Chronic Fatigue Syndrome

Abstract

Introduction Chronic fatigue syndrome (CFS) is a contentious subject and is of unknown aetiology. CFS is characterised by symptoms such as myalgia, disabling fatigue associated with complaints of fever, sore throat, lymphadenopathy, sleep disturbance, neurocognitive difficulties and depression following an acute, presumably viral illness and the subsequent recurrent ‘flu-like’ symptoms. However, no virus has been implicated (Buchwald et al, 1996), and no association has been found between chronic fatigue and initial infections (Goldenberg, 1996). Although the main characteristics of CFS are prolonged debilitating fatigue, myalgia and arthralgia, neither have specific metabolic abnormalities been found to underly the fatigue (Barnes et al, 1993), and there is no evidence of inflammation or necrosis in the muscles (Gow et al, 1991). Furthermore, CFS patients show normal muscle physiology before and after exercises (Gibson et al, 1993). A report on CFS by the joint working group of the Royal Colleges of Physicians, Psychiatrists and General Practitioners (1996) also dismisses the claim that CFS is a chronic viral infection and suggests a biopsychosocial approach for the management of this illness. I t has also been suggested that general anxiety disorder may be a factor for the development of CFS (Fischler et al, 1997). So far there are no diagnostic studies or widely accepted pathogenic explanatory models for this illness (Buchwald, 1996). Myalgia, arthralgia, muscle weakness and fatigue are some of the physical symptoms, yet very little is researched on the pain mechanisms and the effect of pain on muscle strength and fatigue in patients with CFS. The aim of this article is to identify the source of the symptoms presented by a patient with CFS and to treat and present an explanation of these symptoms. Main Complaints of the Patient and Assessment A 26-year-old woman was referred for physiotherapy in June 1995. She had been diagnosed in January 1995 as having Coxsackie B virus. Her main complaints were generalised pain and fatigue following a flu-like illness in November 1994. A detailed subjective examination revealed that she had been experiencing end range ‘stiffness’ at the base of the neck on flexion of the cervical spine since March 1995, constant ‘numb’ pain in the thoraco-lumbar regions and variable ache at the back of the legs since February 1995, and tendency to sleep for a good proportion of the day. Pain tended to increase when she was tired. She had worked as a bank officer for the previous eight years and used a visual display unit (VDU) all day. She had been off work since April 1995 due to this illness. Past medical history revealed that she had been involved in a road traffic accident six years before onset of this illness. The patient’s car was hit from behind, while she was stationary at traffic lights. She wore a collar for three weeks following the accident and her neck gradually got better without physiotherapy. In November 1994 she had collapsed and bumped her head against a door but apart from this there were no other injuries reported. She did however complain of experiencing sharp stabbing pains in the right side of her back since the age of 17 years, when she starting using a VDU at work.