Providing evidence-based explanations and with useful practical exercises across all of these areas and more, it is essential reading for anyone who knows that there are elements of modern life that are not healthy, and who wishes to make changes. It is a fascinating, wise, thorough and potentially life-changing book. You can pick and choose your way across the chapters, choosing whichever needs or symptoms you want to understand and work with. Each chapter has focused exercises and summaries which means you don't even necessarily have to read the entire chapter.
From a healthcare professional's point of view, there are plenty of technical references to get your teeth into. Main menu. Breaking Free from Persistent Fatigue. Over time, you can gradually increase your periods of activity, while making sure they are balanced with periods of rest. Movement is essential for the health of all body systems and processes.
It is the principle body function that is affected, altered and sometimes controlled by fatigue and pain. Movement will always benefit the tissues. Then you find the less you do, as your body gets out of condition, the less you are able to do. Do you recognise this scenario? You work on the project non-stop despite the onset of pain.
As the fatigue and pain decreases, you may then feel you have to work extra hard in order to catch up on time lost. This cycle of work, fatigue and rest is very common for individuals who have chronic fatigue syndrome - see below. Receive news on our special offers and events at our centre with our free newsletter. Click here to sign up. Click here for details. For details of our special offers and promotions for this month Please click here.
Contact Us Call us on or email by clicking here. The Fatigue-Rest Cycle. Boom or Bust Cycle One method for breaking this cycle is called time-based pacing. This is a process in which activity breaks are based on time intervals, not on how much of the job is completed. By taking breaks before the fatigue and sometimes pain begins not after it gets bad , you will be able to return to activity sooner and will actually get more done.
By using time rather than fatigue as an indicator, you will not need long periods of rest to recover from pain because fatigue flare-ups will be much less likely to happen. Professional athletes use pacing techniques by taking regular water breaks on the side lines in order to perform at peak efficiency.
Their coaches know that if the players are kept in the game until they are tired, then they will not be performing at their best. The same reasoning applies in chronic fatigue management. Time Based Pacing Technique. Follow these guidelines: Find a task that you typically do every day that increases your fatigue.
Or think of something you are planning to do this week that you fear may cause increased fatigue. The amount of time should be a few minutes less than the point when fatigue begins. Occasionally, an excess of supplements can cause problems e. The following supplements may sometimes be useful:. Vitamin D if patient lacks sunlight, due to light sensitivity or if seldom outside. Low vitamin D levels can be associated with headaches and pain and these symptoms improve with raising vitamin D blood levels.
Magnesium at bedtime can help with pain and cramps take with apple juice or apple to aid absorption , it also helps relieve constipation. These are short chain carbohydrates oligosaccharides, disaccharides, monosaccharides and related alcohols that are commonly found in the modern western diet and are poorly absorbed in the small intestine. They include short chain polymers of fructose fructans , galactose galactans , disaccharides lactose , monosaccharides fructose , and sugar alcohols polyols such as sorbitol, mannitol, xylitol and maltitol.
There is evidence that restriction of FODMAPs can have a beneficial effect for those with irritable bowel syndrome and other functional gastrointestinal disorders. Anecdotal evidence suggests that acupuncture, massage, pilates, and yoga can help pain in some adults, but no published studies have assessed their benefit in young people.
The contents of complementary medicines are not regulated for dose or composition. Caution must be exercised regarding side effects because if used with prescribed medications, there can be interactions. Their successful management can result in substantial lessening of the burden of illness. This section will discuss those co-morbid conditions that can have a significant impact on the illness, including orthostatic intolerance, joint laxity, gynecological problems, gastrointestinal problems, allergies, intolerances and neuroanatomic abnormalities.
The term OI refers to a group of conditions in which symptoms worsen with quiet upright posture and are improved but not always abolished by lying down. Typical symptoms are those of cerebral hypo-perfusion or sympathetic activation. OI is more common in girls after puberty sex ratio OI can follow an infectious illness or an immunization. Because there are more patients needing help with the management of OI than specialists trained to meet their needs, we have included the salient points of diagnosis and management of OI in this section.
There is more detailed information on the pathophysiology and testing for OI in Appendix G. Orthostatic symptoms include any of the following: increased fatigue, lightheadedness, white-outs or black-outs of the visual field, visual dimming, mental fog, headaches, nasuea, pain, or shortness of breath. Many patients adopt postural counter-maneuvers—such as sitting with knees to chest, doing homework in a reclined position, crossing the legs when standing, fidgeting in line—but are not aware of why they have done so.
Some adolescents might not report lightheadedness, so asking about symptoms that emerge during prolonged upright posture can be revealing. Characteristic physical appearances include facial pallor and a reddish-purple discoloration of the dependent limbs acrocyanosis when sitting or standing for more than a few minutes. Symptoms of OI can occur without prominent changes in heart rate and blood pressure, but are often associated with objective circulatory disorders.
Postural tachycardia syndrome POTS is the most common, neurally mediated hypotension NMH is less common, and orthostatic hypotension OH is uncommon in pediatric patients. Patients with NMH are generally symptomatic soon after standing, but longer duration tilt table testing is required to elicit the hypotension. Tilt table testing requires referral to a specialist center and is costly. For further details on orthostatic testing and standing test data sheet see Appendix G. The terms vasovagal syncope, neurocardiogenic syncope and NMH are synonymous.
Syncope need not be present to make the diagnosis of NMH, as many affected individuals with lightheadedness and other symptoms sit or lie down before fainting. This problem is rarely seen in pediatric patients except at times of hypovolemia, such as febrile illness, acute dehydration, hemorrhage, adrenal insufficiency, or excessive histamine release. The lack of treatment studies in young people with OI and the lack of specialists with experience in OI contribute to difficulties in managing this condition. They might still benefit from treatment. The first step in management is non-pharmacological and emphasizes four main points: a avoid conditions that increase pooling of blood, b improve venous return to the heart, c avoid depletion of salt and water and other causes of low blood volume, and d avoid increasing catecholamines beyond their baseline levels which can be elevated.
7 Types of Tiredness which cause Chronic Fatigue, ME (Myalgic Encephalomyelitis) and Burnout
This involves avoiding prolonged standing or sitting, such as by moving around during longer classroom lectures, standing and stretching periodically to break up study sessions, and shopping at off hours. Patients should avoid saunas, hot-tubs and sunbathing, and take short, cool baths, and showers. Large meals and high carbohydrate intake can interfere with orthostatic tolerance by contributing to a shift of blood volume to the splanchnic circulation. Small, frequent meals are often better tolerated. Adolescents can utilize the muscle pump of the lower limbs by e.
Sitting on a high stool with the legs dangling freely should be avoided, as there is no resistance to blood pooling in the legs. Some adolescents find they can sit longer without symptoms if they put their feet on a low foot rest, or sit with one leg folded under the buttocks.
Some adolescents derive benefit from wearing body shaper garments or abdominal binders. A time-honored recommendation to improve blood volume is to elevate the head of the bed slightly by 10—15 o. While this is not comfortable for everyone, it can help the body retain fluid at night , There is no specific amount of sodium that works for each individual.
Food should be salted according to taste and supplemental buffered salt tablets should be considered if needed. Oral rehydration fluids can also be beneficial. Healthy higher sodium food options include dill pickles, olives, tomato juice, soups, salsa, salted nuts, and soy sauce. Epinephrine Epi and norepinephrine NE levels are increased in those with OI and worsen with upright posture. Physiological stressors, including pain and emotional distress, can elevate catecholamine levels even higher. Stress avoidance can help with symptom management.
Examine whether medications are helping or making symptoms worse. For example, in those with asthma, beta-adrenergic agonists like albuterol and salbutamol mimic the effects of Epi, and can contribute to tremulousness and lightheadedness in patients with OI. While beta-agonists are not completely contraindicated, we try to use inhaled glucocorticoids, sodium chromoglycate, or montelukast for asthma control. Medications that promote vasodilation, such as niacin, phenothiazine anti-emetics and narcotic analgesics are better avoided or minimized.
Although low doses of tricyclic antidepressants used for headache, pain, and insomnia might be tolerated, higher doses can aggravate hypotension. Caffeine intake including soft drinks or coffee can help symptoms by acting as a vasoconstrictor, but some patients experience adverse effects. Alcohol consumption usually aggravates OI symptoms. Treating symptoms, especially pain and sleep problems, can improve OI symptoms.
The third step in management is pharmacological intervention, aiming for monotherapy, but often rational poly-therapy produces better symptom control.
All medications should be started at low doses and increased very slowly. Some physicians recommend a low-dose beta blocker or midodrine as the first-line agents. For example: beta blockers might be chosen for those with elevated supine HRs, fludrocortisone might be chosen if there is a low resting BP or an increased salt appetite. Midodrine is efficacious in treating syncope, but 4 hourly dosing makes it less convenient to take when in school. Stimulants can be helpful in those with fatigue and prominent cognitive symptoms. Adolescent girls with dysmenorrhea, acne or peri-menstrual exacerbation of OI symptoms can benefit from hormonal contraceptive therapy A long-acting injectable progesterone can be considered.
The mechanism by which hormones improve OI is not entirely clear. Improvements in symptoms and in responses to upright tilt have been reported after treatment with selective serotonin reuptake inhibitors SSRIs in non-depressed patients with NMH refractory to other therapies In those with fibromyalgia, duloxetine a SNRI can be effective for pain, independent of its effect on mood.
When symptoms such as anxiety, pain, dysthymia, or premenstrual syndrome are present, these medications might also be chosen. The use of several medications with different pharmacologic effects, e. Among those refractory to treatment, it is important to question whether the OI is exacerbated by another co-morbid condition.
Selected individuals with OI in whom medications have failed to help have occasionally been managed with weekly infusions of IV saline until symptoms stabilize. Infusions provide a more rapid restoration of intravascular volume and a larger intake of sodium than is possible orally. Peripheral IV lines are preferred, as the placement of PICC or central lines poses a risk of local infection or bacteremia The efficacy of this practice has not been studied in a randomized trial and more formal study is needed.
Some with EDS develop early onset of varicose veins. In the classical form of EDS there can be hemosiderin deposition around the knees and shins. Fatigue and pain are substantial contributors to impaired quality of life in EDS , Clinicians can have an increased index of suspicion for joint hypermobility if their patients have been swimmers, dancers, and gymnasts. Joint hypermobility can be overlooked unless the clinician performs specific measurements such as the Beighton score, a nine point measure in which scores of 4 or higher indicate joint hypermobility.
Some with joint hypermobility can have associated postural dysfunctions such as thoracic kyphosis, scoliosis, a head-forward posture, lumbar lordosis, and pes planus. The evaluation and management of these patients often is helped by consultation with a physical therapist. In older adolescents, sexual activity can cause post-exertional symptom exacerbation. Adolescents with endometriosis are more likely than their adult counterparts to report pelvic pain that is also or only non-cyclical. Associated symptoms can include constipation, pain with defecation, and urinary symptoms such as dysuria, urgency, frequency, and hematuria.
Dyspareunia can also be present. A less well recognized problem that can cause chronic pelvic pain, associated with low BP and chronic fatigue, is PCS — It is associated with varicose ovarian and internal iliac veins. Symptoms include chronic, non-cyclical, pelvic pain and perineal heaviness, occasionally associated with lower back pain. Pain is usually present throughout the month, but often worsens with the menses.
Unlike endometriosis, this form of pelvic pain worsens at the end of the day or with prolonged standing due to progressive distention of varicosities in the pelvis. Also in contrast to endometriosis, PCS symptoms get better with prolonged supine posture or after a night in bed. Vulvar and thigh varices are less common in adolescents with PCS than in adults. Intramuscular Depoprovera medroxyprogesterone acetate can also be effective. For menorrhagia, the patient should be tested for the presence of iron deficiency anemia and this should be treated if present.
For persisting pelvic pain, consultation with a gynecologist is often helpful. Gastrointestinal conditions which can be present include: gastroesophageal reflux, gastrointestinal motility disorders, celiac disease and non-celiac gluten sensitivity, lactose intolerance, food allergies e. These conditions should be considered in the differential diagnosis of gastrointestinal complaints and if present should be treated appropriately.
Milk protein is the most common offending food, but soy, wheat, and egg proteins can also cause symptoms. Many young patients are unaware that milk or other specific proteins are a problem, because immediate reactions are absent, and symptoms can be delayed for several hours after ingestion.
Symptoms that indicate the possibility of a non-IgE-mediated allergy or an intolerance of a food protein are: a epigastric or abdominal pain, b gastroesophageal reflux symptoms heartburn, retro-sternal discomfort, acid taste in the mouth, sometimes a mucousy form of vomiting , and c appetite disturbance early satiety, picky appetite , Other associated symptoms can include recurrent aphthous ulcers, intermittent fevers, headaches including migraines , worsening lightheadedness, myalgias, sinusitis, and either constipation or diarrhea.
Skin testing in people with delayed gastrointestinal hypersensitivities is usually negative. Unless delayed food protein hypersensitivities are adequately addressed, they can obscure any improvements that might accompany otherwise effective treatments. A history of suspected food intolerances should be taken. If allergic individuals have already been restricting the offending food and then are inadvertently re-exposed, their symptoms will return.
This occurrence provides support for the diagnosis. For persisting abdominal symptoms, consultation with a gastroenterologist can be helpful. In contrast to non-IgE mediated allergies see Gastrointestinal Issues , IgE-mediated allergies are recognized by the presence of immediate allergic symptoms, including wheezing, pruritus, urticaria, lip and tongue swelling, and more severe features of anaphylaxis.
A mast cell activation syndrome MCAS might be present. The importance of MCAS has likely been underappreciated in the past. Symptoms can include fatigue, lightheadedness, facial flushing, rashes, itching, hives, bone and muscle pain, nausea, vomiting, abdominal pain, diarrhea, brain fog, migraines, and intolerance to multiple medications , Recent work has identified hereditary elevations in tryptase an enzyme released after mast cell activation among those with POTS, joint hypermobility, and atopic disorders Treatment of MCAS involves antihistamines and medications to stabilize the mast cell membrane such as cromolyn, quercetin and the leukotriene receptor antagonists zafirlukast and montelukast.
Several detailed reviews of the clinical features, diagnostic tests and treatments of MCAS are available — , A neurological examination might reveal nystagmus, diplopia, absence of the gag reflex, hyper-reflexia and decreased sensation in the pelvis and lower limb. In those with prominent symptoms including headache, evaluation needs to exclude intracranial hypertension and intracranial hypotension. Referral to a neurologist can be helpful. Correction of dental problems can improve overall health. Commonly reported problems are xerostomia dry mouth , dental caries, periodontal disease, bruxism, temporomandibular joint disorder TMD and impacted third molar teeth.
Dental visits can be stressful, result in lingering discomfort and debilitating fatigue and recovery can be prolonged. During dental procedures, discomfort can be minimized by the use of a mouth prop to maintain an open posture of the mouth. The smallest size mouth prop that is effective should be used. Dentists also need to be familiar with the clinical features of OI and be prepared to treat patients at risk of developing syncope. Treatment planning of elective dentistry in more extensive cases should allow time between appointments to recover from fatigue.
Dry mouth can exist on its own, result from the effects of medications or from co-morbid medical conditions. It can lead to rampant dental caries, exacerbation of periodontal disease, or oral candidiasis. Standard treatment includes increasing oral moistness with regular fluid intake, fluoride supplementation for home use, and professional dental prophylaxis. Treatment for dental caries and periodontal disease follows standard dental practice.
In these patients, a local anesthetic can be used without Epi. If a local anesthetic with added Epi is required, it should be administered with caution. Bruxism often results in loss of tooth structure and can exacerbate TMD. For bruxism, an occlusal guard can be prescribed to protect the dentition and help to alleviate TMD symptoms. Asymptomatic impacted teeth that appear as if they will not erupt or if there is room for proper eruption, are monitored. The impact on the patient of tooth removal is related to the difficulty of the extraction.
In those patients who would be most affected by long, difficult procedures and the possible need for IV or general anesthesia with a significant post-operative recovery time, we would recommend a more conservative approach. Each case must be evaluated individually. Severe post-exertional symptoms can result if a visit to a hospital emergency room should become necessary. Published data on the characteristics of this group are lacking.
The course of the severe form of the illness is unpredictable. Many severely affected young patients do show varying degrees of improvement with time and some manage to return to full activities. A few remain severely affected. Severely ill young patients are often difficult to manage and frequently have received little help from medical practitioners. They can be socially isolated and frequently have to confront disbelief in the reality of their illness from family members, school personnel, social workers and physicians.
They are in need of a great deal of practical help, emotional support and comfort. In addition to medical supervision they might require support from home health services and aides perhaps overseen by a nurse manager. They are under great stress and can sometimes benefit from counseling. The patient can be reassured that improvement is common, even if it takes months or years, and that recovery is possible, but cannot be guaranteed. At the far end of the illness spectrum are the very severely affected patients.
These patients are fortunately, relatively rare. These young patients are in an exceedingly unpleasant situation. Clinical Features of the very severely affected can include :. Difficulty communicating their needs to a caregiver, due to speech difficulties or exhaustion. Emotional changes secondary to the illness: patients can be very frightened and struggle with feelings of frustration, despair, and anger. Vitamin D deficiency in housebound patients and prolonged bed rest can lead to osteopenia. Our advice is based on clinical experience, as there is little literature on this subject.
If the patient is cared for at home, home visits are necessary. Further advice can also be given by telephone consultations or by e-mail. If the patient is very severely affected from the outset, confirmation of the diagnosis is first necessary. Where there is a marked deterioration in a moderately severely affected patient, the practitioner might need to exclude other illnesses. Likewise, the patient and the family might need to adjust their expectations to very modest levels.
Although there are therapeutic options see below , results of therapy are variable. Therefore, targets or predictions for recovery should be avoided. The two best environments in which to care for the very severely affected patient are a the home and b an institution where long-term supportive care and symptom relief are the priorities and where staffs are familiar with the illness. Because of noise and bustle, a general hospital might be unsuitable. However, if general hospital care becomes necessary, attempts should be made to find a facility where the patient can be nursed in a very quiet location.
The best people to take care of the young patient are usually the parents. If the patient has to be admitted to an institution, attempts should be made to have one or two individual nurses be assigned to the patient. The use of patient eye pads can allow the physician to examine the patient in a low ambient light.
General nursing care to consist of gentle help with turning, skin care and toileting, diapers might be necessary. More detailed information on further management strategies is available Medications should be limited to those absolutely necessary and initially prescribed in very low doses and they should be increased slowly, as tolerated.
In rare cases that remain bedbound for prolonged periods, consider bisphosphonates for prevention of osteoporosis. Immunoglobulin therapy has shown some benefit in two randomized trials see Immune System Support.
It can be given IV or IM. The IM injection can be painful. Regular use of IV saline can be helpful see Orthostatic Intolerance. Inflexible, pre-ordained GET is often harmful and leads to exacerbation of symptoms in severe cases. However, movement is important to help reduce stiffness, maintain range of motion and prevent contractures. In very severely affected patients who are confined to bed, movement is limited to tolerated activities of daily living. When possible, the gradual resumption of some activities of daily living can be encouraged, but the patient should not be pressured into this.
Orthostatic symptoms might need to be treated before the patient is able to sit up for very long. Further progress is shown when the patient can tolerate sitting out of bed in a chair. When there is progress to the point that standing up is possible, minimal leisurely walking, for a few minutes daily can be tried. Any activity program should allow severely ill patients to pace themselves and stay within their energy envelope, however small that might be. In our experience, the majority of families draw on their strengths.
The parents are usually able provide the necessary care, and siblings learn to cope with diminished parental attention. Difficulties can arise when family members are ill-informed about the illness, when they do not believe that the young patient has a physical illness, when one parent needs to cease working in order to take care of the sick young person, when there is only one parent and the young person is too ill to go to school and has to be left at home alone, or when the school system is unable or unwilling to provide suitable education for the patient.
As with other chronic illnesses, pre-existing marital difficulties can be compounded by the strain of dealing with a sick child. Members of the wider extended family who show disbelief in the illness can also cause problems, even from a distance. Communication within the family, social support and extra activities were found to have a positive impact Educating the immediate family about the illness and ensuring that siblings receive age-appropriate information.
Immunization against human papilloma virus and hepatitis B are important for long-term health. Yearly immunization against influenza will prevent the serious relapse that can follow this illness.
Overcoming Chronic Fatigue : A Books on Prescription Title
Post immunization relapse has been reported, but is uncommon. Immunization of other family members can also help to protect the patient. Further recommendations are given in Appendix F. Absence from school is usually due to poor physical and cognitive function. An educational fact sheet giving information about the disease and its impact on education is included in Appendix D.
It is helpful for school personnel to be aware of the following. The illness is very unpredictable. Symptoms vary widely between patients and wax and wane. Large fluctuations in illness severity can occur making planning and school attendance a challenge. Some students are able to attend school daily, others can only manage a part-time schedule, while others are homebound or bedbound. Early in the illness, students might be too ill to attend school and this situation can sometimes persist for months or years.
Sometimes a student who is able to go school might appear fine one day and the next day they may be unable to go to school, and that inability to attend might continue for several weeks. While this might raise suspicions of truancy, or school refusal in some school personnel, the student usually wants to attend school, but is too ill to do so.
Students can become demoralized if they are asked to withdraw from school. Education helps students to fulfill their aspirations and allows important aspects of their lives such as socializing with their peer group, to develop It widens the range of possible occupations in later life. Work that is low skilled is usually more physically demanding. During regular appointments with the young patient, the physician should ask how school is going.
Many families have followed a long and circuitous route to a diagnosis and the young patient can be months or years behind in school by the time a diagnosis is reached. If both parents need to work, that can be problematic for the young patient at home alone. Students who have understanding teachers, a flexible program, and assistance from sympathetic advocates often need less help from medical and psychological professionals.
Other schools might appear to agree with the recommendations yet never follow through with implementation. Students experience mental confusion, forgetfulness, difficulty concentrating, a short attention span and a slowing of mental processing speed. Working memory can be significantly reduced and there is often increased distractibility, which can be exacerbated by noise in the classroom 85 — IQ scores might be lower than the scores of healthy peers Cognitive problems can sometimes mimic attention deficit disorder without hyperactivity.
For those with more severe illness, cognitive problems are very limiting. Generally, if students are homebound, the most that they can manage are one or two essential or core subjects. Although not easy and requiring a real commitment, completing school work can give the student a real sense of achievement, which is important. They might be able to complete the steps to solve a complex problem correctly, but can make simple addition, subtraction, or multiplication mistakes.
Teachers should be aware of this problem when grading tests Educators need to be aware that it is difficult for these students to stand or even sit for prolonged periods of time. These students might need to move around during lessons. They might also need access to drinks and salty snacks especially during testing. They might also be physically unable to complete long exams in one sitting. Returning to school after a long absence can be a challenge. If the student needs to travel long distances to school, this is very tiring.
The situation needs to be handled with understanding and patience. The legal and procedural requirements for students to receive services for their disabilities vary significantly from place to place and are beyond the scope of this Primer. If tested on a relatively good day, they might not have scores that differ from healthy individuals. Third, this kind of testing is often not covered by insurance, and can be costly.
At a practical level, the testing usually does not alter the suggested management, which most often is to decrease the volume of academic work. Regular communication with the school is helpful. A reduction in course load and flexible scheduling where only classes in selected subjects are attended. Provide homebound instruction or Distance Education for students who are partly or completely homebound.
Permit the use of electronic devices such as a laptop or tablet and allow work to be completed and submitted online. Allow salty snacks and a water bottle for use in the classroom and especially during long tests. Provide tutorial or homebound instruction for work missed or if the student is too ill to attend school.
Significant extended time might be needed for testing as well as adjusted time of day for assessments, depending on the time when the student functions best. Some students might be able to participate in a short physical activity, but not an activity that requires stamina. When this occurs, the student must stop and rest. The student might want to continue, but failure to stop and rest at the onset of increased fatigue often causes a serious and prolonged relapse of symptoms.
When possible, these opportunities should be facilitated , Access to extra-curricular activities is also important for social reasons. Students who are unable to attend school often feel isolated at home, and miss their friends. The text of this monograph was developed by consensus of all the authors, and all authors agree to the content of the manuscript. Drafts of the main chapters were revised extensively by the entire group until consensus was achieved.
The authors declare that this monograph was written in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. We gratefully acknowledge the contributions of the following: Faith Newton Ed. Patients can be classified as having CFS if they meet the following criteria:.
The individual has had severe, clinically evaluated, persisting or relapsing fatigue for six or more consecutive months. The fatigue is not due to ongoing exertion or other medical conditions associated with fatigue. The fatigue significantly interferes with daily activities and work. The individual has four or more of the following symptoms, persisting, or relapsing and concurrent with the fatigue:. A thorough medical history, physical examination, mental status examination, and laboratory tests are necessary to identify other conditions with similar symptoms that require treatment.
The diagnosis of chronic fatigue syndrome cannot be made without such an evaluation. There is severe, overwhelming fatigue with a substantial loss of physical and mental stamina.
The cardinal feature is a worsening of symptoms and malaise feeling ill following minimal physical or mental exertion. This can persist for hours, days, or weeks and is not relieved by rest or sleep. A new name, systemic exertion intolerance disease SEID has been proposed, but is not in general use. Clusters of cases or outbreaks of the illness epidemics have been found worldwide and in several of these outbreaks the illness has been prominent in schoolchildren. In some families, genetic factors may produce a susceptibility to the illness.
No known infectious agent has been shown to be the cause and in sporadic non-epidemic cases, the illness is not thought to be transmissible by casual contact. Many patients remain undiagnosed. The main diagnostic features of the illness have been incorporated into several different case definitions.
Breaking Free from Persistent Fatigue - video dailymotion
We recommend the following clinical diagnostic criteria which have been found to be useful in pediatric patients:. There is a new onset of fatigue that is not the result of ongoing exertion and is not relieved by rest. Fatigue can worsen with prolonged upright posture. Recovery can take days, weeks, or months. Pain can be widespread or localized. Pains can be worsened by prolonged upright posture. Rarely is pain absent. Sometimes the onset is gradual. In younger children, a gradual onset over months or years is more likely.
The diagnosis can be made retrospectively when the child is older. Early diagnosis can lessen the impact of the illness by ensuring an appropriate management plan. Some young patients are severely disabled and bedridden, while others can go to school and a few can even do sports. Most are between these extremes.
Over time, slow improvement is likely. Dramatic improvement is more likely to occur in the first four years. Relapses can be caused by overexertion or by infectious illnesses. Young patients whose health improves to near pre-illness levels are likely to find that they need more rest than their contemporaries. There is currently no medication or intervention that will cure the disease.
Management differs between individuals. Determining the optimum balance of rest and activity pacing of activities can help prevent post-exertional worsening of symptoms. Medications are helpful to treat pain, insomnia, and orthostatic intolerance. Advice on nutrition can be helpful. Supportive psychotherapy can sometimes benefit mildly affected young patients, but inflexible, graded exercise GET is harmful and can lead to worsening of symptoms. Legal and procedural requirements for students to receive services for their disabilities vary significantly from place to place.
The main symptoms include:. The cardinal symptom of worsening of symptoms and malaise feeling ill following minimal physical or mental exertion which can persist for hours, days, or weeks and is not relieved by rest. Cognitive problems may worsen with prolonged upright posture. There is no medical test for the illness. Symptoms can vary unpredictably in severity from day-to-day and from week-to-week. Successful management is directed toward determining the optimum balance of rest and activity to help prevent post-exertional worsening of symptoms. Medications are helpful to treat pain, insomnia, orthostatic intolerance and other symptoms.
Absence from school is usually due to poor physical and cognitive function, not behavioral factors.
Some students can attend school daily, others can manage part-time, while others are homebound and some are confined to bed. Sometimes a student has enough energy for school at the start of the week, but is unable to manage school on Thursday and Friday. A student might appear fine one day but the next day might be unable to come to school, sometimes for several weeks. Cognitive problems include confusion, difficulty with concentration, slow information processing, short-term memory problems, impaired word retrieval, and easy distractibility.
These problems can manifest in several ways. The student might require extra time to answer questions or complete assignments. The student might temporarily lose the ability to retrieve information learned the day before. Classroom noise can worsen distractibility. This distractibility can result in teachers perceiving that the student is uninterested, or cannot pay attention.
They can often complete the steps to solve a complex calculus problem, but make simple addition or multiplication mistakes. Intellectual reasoning is usually retained in spite of cognitive problems, and many students are capable of taking academic classes with their peers, provided that that the number of their classes is strictly limited.
Some students may manage a short physical activity, but not an activity that requires stamina. The student might want to participate, but failure to stop and rest at the onset of increased fatigue can cause a serious relapse of symptoms. Students may need a personalized school schedule. The following accommodations can be helpful:. A quiet place for the student to rest if fatigue is evident to the student or the teacher. Use multi-sensory instruction, e. Teach tasks serially instead of having the student multitask, break work down into manageable segments—short frequent projects are better than long-term projects.