.
A subset of ill veterans of military campaigns suffer from CFS. The U.S. Centres for Disease Control and Prevention (CDC) has developed diagnostic criteria for CFS based upon symptoms and the exclusion of other illnesses.
Patients with CFS are twice as likely to be women as men and are generally 25 to 45 years old, although cases in childhood and in later life have been described.
Cases are recognized in many developed countries. Most arise sporadically, but many clusters have also been reported. Famous outbreaks of CFS occurred in Los Angeles County Hospital in 1934; in Akureyri, Iceland, in 1948; in the Royal Free Hospital, London, in 1955; and in Incline Village, Nevada, in 1985. While these clustered cases suggest a common environmental or nfectious cause, none has been identified.
Estimates of the prevalence of CFS have depended on the case definition used and the method of study. Chronic fatigue itself is a common symptom, occurring in as many as 20% of patients attending general medical clinics; CFS is far less common. Community-based studies find that 100 to 300 individuals per 100,000 population in the United States meet the current CDC case definition.
The diverse names for the syndrome reflect the many and controversial hypotheses about its etiology. Several common themes underlie attempts to understand the disorder: It is often postinfectious, it is associated with immunologic disturbances, and it is commonly accompanied or even preceded by neuropsychological complaints, somatic preoccupation, and/or depression.
Many studies in the 1980s and 1990s attempted to link CFS to infection with Epstein-Barr virus, a retrovirus, or an enterovirus. In many patients with chronic fatigue, titers of antibodies to several viruses are elevated. Reports that viral antigens and nucleic acids could be specifically identified in patients with CFS have not been confirmed. One study from the United Kingdom failed to detect any association between acute infections and subsequent prolonged fatigue. Another study found
that chronic fatigue did not develop after typical upper respiratory infections but did in some individuals after infectious mononucleosis. Thus, while antecedent viral infections are associated with CFS, a direct viral pathogenesis is unproven and unlikely.
Changes in numerous immune parameters of uncertain functional significance have been reported in CFS. Modest elevations in titers of antinuclear antibodies, reductions in immunoglobulin subclasses, deficiencies in mitogen-driven lymphocyte proliferation, reductions in natural killer cell activity, disturbances in cytokine production, and shifts in lymphocyte subsets have been described. None of the immune findings appears in all patients, nor do any correlate with the
severity of CFS. Careful comparison of affected and unaffected monozygotic twins showed no substantive immunologic differences. In theory, symptoms of CFS could result from excessive production of a cytokine, such as interleukin 1, that induces asthenia and other flulike symptoms; however, compelling data in support of this long-held hypothesis are lacking.
In some studies, patients with CFS manifest unusual sensitivity to sustained upright tilting, resulting in hypotension and syncope, so as to suggest a form of dysautonomia.
Disturbances in the hypothalamic-pituitary-adrenal function have been identified in several controlled studies of CFS, with some evidence for normalization in patients whose fatigue abates. These neuroendocrine abnormalities could contribute to the impaired energy and depressed mood of patients.
Mild to moderate depression is present in half to two-thirds of patients. Much of this depression may be reactive, but its prevalence exceeds that seen in other chronic medical illnesses. Some
propose that CFS is fundamentally a psychiatric disorder and that the various neuroendocrine and immune disturbances arise secondarily.
Typically, CFS arises suddenly in a previously active individual. An otherwise unremarkable flulike illness or some other acute stress leaves unbearable exhaustion in its wake. Other symptoms, such as headache, sore throat, tender lymph nodes, muscle and joint aches, and frequent feverishness, lead to the belief that an infection persists, and medical attention is sought. Over
several weeks, despite reassurances that nothing serious is wrong, the symptoms persist and other features of the syndrome become evident — disturbed sleep, difficulty in concentration, and depression.
Depending on the dominant symptoms and the beliefs of the patient, additional consultations may be sought from allergists, rheumatologists, infectious disease specialists, psychiatrists, ecologic therapists, or other professionals, frequently with unsatisfactory results. Once the pattern of illness is established, the symptoms may fluctuate somewhat. Many patients report that diverse complaints are linked — that during periods of greatest fatigue they perceive the most pain and difficulty with concentration. Patients also commonly assert that excessive physical or emotional stress may exacerbate their symptoms.
Most patients remain capable of meeting family, work, or community obligations despite their symptoms; discretionary activities are abandoned first. Some feel unable to engage in any gainful employment. A minority of individuals require help with the activities of daily living.
Ultimately, isolation, frustration, and pathetic resignation can mark the protracted course of illness. Patients may become angry at physicians for failing to acknowledge or resolve their plight. Fortunately, CFS does not appear to progress. On the contrary, many patients experience gradual improvement, and a minority recover fully.
A thorough history, physical examination, and judicious use of laboratory tests are required to exclude other causes of the patient's symptoms. Prominent abnormalities argue strongly in favor of alternative diagnoses. No laboratory test, however, can diagnose this condition or measure its severity. In most cases, elaborate, expensive workups are not helpful. Early claims that magnetic
resonance imaging or single photon emission computed tomography can identify abnormalities in the brain of CFS patients have not withstood further study. The dilemma for patient and clinician alike is that CFS has no pathognomonic features and remains a constellation of symptoms and a diagnosis of exclusion. Often the patient presents with features that also meet criteria for other subjective disorders such as fibromyalgia and irritable bowel syndrome.
After other illnesses have been excluded, there are several points to address in the long-term care of a patient with chronic fatigue.
The patient should be informed about the illness and what is known of its pathogenesis; its potential impact on the physical, psychological, and social dimensions of life; and its prognosis. Patients are relieved when their complaints are taken seriously. Periodic reassessment is appropriate to identify a possible underlying process that is late in declaring itself and to address intercurrent symptoms that should not be simply dismissed as yet another subjective complaint.
With symptomatic and constitutional homoeopathic treatment prognosis is good and even modest improvements in symptoms can make an important difference in the patient's degree of self-sufficiency and ability to appreciate life's pleasures.
Owing to the vast rubrics and symptoms along with their remedies in homeopathy, this disorder can be managed with ease. The remedies for the particular condition can be sought from the following rubrics in the compete repertory:
- extremity, pain
Practical advice should be given regarding life-style. Sleep disturbances are common; consumption of heavy meals with alcohol and caffeine at night can make sleep even more elusive, compounding fatigue. Total rest leads to further deconditioning and the self-image of being an invalid, whereas overexertion may worsen exhaustion and lead to total avoidance of exercise. A moderate, carefully graded regimen should be encouraged and has been proven to relieve
symptoms and enhance exercise tolerance.
The physician should promote the patient's efforts to recover. Controlled trials in the United Kingdom, in Australia, and in the Netherlands showed cognitive-behavioral therapy to be helpful. This approach aims to dispel misguided beliefs and fears about CFS that can contribute to inactivity and despair. For CFS, as for many other conditions, a comprehensive approach to physical, psychological, and social aspects of well-being is in order.
HARRISON'S PRINCIPLES OF INTERNAL MEDICINE - 16th Ed. (2005)
PART FIFTEEN - NEUROLOGIC DISORDERS
Section 4 - Chronic Fatigue Syndrome
370. CHRONIC FATIGUE SYNDROME - Stephen E. Straus
COMPLETE REPERTORY (HOMPATH 0.7)
ORIGINALLY PRESENTED AS A SEMINAR BY ME ON 23 FEB 2009 AT BHMC PG RESEARCH CENTRE, BELGAUM