Sierra Acai Company
Sierra Acai Company
Open 7 Days a Week
MonaVie Independent Distributor
Distributor Training
Shop Online
Enroll Now
Buy Wholesale and maintain an Active status for 2 months and we will refund your $39 Distributor Fee
Friends
Buy Wholesale and maintain an Active status for 2 months and we will refund your $39 Distributor Fee
20-September-2008 10:21:21 - fatigue syndrome Chronic fatigue syndrome/ Myalgic encephalomyelitis Classification and external resources ICD-10 G93.3 ICD-9 780.71 DiseasesDB 1645 MedlinePlus 001244 eMedicine med/3392 ped/2795 MeSH D015673 Chronic fatigue syndrome CFS is one of several names given to a poorly understood, variably debilitating disorder or disorders of uncertain causation. CFS is thought, based on a 1999 study, to affect approximately 4 per 1,000 adults in the United States.1 For unknown reasons, CFS occurs more often in women than men, and in people in their 40s and 50s.23 The illness is estimated to be less prevalent among children and adolescents, but studies are contradictory as to the degree.4 CFS often manifests with widespread myalgia and arthralgia, cognitive difficulties, chronic mental and physical exhaustion, often severe, and other characteristic symptoms in a previously healthy and active person. Despite promising avenues of research, there remains no assay or pathological finding which is widely accepted to be diagnostic of CFS. It remains a diagnosis of exclusion based largely on patient history and symptomatic criteria, although a number of tests can aid diagnosis.5 Whereas there is agreement on the genuine threat to health, happiness, and productivity posed by CFS, various physicians' groups, researchers, and patient activists champion very different nomenclature, diagnostic criteria, etiologic hypotheses, and treatments, resulting in controversy about nearly all aspects of the disorder. Even the term chronic fatigue syndrome is controversial because a large part of the patient community believes the name trivializes the illness.6 Chronic fatigue syndrome is not the same as chronic fatigue.5 Fatigue is a common symptom in many illnesses, but CFS is a multi-systemic disease and is relatively rare by comparison.7 Definitions other than the 1991 UK Oxford criteria8 require a number of features, the most common being severe mental and physical exhaustion which is unrelieved by rest 1994 Fukuda definition,9 and may be worsened by even trivial exertion a mandatory diagnostic criterion according to some systems. Most diagnostic criteria require that symptoms must be present for at least six months, and all state the symptoms must not be caused by other medical conditions. CFS patients may report many symptoms which are not included in all diagnostic criteria, including muscle weakness, cognitive dysfunction, hypersensitivity, orthostatic intolerance, digestive disturbances, depression, poor immune response, and cardiac and respiratory problems. It is unclear if these symptoms represent co-morbid conditions or are produced by an underlying etiology of CFS.10 Some cases improve over time, and treatments though none are universally accepted bring a degree of improvement to many others, though full resolution may be only 5-10% according to the United States Centers for Disease Control and Prevention CDC.11 Contents 1 Nomenclature 2 Signs and symptoms 2.1 Onset 2.1.1 Sudden onset cases 2.1.2 Gradual onset cases 2.2 Course 2.3 Activity levels 3 Pathophysiology 4 Hypotheses 5 Definitions, Guidelines, and Summaries 6 Therapies 7 Treatment 8 Prognosis 8.1 Recovery 8.2 Deaths 9 Epidemiology 9.1 Disease associations 9.2 Co-morbidity 9.3 Social issues 10 History 11 Controversies 11.1 The name 11.2 The causes, diagnosis, and treatment 11.3 Research priorities 11.4 Support for patients 12 See also 13 References 14 External links Nomenclature Main article: ME/CFS nomenclatures The nomenclature of the conditions has been challenging, since consensus is lacking within the clinical, research, and patient communities regarding its defining features and causes. Authorities on the illness do not agree if it is a central nervous system, metabolic, post-infectious, immune system, or neuropsychiatric disorder, nor even if it is a single homogenous disorder with a range of possible clinical presentations, or several distinct disorders having many clinical characteristics in common. Over time and in different countries many names have been associated with the conditions. Some of the more common names in use include:1213 Chronic Fatigue Syndrome CFS Myalgic Encephalomyelitis ME Post-Viral Fatigue Syndrome PVFS Chronic Fatigue Immune Dysfunction Syndrome CFIDS Signs and symptoms Onset Sudden onset cases The majority of CFS cases start suddenly,14 usually accompanied by a flu-like illness10151617 which is more likely to occur in winter,1819 while a significant proportion of cases begin within several months of severe adverse stress.202114 Many people report getting a case of a flu-like or other respiratory infection such as bronchitis, from which they seem never to fully recover and which evolves into CFS. The diagnosis of Post-viral fatigue syndrome is sometimes given in the early stage of the illness.22 One study reported CFS occurred in some patients following a vaccination or a blood transfusion.23 The accurate prevalence and exact roles of infection and stress in the development of CFS however are currently unknown. Gradual onset cases Other cases have a gradual onset, sometimes spread over years.23 Patients with Lyme disease may, despite a standard course of treatment, evolve clinically from the symptoms of acute Lyme to those similar to CFS.24 This has become an area of great controversy. Course It can be inferred from the 2003 Canadian clinical working definition of ME/CFS5 that there are 8 categories of symptoms: Fatigue: Unexplained, persistent, or recurrent physical and mental fatigue/exhaustion that substantially reduces activity levels and is not relieved or not completely relieved by rest. Post-exertional malaise: An inappropriate loss of physical and mental stamina, rapid muscular and cognitive fatigability, post exertional malaise and/or fatigue and/or pain and a tendency for other associated symptoms to worsen with a pathologically slow recovery period of usually 24 hours or longer. According to the authors of the Canadian clinical working definition of ME/CFS,5 the malaise that follows exertion is often reported to be similar to the generalized pain, discomfort and fatigue associated with the acute phase of influenza. Although common in CFS, this may not be the most severe symptom in the individual case, where other symptoms such as headaches, neurocognitive difficulties, pain and sleep disturbances can dominate. Sleep dysfunction: Unrefreshing sleep/rest, poor sleep quantity, insomnia or rhythm disturbances. A study found that most CFS patients have clinically significant sleep abnormalities that are potentially treatable.25 Several studies suggest that while CFS patients may experience altered sleep architecture such as reduced sleep efficiency, a reduction of deep sleep, prolonged sleep initiation, and alpha-wave intrusion during deep sleep and mildly disordered breathing, overall sleep dysfunction does not seem to be a critical or causative factor in CFS.26272829 Sleep may present with vivid disturbing dreams, and exhaustion can worsen sleep dysfunction.30 Pain: Pain is often widespread and migratory in nature, including a significant degree of muscle pain and/or joint pain without joint swelling or redness, and may be transitory. Other symptoms include headaches particularly of a new type, severity, or duration, lymph node pain, sore throats, and abdominal pain often as a symptom of irritable bowel syndrome. Patients also report bone, eye and testicular pain, nerve pain and painful skin sensitivity. Chest pain has been attributed variously to microvascular disease or cardiomyopathy by researchers, and many patients also report painful tachycardia. A systematic review assessing the studies of chronic pain in CFS found that although the exact prevalence is unknown, it is strongly disabling in patients, but unrelated to depression.31 Neurological/cognitive manifestations: Common occurrences include confusion, forgetfulness, mental fatigue/brain fog, impairment of concentration and short-term memory consolidation, disorientation, difficulty with information processing, categorizing and word retrieval, and perceptual and sensory disturbances e.g. spatial instability and disorientation and inability to focus vision, ataxia unsteady and clumsy motion of the limbs or torso, muscle weakness and twitches. There may also be cognitive or sensory overload e.g. photophobia and hypersensitivity to noise and/or emotional overload, which may lead to crash periods and/or anxiety. A review of research relating to the neuropsychological functioning in CFS was published in 2001 and found that slowed processing speed, impaired working memory and poor learning of information are the most prominent features of cognitive dysfunctioning in patients with CFS, which couldn't be accounted solely by the severity of the depression and anxiety.32 Autonomic manifestations: Common occurrences include orthostatic intolerance, neurally mediated hypotension NMH, postural orthostatic tachycardia syndrome POTS, delayed postural hypotension, lightheadedness, extreme pallor, nausea and irritable bowel syndrome, urinary frequency and bladder dysfunction, palpitations with or without cardiac arrhythmias, and exertional dyspnea perceived difficulty breathing or pain on breathing. Neuroendocrine manifestations: Common occurrences include poor temperature control or loss of thermostatic stability, subnormal body temperature and marked daily fluctuation, sweating episodes, recurrent feelings of feverishness and cold extremities, intolerance of extremes of heat and cold, digestive disturbances33 and/or marked weight change - anorexia or abnormal appetite, loss of adaptability and worsening of symptoms with stress. Immune manifestations: Common occurrences include tender lymph nodes, recurrent sore throat, recurrent flu-like symptoms, general malaise, new sensitivities to food and/or medications and/or chemicals which may complicate treatment. At least one study has confirmed that most CFS patients reduce or cease alcohol intake, mostly due to personal experience of worsening symptoms34 although the cause of this is unknown and may not be strictly immunological as implied by the symptom list. Activity levels Patients report critical reductions in levels of physical activity35 and are as impaired as persons whose fatigue can be explained by another medical or a psychiatric condition.36 According to the CDC, studies show that the disability in CFS patients is comparable to some well-known, very severe medical conditions, such as; multiple sclerosis, AIDS, lupus, rheumatoid arthritis, heart disease, end-stage renal disease, chronic obstructive pulmonary disease COPD and similar chronic conditions.3738 The severity of symptoms and disability is the same in both genders,39 and chronic pain is strongly disabling in CFS patients,31 but despite a common diagnosis the functional capacity of CFS patients varies greatly.40 While some patients are able to lead a relatively normal life, others are totally bed-bound and unable to care for themselves. A systematic review found that in a synthesis of studies, 42% of patients were employed, 54% were unemployed, 64% reported CFS-related work limitations, 55% were on disability benefits or temporary sick leave, and 19% worked full-time.41 Pathophysiology Main article: ME/CFS pathophysiology The mechanisms and processes pathogenesis of Chronic Fatigue Syndrome are gradually being revealed through research, including physiological and epidemiological studies. In a basic overview of CFS for health professionals, the CDC states that After more than 3,000 research studies, there is now abundant scientific evidence that CFS is a real physiological illness.42 Chronic fatigue syndrome CFS or ME has been described in a 2008 Toxicology journal article as, a constellation of multi-system dysfunctions primarily involving the neurological nervous system, endocrine hormone system, and immune systems. The article states recent research suggests the potential that xenobiotic chemicals, infectious agents, stress, and other insults in early life may be a component of later-life CFS.43 A 2007 article in the journal Autoimmunity summarised; The current concept is that CFS pathogenesis is a multi factorial condition in which an infective agent cause an aberrant immune response characterized by a shift to Th-2 cytokine dominant response. When the response fails to be switched-off, a chronic immune activation occurs and is clinically expressed in the symptomatology of CFS. 44 In a 2006 update in the journal Curr Opin Psychiatry it was said; Recent advances in understanding the pathophysiology of chronic fatigue syndrome continue to demonstrate the involvement of the central nervous system. Hyperserotonergic state and hypoactivity of the hypothalamic-pituitary-adrenal axis HPA axis constitute other findings, but the question of whether these alterations are a cause or consequence of chronic fatigue syndrome still remains unanswered. 45 Alterations in serotonin signaling can lead to physiologic and behavioral changes. A 2008 study of gene polymorphisms indicates genetic predisposition possibly resulting in enhanced activity of serotonin may be involved in the pathophysiology of CFS. 46 Chronic fatigue is a typical symptom of neurological diseases, including chronic fatigue syndrome, is also seen in diseases that affect the central, peripheral, and autonomic nervous systems central fatigue. Enhanced perception of effort and limited endurance of sustained physical and mental activities are the main characteristics of central fatigue. Metabolic and structural lesions can cause muscle fatigability peripheral fatigue also disrupt the usual process of activation in pathways interconnecting the basal ganglia peripheral nerves, thalamus, limbic system, and higher cortical centre are implicated in the pathophysiological process of central fatigue. A state of low cortisol might sensitize the hypothalamic-pituitary-adrenal axis HPA axis to development of persistent central fatigue after stress. 47 Chronic Fatigue Syndrome CFS is a disorder whose etiology and pathogenesis are still unknown. In this syndrome both abnormalities of nervous and immune systems have been reported. Nervous and immune systems mutually cooperate via release of mediators of both neurological and immunological derivation. Hormone ACTH is a product of the HPA axis which stimulates secretion of corticosteroids from adrenals. In turn, corticosteroids modulate the immune response by virtue of their anti-inflammatory activity. On the other hand, catecholamines, products of the sympathetic nervous system SNS, regulate immune function by acting on specific beta-adrenergic receptors. Conversely, cytokines released by certain immune cells, upon stimulation, are able to cross the blood-brain-barrier, thus modulating nervous functions e.g., thermoregulation, sleep, and appetite. However, cytokines are locally produced in the brain, especially in the hypothalamus, thus contributing to the development of appetite, thermoregulation, sleep and behavioural effects. In addition infections/pathogens and/or their products, the so-called stressors are able to activate both HPA axis and SNS, thus influencing immune responses. 48 Hypotheses Main article: ME/CFS hypotheses The etiology of CFS is unknown, and many causes have been proposed. The etiology may be different for subgroups of patients, and may result in a common clinical outcome.42 Some plausible hypotheses are as follows. 1 CFS is often associated with viral infection. 2 Anomalies of the HPA axis are often observed in CFS, but it is not clear if they are a cause or consequence of the disorder. 3 Immune dysfunction is also found in CFS studies, and hypothesized as the cause of CFS. 4 In the psychiatric and psychosocial model, some researchers hypothesize cognitive and behavioral factors are involved in the persistence of fatigue and illness behavior.49 Other hypotheses for the causes of CFS are 5 Oxidative stress and 6 genetic predisposition.50 Definitions, Guidelines, and Summaries Main article: ME/CFS descriptions In 1938, Assistant Surgeon General of United States, Dr A Gilliam reported on a 1934 epidemic of what was diagnosed at the time as Poliomyelitis. He called the unusual symptoms and attack rate in adults unparalleled. His detailed description that added up to a twenty-point definition of 90 pages is considered by Byron Hyde of the Nightingale Research Foundation as the first useful description of ME/CFS. Dr Hyde in a Review of Publication of Gilliam refers to Gilliam's own communications and his claims that the publication of the report was delayed by concerned US authorities until 1938.51 Competing definitions, guidelines, and summary descriptions have accrued. Among them, some of the most notable are The Ramsay definition 1986 52 The Holmes et al 1988 scoring system,53 sometimes called CDC 1988 The Oxford criteria 19918 The Fukuda CDC definition 1994,9 or CDC 1994 The Carruthers et al 2003 Canadian Case definition for ME/CFS5 The NICE UK 2007 criteria, a multidisciplinary clinical practice guideline published in 2007 by the UK's National Institute for Health and Clinical Excellence NICE54 Case definitions in CFS have largely been established to define patients for research study purposes, and have certain limitations when used for general practitioner purposes. Several studies have found that using different case definitions eg broad vs conservative55 has major influence on the types of patients selected and have also supported the distinction between specific subgroups of CFS to be identified and/or for the case definition to be further clarified with emphasis on using empirical studies: An international CFS study group for the CDC found in 2003 that ambiguities in the CDC 1994 CFS research case definition contribute to inconsistent case identification.56 At this time, there is no accepted conclusive test or series of tests for ME/CFS. According to the CDC, the main purpose of performing diagnostic tests of any sort at this point in time, is to rule out other causes for fatigue and other symptoms of CFS.9 A review published in 2006 found that the accurate diagnosis of CFS is low57 Clinical practice guidelines, with the aim of improving diagnosis, several countries have now produced these, which are generally based on case descriptions but these documents have the aim of guiding decisions and criteria regarding diagnosis, management, and treatment. Modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine and they usually include summarized consensus statements. Guidelines are usually produced at national or international levels by medical associations or governmental bodies. Therapies Main article: ME/CFS therapies Improvement may occur with medical care and additional therapies of pacing, cognitive behavioral therapy CBT and graded exercise therapy GET. The latter two therapies have been found to be efficacious in small trials, but patient organisations surveys have reported adverse effects.58 Interventions involving rehabilitation therapies have been shown to be at least partially effective in some people with CFS. 59606162 Some therapies recommended by different sources include: Adaptive pacing58 Cognitive behavior therapy63 Envelope theory64 Graded exercise therapy65 Yoga66 Physiotherapy67 Treatment Main article: ME/CFS treatments Many patients do not fully recover from CFS, even with treatment.68 Some management strategies are suggested to reduce the consequences of having CFS. Medications, other medical treatments, complementary and alternative medicine are considered. A systematic review has shown that CFS patients are less susceptible to placebo effects than predicted, and have a low placebo response compared to patients with other diseases.69 CFS is associated with chemical sensitivity,70 71 and some patients often respond to a fraction of a therapeutic dose that is normal for other conditions.7273 A 2005 review in the journal Curr Med Chem. concluded, it seems that major drug targets in stress-related disorders are immune cells in terms of inhibition of proinflammatory cytokines and modulation of Th cytokine pattern responses. In CFS, in a series of recent therapeutic trials several immunomodulating agents have been used, such as staphypan Berna, lactic acid bacteria, kuibitang and intravenous immunoglobulin. In particular, according to recent evidences, antidepressants seem to exert beneficial effects in augmenting NK cell activity in depressed patients. 48 Prognosis Recovery A systematic review of 14 studies of the outcome of untreated people with CFS found that the median full recovery rate was 5% range 0-31% and the median proportion of patients who improved during follow-up was 39.5% range 8-63%. Return to work at follow-up ranged from 8 to 30% in the three studies that considered this outcome. .... In five studies, a worsening of symptoms during the period of follow-up was reported in between 5 and 20% of patients.74 It is not known whether any patients truly recover entirely from the illness, or achieve remission from a relapsing, remitting illnesscitation needed. Few untreated patients report a total cure. Deaths CFS is unlikely to increase the risk of an early death. A systematic review of 14 studies of the outcome of CFS reported 8 deaths, but none were considered directly attributable to CFS.74 To date there have been two studies directly addressing life expectancy in CFS. In a preliminary 2006 study of CFS self-help group members, it was reported that CFS patients were likely to die at a younger than average age for cancer, heart failure, and suicide.75 However, a much larger study of 641 CDC criteria diagnosed patients with CFS, who were followed up for a mean of 9 years, showed no excess risk of dying from any cause.76 People diagnosed with CFS may die, as in the case in the UK of Sophia Mirza, where the coroner recorded a verdict of Acute anuric renal failure due to dehydration arising as a result of CFS. According to Sophia's mother, Sophia became intolerant to water and managed only 4 fluid ounces per day.77 The pathologist said, ME describes inflammation of the spinal cord and muscles. My work supports the inflammation theory...The changes of dorsal root ganglionitis seen in 75% of Sophia's spinal cord were very similar to that seen during active infection by herpes viruses. This was seen as a form of recognition by the ME community.78 Previous cases have listed CFS as the cause of death in the US and Australia79 Epidemiology Due to problems with the definition of CFS, estimates of its prevalence vary widely. Studies in the United States have previously found between 75 and 420 cases of CFS for every 100,000 adults. The CDC states that more than 1 million Americans have CFS and approximately 80% of the cases are undiagnosed.11 All ethnic and racial groups appear susceptible to the illness, and lower income groups are slightly more likely to develop CFS.3 More women than men get CFS - between 60 and 85% of cases are women; however, there is some indication that the prevalence among men is underreported. The illness is reported to occur more frequently in people between the ages of 40 and 59. Blood relatives of people who have CFS appear to be more predisposed.380 However, CFS does not appear directly contagious; caretakers, partners and others in close contact with persons with CFS for years do not develop CFS any more frequently excluding relatives, as earlier. Epidemiological research on children and adolescents has received minimal focus according to a 2006 research review. Among minors, prevalence appears to be lower than for adults and various studies have found a range of 50-80% of the cases occur in girls. The authors hypothesize the differences in estimates of ME/CFS among pediatric studies may result because of the lack of a reliable pediatric case definition.4 CFS generally occurs in endemic cases. In addition, over 50 instances have been documented, such as the Royal Free Hospital incident, where epidemic clusters were reported.who?5251 In these instances, significant numbers of people came down with illnesses describedweasel words as ME or CFS simultaneously, confined to a local area or even a single building. An infectious origin for these clusters was considered highly likely due to: transference by inoculation to monkeys which developed symptomology and on post-mortem demonstrated neurological, vascular and cardiac damage Fellow and Miles, 1955. human post-mortems or scans demonstrating abnormalities consistent with chronic infection Wallis 1957, Schwartz et al 1994 serologic evidence of Iceland Disease blocking spread of polio type I spreading northwards Sigurdsson et al, 1958. the pattern of acute onset with pharyngitis, mild fever, muscular pain, neck stiff-ness, cervical lymphadenopathy, gastroenteric symptoms, diffuse CNS involvement and photosensitivity were consistent with viral infection with an observed incubation period of 5-7 days. The biphasic clinical picture echoes pathogenesis through the pharynx, spreading through the reticuloendothelial barrier, then the CNS, resulting in morphological changes in mature lymphocytes and antibody creation. Acheson, Ramsay, RIchardson, Crowley, Dillon et al A predeliction for residential communities and most outbreaks occurring in summer Acheson The isolation of the non-polio enterovirus ECHO-9 in patients Lyle, Annals of Internal Medicine 1959; 51: 248-269 psychiatric disease was a widely regarded exclusion for M.E. diagnosis e.g. Acheson and positive criteria for hysteria were absent Gosling, Mayne, 1970. At the 1978 RSM Symposium, new evidence was presented of increased anti-complementary activity and the ability of lymphocytes to proliferate and survive in vitro for up to 19 weeks. Compston 1978. Since most current definitions of CFS exclude such findings and signs, it is disputed whether they refer to a differential diagnosis but see below. According to the CDC, CFS itself is not contagious.81 Disease associations Some diseases show a considerable overlap with CFS. According to an article in American Family Physician in 2002, Multiple Sclerosis, Thyroid disorders, anemia, and diabetes are but a few of the diseases that must be ruled out if the patient presents with appropriate symptoms.982 People with fibromyalgia FM, or Fibromyalgia Syndrome, FMS have muscle pain and sleep disturbances. Fatigue and muscle pain occurs frequently in the initial phase of various herary muscle disorders and in several autoimmune, endocrine and metabolic syndromes; and are frequently labelled as CFS or fibromyalgia in the absence of obvious biochemical/metabolic abnormalities and neurological symptoms.83 Those with multiple chemical sensitivity MCS are sensitive to chemicals and have sleep disturbances. Many veterans with Gulf War syndrome GWS have symptoms almost identical to CFS.84 One study found several parallels when relating the symptoms of Post-polio syndrome with CFS, and postulates a possible common pathophysiology for the illnesses.85 Although post-Lyme syndrome and CFS share many features/symptoms, a study found that patients of the former experience more cognitive impairment and the patients of the latter experience more flu-like symptoms.86 One review 2006 found that there was a lack of literature to establish the discriminant validity of undifferentiated somatoform disorder from CFS. The author stated that there is a need for proponents of chronic fatigue syndrome to distinguish it from undifferentiated somatoform disorder. The author also mentioned that the experience of fatigue as exclusively physical and not mental is captured by the definition of somatoform disorder but not CFS.87 Hysterical diagnoses are not merely diagnoses of exclusion but require criteria to be met on the positive grounds of both primary and secondary gain.88 Primary Depression can be excluded in the differential diagnosis due to the absence of anhedonia and la belle indifference, the variability lability of mood, and the presence of sensory phenomena and somatic signs such as ataxia, myclonus and most importantly, exercise intolerance with paresis, malaise and general deterioration,5 which can in some cases become a comorbid situational depression. Co-morbidity Many CFS patients will also have, or appear to have, other medical problems or related diagnoses. Co-morbid fibromyalgia is common, although there are differences in pain complaints.89 Fibromyalgia occurs in a large percentage of CFS patients between onset and the second year, and some researchers suggest fibromyalgia and CFS are related.90 Similarly, multiple chemical sensitivity MCS is reported by many CFS patients, and it is speculated that these similar conditions may be related by some underlying mechanism, such as elevated nitric oxide/peroxynitrite.91 As previously mentioned, many CFS sufferers also experience symptoms of irritable bowel syndrome, temporomandibular joint pain, headache including migraines, and other forms of myalgia. Clinical depression and anxiety are also commonly co-morbid. Compared with the non-fatigued population, male CFS patients are more likely to experience chronic pelvic pain syndrome CP/CPPS, and female CFS patients are also more likely to experience chronic pelvic pain.92 CFS is significantly more common in women with endometriosis compared with women in the general USA population.93 Social issues Many patients report that a chronic fatigue syndrome diagnosis carries a considerable stigma, and has frequently been viewed as malingering, hypochondria, phobia, wanting attention or yuppie flu. As there is no objective test for the condition at this time, it has been argued that it is easy to invent or feign CFS-like symptoms for financial, social, or emotional benefits.9495 CFS sufferers argue in turn that the perceived benefits are hardly as generous as some may believe, and that CFS patients would greatly prefer to be healthy and independent. A study found that CFS patients endure a heavy psychosocial burden.96 2,338 respondents of a survey by a UK patient organization highlights that those with the worst symptoms often receive the least support from health and social services.97 A study found that CFS patients receive worse social support than disease-free cancer patients or healthy controls, which may perpetuate fatigue severity and functional impairment in CFS.98 A survey by the Thymes Trust found that children with CFS often state that they struggle for recognition of their needs and/or they feel bullied by medical and educational professionals.99 The ambiguity of the status of CFS as a medical condition may cause higher perceived stigma.100 A study suggests that while there are no gender differences in CFS symptoms, men and women have different perceptions of their illness and are treated differently by the medical profession.101 Anxiety and depression often result from the emotional, social and financial crises caused by CFS. While few studies have been made, it is believed that CFS patients are at a high risk of suicide.102 A lack of information and awareness has led to many patients to feel stigmatized.103 CFS patients may not receive total medical and social acceptance and they state that some people trivialise the illness.98 History Main article: ME/CFS history Attempts to describe conditions similar to ME/CFS date back to at least the 17th Century.10451 A major outbreak in 1934 at the Los Angeles County Hospital infected all or most of its nurses and doctors. It was referred to as Atypical Poliomyelitis, and was generally believed to be a form of polio.105 The outbreak that gave it one of its most common names, Myalgic Encephalomyelitis, occurred at London's Royal Free Hospital in 1955, inflicting mostly the hospital staff, and formed the basis of descriptions by Achenson, Ramsay, and others.106 Although early reports described epidemics, and by the 1950's at least fourteen had occurred worldwide, see ME/CFS outbreaks of which seven of the fourteen occurred in staffs of hospitals. By the 1990s at least 50 similar clusters or epidemics have appeared in the medical literature. It has always been known by investigators that these epidemics of ME/CFS tended merely to highlight the same disease activity in the general public in the epidemic area. Reports of cases were fairly stable through the 70's. But since 1979 there has been an enormous but poorly documented increase in cases of ME/CFS. These increases compounded slowly until 1984 when an exponential increase occurred. The numbers did not drop afterwards as one might expect after an epidemic but have continued to rise in increasing number. 51 Benign Myalgic Encephalomyelitis was first classified into the International Classification of Diseases in 1969 under Diseases of the nervous system.107 The name Chronic Fatigue Syndrome has been attributed to the 1988 article, Chronic fatigue syndrome: a working case definition, Holmes definition. This research case definition was published after US Centers for Disease Control epidemiologists examined patients at the Lake Tahoe outbreak.10810953 In 2006 the CDC estimated there were more than 1 million cases of CFS in the US and commenced a public awareness program.11 Since inception, the condition has been steeped in controversy. Despite continuous research and many findings, indicating also likely subsets of patients, the present state of study on this condition is fragmented and contentious.110 Controversies Main article: ME/CFS controversies ME/CFS is an illness with a long history of controversies, which include: The name Different terms to describe the conditions have been used over the years in different parts of the world see ME/CFS nomenclatures. Many members of CFS advocacy groups feel the name Chronic fatigue syndrome trivializes the illness and should be changed.6 The causes, diagnosis, and treatment For years, many professionals within the medical community did not recognize ME/CFS as a real condition, nor was there agreement on its prevalence.111112 There has been much disagreement over proposed causes, diagnosis, and treatment of the illness.113114115116117 It may be necessary to embrace medical uncertainty, and also to accept patient experience in order to facilitate diagnosis, treatment, and recovery process. 118 It is suggested that a context of contested causation may have serious negative effects on healthcare for individuals. An adverserial social context, may erode patient-provider trust, test the provider's self-assurance and capability to share power with the patient, and raise problematic issues of reparation, compensation, and blame. 119 Research priorities The etiology is still not known, and a major divide still exists over funding for research and treatment of physiological versus psychological and psychosocial aspects of the illness. The division is especially great between ME patient groups and psychological and psychosocial treatment advocates in Great Britain.117 Support for patients Sufferers describe the struggle for healthcare and legitimacy due to bureaucratic denial of the condition because of its lack of a known etiology. Institutions maintain the exclusion of patient support by rhetorical arguments of the open-endedness of science to delay new findings of fact. Patient groups respond to the systematic nature of these exclusions by developing counter-arguments. This has resulted in an expensive and prolonged conflict for all involved.120112 In 1998 it became known almost 13 million dollars for CFS research had been redirected or improperly accounted for by the United States CDC. The agency stated the need to respond to other public health emergencies. The director of a U.S. national patient advocacy group charged the CDC had a bias against studying the disease.121 See also Navigation guide for articles about ME/CFS References ^ Jason LA, Richman JA, Rademaker AW, Jordan KM, Plioplys AV, Taylor RR, McCready W, Huang CF, Plioplys S 1999. A community-based study of chronic fatigue syndrome. Arch. Intern. Med. 159 18: 2129-37. doi:10.1001/archinte.159.18.2129. PMID 10527290. ^ Gallagher AM, Thomas JM, Hamilton WT, White PD 2004. Incidence of fatigue symptoms and diagnoses presenting in UK primary care from 1990 to 2001. J R Soc Med 97 12: 571-5. doi:10.1258/jrsm.97.12.571. PMID 15574853. ^ a b c Chronic Fatigue Syndrome Who's at risk? htm. Centers for Disease Control and Prevention March 10, 2006. Retrieved on 2008-02-07. ^ a b Jason LA, Jordan K, Miike T, Bell DS, Lapp C, Torres-Harding S, Rowe K, Gurwitt A, De Meirleir K, Van Hoof ELS 2006. A Pediatric Case Definition for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome. Journal of Chronic Fatigue Syndrome 13 2-3: 1-44. doi:10.1300/J092v13n02_01. ^ a b c d e f Carruthers BM, Jain AK, De Meirleir KL, Peterson DL, Klimas MD, Lerner AM, Bested AC, Flor-Henry P, Joshi P, Powles ACP, Sherkey JA, van de Sande MI 2003. Myalgic encephalomyalitis/chronic fatigue syndrome: Clinical working definition, diagnostic and treatment protocols. Journal of Chronic Fatigue Syndrome 11 1: 7-36. doi:10.1300/J092v11n01_02. ^ a b Jason LA, Taylor RR 2001. Measuring Attributions About Chronic Fatigue Syndrome TXT. J Chronic Fatigue Syndr 8 3/4: 31-40. doi:10.1300/J092v08n03_04. ^ Ranjith G 2005. Epidemiology of chronic fatigue syndrome.. Occup Med Lond 55 1: 13-9. doi:10.1093/occmed/kqi012. PMID 15699086. ^ a b Sharpe M, Archard L, Banatvala J, Borysiewicz L, Clare A, David A, Edwards R, Hawton K, Lambert H, Lane R 1991. A report--chronic fatigue syndrome: guidelines for research. J R Soc Med 84 2: 118-21. PMID 1999813. Full text at PMC: 1293107 Synopsis by Oxford criteria for the diagnosis of chronic fatigue syndrome at GPnotebook ^ a b c d Fukuda K, Straus S, Hickie I, Sharpe M, Dobbins J, Komaroff A 1994. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group.. Ann Intern Med 121 12: 953-9. PMID 7978722. ^ a b Afari N, Buchwald D 2003. Chronic fatigue syndrome: a review. Am J Psychiatr 160 2: 221-36. doi:10.1176/appi.ajp.160.2.221. PMID 12562565. ^ a b c Chronic Fatigue Syndrome Basic Facts htm. Centers for Disease Control and Prevention May 9, 2006. Retrieved on 2008-02-07. ^ Byron M. Hyde 1992. The Clinical and scientific basis of myalgic encephalomyelitis/chronic fatigue syndrome. Ogdensburg, N.Y: Nightingale Research Foundation, X. ISBN 0969566204. ^ NORD June 23, 2008. Chronic Fatigue Syndrome/Myalgic Encephalomyelitis html. National Organization for Rare Disorders, Inc.. Retrieved on 2008-07-01. ^ a b Salit IE 1997. Precipitating factors for the chronic fatigue syndrome.. J Psychiatr Res 31 1: 59-65. doi:10.1016/S0022-39569600050-7. PMID 9201648. ^ Sairenji T, Nagata K 2007. Viral infections in chronic fatigue syndrome.. Nippon Rinsho 65 6: 991-6. PMID 17561687. ^ EvengÃ¥rd B, Jonzon E, Sandberg A, Theorell T, Lindh G 2003. Differences between patients with chronic fatigue syndrome and with chronic fatigue at an infectious disease clinic in Stockholm, Sweden.. Psychiatry Clin Neurosci 57 4: 361-8. doi:10.1046/j.1440-1819.2003.01132.x. PMID 12839515. ^ EvengÃ¥rd B, Schacterle RS, Komaroff AL 1999. Chronic fatigue syndrome: new insights and old ignorance.. J Intern Med 246 5: 455-69. doi:10.1046/j.1365-2796.1999.00513.x. PMID 10583715. ^ Jason LA, Taylor RR, Carrico AW 2001. A community-based study of seasonal variation in the onset of chronic fatigue syndrome and idiopathic chronic fatigue.. Chronobiol Int 18 2: 315-9. doi:10.1081/CBI-100103194. PMID 11379670. ^ Zhang QW, Natelson BH, Ottenweller JE, Servatius RJ, Nelson JJ, De Luca J, Tiersky L, Lange G 2000. Chronic fatigue syndrome beginning suddenly occurs seasonally over the year.. Chronobiol Int 17 1: 95-9. doi:10.1081/CBI-100101035. PMID 10672437. ^ Hatcher S, House A 2003. Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study.. Psychol Med 33 7: 1185-92. doi:10.1017/S0033291703008274. PMID 14580073. ^ Theorell T, Blomkvist V, Lindh G, Evengard B. Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome CFS: an examination of CFS patients and subjects with a nonspecific life crisis.. Psychosom Med. 61 3: 304-10. PMID 10367610. ^ Hickie I, Davenport T, Wakefield D, et al 2006. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ 333 7568: 575. doi:10.1136/bmj.38933.585764.AE. PMID 16950834. ^ a b De Becker P, McGregor N, De Meirleir K 2002. Possible Triggers and Mode of Onset of Chronic Fatigue Syndrome. Journal of Chronic Fatigue Syndrome 10 2: 2-18. doi:10.1300/J092v10n02_02. ^ Donta S 2002. Late and chronic Lyme disease.. Med Clin North Am 86 2: 341-9, vii. doi:10.1016/S0025-71250300090-7. PMID 11982305. ^ Krupp LB, Jandorf L, Coyle PK, Mendelson WB 1993. Sleep disturbance in chronic fatigue syndrome.. J Psychosom Res 37 4: 325-31. doi:10.1016/0022-39999390134-2. PMID 8510058. ^ Reeves WC, Heim C, Maloney EM, Youngblood LS, Unger ER, Decker MJ, Jones JF, Rye DB 2006. Sleep characteristics of persons with chronic fatigue syndrome and non-fatigued controls: results from a population-based study.. BMC Neurol 6: 41. doi:10.1186/1471-2377-6-41. PMID 17109739. ^ Watson NF, Kapur V, Arguelles LM, Goldberg J, Schmidt DF, Armitage R, Buchwald D 2003. Comparison of subjective and objective measures of insomnia in monozygotic twins discordant for chronic fatigue syndrome.. Sleep 26 3: 324-8. PMID 12749553. ^ Van Hoof E, De Becker P, Lapp C, Cluydts R, De Meirleir K 2007. Defining the occurrence and influence of alpha-delta sleep in chronic fatigue syndrome.. Am J Med Sci 333 2: 78-84. doi:10.1097/00000441-200702000-00003. PMID 17301585. ^ Ball N, Buchwald DS, Schmidt D, Goldberg J, Ashton S, Armitage R 2004. Monozygotic twins discordant for chronic fatigue syndrome: objective measures of sleep.. J Psychosom Res 56 2: 207-12. doi:10.1016/S0022-39990300598-1. PMID 15016580. ^ Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Clinical Case Definition and Guidelines for Medical Practitioners - An Overview of the Canadian Consensus Document; authored by Carruthers and van de Sande; published in 2005, ISBN 0-9739335-0-X, PDF ^ a b Meeus M, Nijs J, Meirleir KD 2007. Chronic musculoskeletal pain in patients with the chronic fatigue syndrome: A systematic review.. Eur J Pain 11 4: 377-386. doi:10.1016/j.ejpain.2006.06.005. PMID 16843021. ^ Michiels V, Cluydts R 2001. Neuropsychological functioning in chronic fatigue syndrome: a review.. Acta Psychiatr Scand 103 2: 84-93. doi:10.1034/j.1600-0447.2001.00017.x. PMID 11167310. ^ Burnet RB, Chatterton BE 2004. Gastric emptying is slow in chronic fatigue syndrome.. BMC Gastroenterol 4: 32. doi:10.1186/1471-230X-4-32. PMID 15619332. ^ Woolley J, Allen R, Wessely S 2004. Alcohol use in chronic fatigue syndrome.. J Psychosom Res 56 2: 203-6. doi:10.1016/S0022-39990300077-1. PMID 15016579. ^ McCully KK, Sisto SA, Natelson BH 1996. Use of exercise for treatment of chronic fatigue syndrome.. Sports Med 21 1: 35-48. doi:10.2165/00007256-199621010-00004. PMID 8771284. ^ Solomon L, Nisenbaum R, Reyes M, Papanicolaou DA, Reeves WC 2003. Functional status of persons with chronic fatigue syndrome in the Wichita, Kansas, population.. Health Qual Life Outcomes 1 1: 48. doi:10.1186/1477-7525-1-48. PMID 14577835. Full text at PMC: 239865 ^ Press Conference: The Chronic Fatigue and Immune Dysfunction Syndrome Association of America and The Centers For Disease Control and Prevention Press Conference at The National Press Club to Launch a Chronic Fatigue Syndrome Awareness Campaign - November 3, 2006 ^ The Centers For Disease Control and Prevention website: Chronic Fatigue Syndrome For Healthcare Professionals Symptoms Clinical Course ^ Ho-Yen DO, McNamara I 1991. General practitioners' experience of the chronic fatigue syndrome. Br J Gen Pract 41 349: 324-6. PMID 1777276. ^ Vanness JM, Snell CR, Strayer DR, Dempsey L 4th, Stevens SR 2003. Subclassifying chronic fatigue syndrome through exercise testing.. Med Sci Sports Exerc 35 6: 908-13. doi:10.1249/01.MSS.0000069510.58763.E8. PMID 12783037. ^ Ross SD, Estok RP, Frame D, Stone LR, Ludensky V, Levine CB 2004. Disability and chronic fatigue syndrome: a focus on function.. Arch Intern Med 164 10: 1098-107. doi:10.1001/archinte.164.10.1098. PMID 15159267. ^ a b CFS Toolkit for Health Care Professionals: Basic CFS Overview PDF file, 31 KB. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved on 2008-03-19. ^ Dietert, RR; Dietert JM 2008 Feb 8. Possible role for early-life immune insult including developmental immunotoxicity in chronic fatigue syndrome CFS or myalgic encephalomyelitis ME. Toxicology. PMID 18336982. ^ Appel S, Chapman J, Shoenfeld Y 2007. Infection and vaccination in chronic fatigue syndrome: myth or reality?. Autoimmunity 40 1: 48-53. doi:10.1080/08916930701197273. PMID 17364497. ^ Cho HJ, Skowera A, Cleare A, Wessely S 2006. Chronic fatigue syndrome: an update focusing on phenomenology and pathophysiology. Curr Opin Psychiatry 19 1: 67-73. doi:10.1097/01.yco.0000194370.40062.b0. PMID 16612182. ^ Smith AK, Dimulescu I, Falkenberg VR, et al 2008. Genetic evaluation of the serotonergic system in chronic fatigue syndrome. Psychoneuroendocrinology 33 2: 188-97. doi:10.1016/j.psyneuen.2007.11.001. PMID 18079067. ^ Chaudhuri A, Behan PO 2004. Fatigue in neurological disorders. Lancet 363 9413: 978-88. doi:10.1016/S0140-67360415794-2. PMID 15043967. ^ a b Covelli V, Passeri ME, Leogrande D, Jirillo E, Amati L 2005. Drug targets in stress-related disorders. Curr. Med. Chem. 12 15: 1801-9. doi:10.2174/0929867054367202. PMID 16029148. ^ Vercoulen JH, Swanink CM, Galama JM, et al 1998. The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: development of a model. J Psychosom Res 45 6: 507-17. doi:10.1016/S0022-39999800023-3. PMID 9859853. ^ Sanders P, Korf J 2007. Neuroaetiology of chronic fatigue syndrome: An overview. World J Biol Psychiatry: 1-7. doi:10.1080/15622970701310971. PMID 17853290. ^ a b c d Byron M. Hyde 1992. The Clinical and scientific basis of myalgic encephalomyelitis/chronic fatigue syndrome. Ogdensburg, N.Y: Nightingale Research Foundation. ISBN 0-9695662-0-4. ^ a b Ramsay MA 1986, Postviral Fatigue Syndrome. The saga of Royal Free disease, Londen, ISBN 0-906923-96-4 ^ a b Holmes G, Kaplan J, Gantz N, Komaroff A, Schonberger L, Straus S, Jones J, Dubois R, Cunningham-Rundles C, Pahwa S 1988. Chronic fatigue syndrome: a working case definition,. Ann Intern Med 108 3: 387-9. PMID 2829679. Details ^ National Institute for Health and Clinical Excellence. Guideline 53: Chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy. London, 2007. ISBN 1846294533. NICE CG53 page. ^ Jason LA, Corradi K, Torres-Harding S, Taylor RR, King C 2005. Chronic fatigue syndrome: the need for subtypes.. Neuropsychol Rev 15 1: 29-58. doi:10.1007/s11065-005-3588-2. PMID 15929497. ^ Reeves WC, Lloyd A, Vernon SD, Klimas N, Jason LA, Bleijenberg G, Evengard B, White PD, Nisenbaum R, Unger ER 2003. Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution.. BMC Health Serv Res 3 1: 25. doi:10.1186/1472-6963-3-25. PMID 14702202. ^ Maoz D, Shoenfeld Y 2006. Chronic fatigue syndrome. Harefuah 145 4: 272-5, 319, 318. PMID 16642629. ^ a b White PD, Sharpe MC, Chalder T, DeCesare JC, Walwyn R 2007. Protocol for the PACE trial: a randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise, as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy. BMC Neurol 7: 6. doi:10.1186/1471-2377-7-6. PMID 17397525. ^ Chambers D, Bagnall AM, Hempel S, Forbes C 2006. Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. Journal of the Royal Society of Medicine 99 10: 506-20. doi:10.1258/jrsm.99.10.506. PMID 17021301. ^ Van Houdenhove B, Verheyen L, Pardaens K, Luyten P, Van Wambeke P 2007. Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: should we treat low effort capacity or reduced effort tolerance?. Clin Rehabil 21 12: 1121-42. doi:10.1177/0269215507080769. PMID 18042608. ^ van Weering M, Vollenbroek-Hutten MM, Kotte EM, Hermens HJ 2007. Daily physical activities of patients with chronic pain or fatigue versus asymptomatic controls. A systematic review. Clin Rehabil 21 11: 1007-23. doi:10.1177/0269215507078331. PMID 17984153. ^ Maquet D, Demoulin C, Croisier JL, Crielaard JM 2007. Benefits of physical training in fibromyalgia and related syndromes. Ann Readapt Med Phys 50 6: 363-8, 356-62. doi:10.1016/j.annrmp.2007.03.021. PMID 17467103. ^ Scheeres K, Wensing M, Mes C, Bleijenberg G 2007. The impact of informational interventions about cognitive behavioral therapy for chronic fatigue syndrome on GPs referral behavior. Patient Educ Couns 68 1: 29-32. doi:10.1016/j.pec.2007.04.002. PMID 17521842. ^ Jason L May 2008. The Energy Envelope Theory and myalgic encephalomyelitis/chronic fatigue syndrome. AAOHN J 56 5: 189-95. PMID 18578185. ^ Nijs J, Paul L, Wallman K 2008. Chronic fatigue syndrome: An approach combining self-management with graded exercise to avoid exacerbations. J Rehabil Med 40 4: 241-7. doi:10.2340/16501977-0185 inactive 2008-06-25. PMID 18382818. ^ Bentler SE, Hartz AJ, Kuhn EM 2005. Prospective observational study of treatments for unexplained chronic fatigue. J Clin Psychiatry 66 5: 625-32. PMID 15889950. ^ Nijs J, Meeus M, De Meirleir K 2006. Chronic musculoskeletal pain in chronic fatigue syndrome: recent developments and therapeutic implications. Man Ther 11 3: 187-91. doi:10.1016/j.math.2006.03.008. PMID 16781183. ^ Rimes KA, Chalder T. 2005. Treatments for chronic fatigue syndrome.. Occupational Medicine 55 1: 32-39. doi:10.1093/occmed/kqi015. PMID 15699088. ^ Cho HJ, Hotopf M, Wessely S 2005. The placebo response in the treatment of chronic fatigue syndrome: a systematic review and meta-analysis.. Psychosom Med 67 2: 301-13. doi:10.1097/01.psy.0000156969.76986.e0. PMID 15784798. ^ Jason LA, Taylor RR, Kennedy CL 2000. Chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities in a community-based sample of persons with chronic fatigue syndrome-like symptoms. Psychosom Med 62 5: 655-63. PMID 11020095. ^ Clauw DJ 2001. Potential mechanisms in chemical intolerance and related conditions. Ann. N. Y. Acad. Sci. 933: 235-53. PMID 12000024. ^ Gruber AJ, Hudson JI, Pope HG 1996. The management of treatment-resistant depression in disorders on the interface of psychiatry and medicine. Fibromyalgia, chronic fatigue syndrome, migraine, irritable bowel syndrome, atypical facial pain, and premenstrual dysphoric disorder. Psychiatr. Clin. North Am. 19 2: 351-69. doi:10.1016/S0193-953X0570292-6. PMID 8827194. ^ National Center for Infectious Diseases 2005-05-11. Treatment of Patients with Chronic Fatigue Syndrome htm. Centers for Disease Control and Prevention. Retrieved on 2008-04-07. ^ a b Cairns R, Hotopf M 2005. A systematic review describing the prognosis of chronic fatigue syndrome. Occupational medicine Oxford, England 55 1: 20-31. doi:10.1093/occmed/kqi013. PMID 15699087. ^ Jason LA, Corradi K, Gress S, Williams S, Torres-Harding S 2006. Causes of death among patients with chronic fatigue syndrome. Health care for women international 27 7: 615-26. doi:10.1080/07399330600803766. PMID 16844674. ^ Smith WR, Noonan C, Buchwald D 2006. Mortality in a cohort of chronically fatigued patients. Psychological medicine 36 9: 1301-6. doi:10.1017/S0033291706007975. PMID 16893495. ^ Sophia's story ^ Fatigue syndrome ruling welcomed in English 2006-06-23. Retrieved on 2007-09-03. ^ Inquest Implications: Marshall E, Williams, M, June 2006 ^ Walsh CM, Zainal NZ, Middleton SJ, Paykel ES 2001. A family history study of chronic fatigue syndrome.. Psychiatr Genet 11 3: 123-8. doi:10.1097/00041444-200109000-00003. PMID 11702053. ^ Chronic Fatigue Syndrome Demographics htm. Centers for Disease Control and Prevention May 11, 2005. Retrieved on 2008-02-07. ^ Craig, T and Kakumanu S Mar 2002. Chronic fatigue syndrome: evaluation and treatment. Am Fam Physician. 65 6: 1083-90. PMID 11925084. ^ van de Glind G, de Vries M, Rodenburg R, Hol F, Smeitink J, Morava E 2007. Resting muscle pain as the first clinical symptom in children carrying the MTTK A8344G mutation.. Eur J Paediatr Neurol. PMID 17293137. ^ Vojdani A, Thrasher J 2004. Cellular and humoral immune abnormalities in Gulf War veterans.. Environ Health Perspect 112 8: 840-6. doi:10.1289/ehp.6881. PMID 15175170. ^ Bruno RL, Creange SJ, Frick NM 1998. Parallels between post-polio fatigue and chronic fatigue syndrome: a common pathophysiology?. Am J Med. 105 3A: 66S-73S. doi:10.1016/S0002-93439800161-2. PMID 9790485. ^ Gaudino EA, Coyle PK, Krupp LB 1997. Post-Lyme syndrome and chronic fatigue syndrome. Neuropsychiatric similarities and differences.. Arch Neurol 54 11: 1372-6. PMID 9362985. ^ van Staden WC 2006. Conceptual issues in undifferentiated somatoform disorder and chronic fatigue syndrome.. Curr Opin Psychiatry 19 6: 613-8. PMID 17012941. ^ Jenkins R, Mowbray J, ed. Post-viral Fatigue Syndrome. 1991 John Wiley Sons Ltd ^ Bradley LA, McKendree-Smith NL, Alarcon GS 2000. Pain complaints in patients with fibromyalgia versus chronic fatigue syndrome.. Curr Rev Pain 4 2: 148-57. PMID 10998728. ^ Friedberg F, Jason LA 2001. Chronic fatigue syndrome and fibromyalgia: clinical assessment and treatment.. J Clin Psychol. 57 4: 433-55. doi:10.1002/jclp.1040. PMID 11255201. ^ Pall ML, Satterlee JD 2001. Elevated nitric oxide/peroxynitrite mechanism for the common etiology of multiple chemical sensitivity, chronic fatigue syndrome, and posttraumatic stress disorder.. Ann N Y Acad Sci 933: 323-9. PMID 12000033. ^ Aaron LA, Herrell R, Ashton S, Belcourt M, Schmaling K, Goldberg J, Buchwald D 2001. Comorbid clinical conditions in chronic fatigue: a co-twin control study.. J Gen Intern Med 16 1: 24-31. doi:10.1111/j.1525-1497.2001.03419.x. PMID 11251747. ^ Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P 2002. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis.. Hum Reprod 17 10: 2715-24. doi:10.1093/humrep/17.10.2715. PMID 12351553. ^ Rogers, Richard 1997. Clinical Assessment of Malingering and Deception, Second ion. New York, London: Guilford Press, pg 40 of 525. ISBN 1572301732. ^ Malleson, Andrew 2005. Whiplash and Other Useful Illnesses. Quebec: McGill-Queen's Press, pg 59 of 544. ISBN 0773529942. ^ Van Houdenhove B, Neerinckx E, Onghena P, Vingerhoets A, Lysens R, Vertommen H 2002. Daily hassles reported by chronic fatigue syndrome and fibromyalgia patients in tertiary care: a controlled quantitative and qualitative study.. Psychother Psychosom 71 4: 207-13. doi:10.1159/000063646. PMID 12097786. ^ Action for M.E. in the UK, Severely Neglected: Membership Survey London: Action for M.E.; 2001 ^ a b Prins JB, Bos E, Huibers MJ, Servaes P, van der Werf SP, van der Meer JW, Bleijenberg G 2004. Social support and the persistence of complaints in chronic fatigue syndrome.. Psychother Psychosom 73 3: 174-82. doi:10.1159/000076455. PMID 15031590. ^ Colby J 2007. Special problems of children with myalgic encephalomyelitis/chronic fatigue syndrome and the enteroviral link.. J Clin Pathol 60 2: 125-8. doi:10.1136/jcp.2006.042606. PMID 16935964. 16935964. ^ Looper KJ, Kirmayer LJ 2004. Perceived stigma in functional somatic syndromes and comparable medical conditions.. J Psychosom Res 57 4: 373-8. PMID 15518673. ^ Clarke JN 1999. Chronic fatigue syndrome: gender differences in the search for legitimacy.. Aust N Z J Ment Health Nurs 8 4: 123-33. doi:10.1046/j.1440-0979.1999.00145.x. PMID 10855087. ^ Jason L, Corradi K, Gress S, Williams S, Torres-Harding S 2006. Causes of death among patients with chronic fatigue syndrome.. Health Care Women Int 27 7: 615-26. doi:10.1080/07399330600803766. PMID 16844674. ^ Green J, Romei J, Natelson BH 1999 Stigma and Chronic Fatigue Syndrome Journal of Chronic Fatigue Syndrome, Vol. 5, No. 2, 1999 ^ Sydenham T, The Works of Thomas Sydenham, M.D., translated from the Latin ion of Greenhill WA by Latham RG, Vol. 1, Londen, Sydenham Society, 1847 ^ Roberto Patarca-Montero 2004. Medical Etiology, Assessment, and Treatment of Chronic Fatigue and Malaise. Haworth Press, 6-7. ISBN 078902196X. ^ 1 AN OUTBREAK of encephalomyelitis in the Royal Free Hospital Group, London, in 1955 1957. Br Med J 2 5050: 895-904. PMID 13472002. ^ International Classification of Diseases, I, World Health Organization, 1969, pp. 158, vol 2, pp. 173 ^ Sharpe, Michael; Frankie Campling 2000. Chronic Fatigue Syndrome CFS/ME: TheFacts. Oxford: Oxford Press, 14,15. ISBN 0-19-263049-0. Retrieved on 2008-04-02. ^ Packard RM, Berkelman RL, Brown PJ, Frumkin H 2004. Emerging Illnesses and Society. JHU Press, 156. ISBN 0801879426. Retrieved on 2008-04-02. ^ Evangard B, Schacterie R.S., Komaroff A. L. 1999. Chronic fatigue syndrome: new insights and old ignorance. Journal of Internal Medicine Nov;246 5: 455-469. doi:10.1046/j.1365-2796.1999.00513.x. PMID 10583715. Retrieved on 2008-04-02. ^ Wallace, PG. 1991 Oct.. Post-viral fatigue syndrome. Epidemiology: a critical review. Br Med Bull. 47 4: 942-951. PMID 1794092. ^ a b Mounstephen, A,; Sharpe M. 1997 May. Chronic fatigue syndrome and occupational health. Occup Med Lond. May;474:. 47 4: 217-227. doi:10.1093/occmed/47.4.217. PMID 1794092. ^ Hooge J 1992. Chronic fatigue syndrome: cause, controversy and care. Br J Nurs 1 9: 440-1, 443, 445-6. PMID 1446147. ^ Sharpe M 1996. Chronic fatigue syndrome. Psychiatr. Clin. North Am. 19 3: 549-73. doi:10.1016/S0193-953X0570305-1. PMID 8856816. ^ Denz-Penhey H, Murdoch JC 1993. General practitioners acceptance of the validity of chronic fatigue syndrome as a diagnosis. N. Z. Med. J. 106 953: 122-4. PMID 8474729. ^ Greenlee JE, Rose JW 2000. Controversies in neurological infectious diseases. Semin Neurol 20 3: 375-86. doi:10.1055/s-2000-9429. PMID 11051301. ^ a b Horton-Salway M 2007. The ME Bandwagon and other labels: constructing the genuine case in talk about a controversial illness. Br J Soc Psychol 46 Pt 4: 895-914. doi:10.1348/014466607X173456. PMID 17535450. ^ Zavestoski S, Brown P, McCormick S, Mayer B, D'Ottavi M, Lucove JC 2004. Patient activism and the struggle for diagnosis: Gulf War illnesses and other medically unexplained physical symptoms in the US. Soc Sci Med 58 1: 161-75. doi:10.1016/S0277-95360300157-6. PMID 14572929. ^ Engel CC, Adkins JA, Cowan DN 2002. Caring for medically unexplained physical symptoms after toxic environmental exposures: effects of contested causation. Environ. Health Perspect. 110 Suppl 4: 641-7. PMID 12194900. ^ Dumit, J. 2005 Aug 8. Illnesses you have to fight to get: facts as forces in uncertain, emergent illnesses.. Soc Sci Med. Feb;62 3: 577-90. PMID 16085344. ^ Dove, A. 2000 Aug.. GAO reports on CFS funding controversy. Nat Med. 6 8: 846. doi:10.1038/78579. PMID 10932206. Retrieved on 2008-04-02. v d e Articles about ME/CFS Main Article Chronic Fatigue Syndrome Descriptions Nomenclatures · Definitions, Guidelines, and Summaries Proposed Causes and Pathophysiology Hypothesized Causes · Pathophysiology Treatments Treatments · Therapies Other History · Controversies · Outbreaks · Cultural References · Notable patients External links Chronic fatigue syndrome at the Open Directory Project Retrieved from http://en..org/wiki/Chronic_fatigue_syndrome Categories: Immune system disorders | Neurological disorders | Ailments of unknown etiology | Syndromes | Chronic illnessHidden categories: Pages with DOIs broken since 2008 | All articles with statements | Articles with statements since January 2008 | Articles with specifically-marked weasel-worded phrases Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Català Česky Deutsch Español Français Italiano עברית Lëtzebuergesch Lietuvių Magyar Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Português РуÑ?Ñ?кий SlovenÄ?ina СрпÑ?ки / Srpski Suomi Svenska Tiếng Việt This page was last modified on 20 August 2008, at 07:13
39 Reasons to Drink Acai Juice Every Day
What is MonaVie - Watch the 8-minute video
Discovering MonaVie Video
The Power of You Video
Effects of MonaVie Active on Antioxidant Capacity in Humans
Log into your Wholesale MonaVie Account
So many of us do not eat a balanced diet, get enough sleep, have too much stress, or are impacted with toxins and pollutants. Drinking 2 ounces of MonaVie twice a day will help your body detoxify as well as build your immune system. Its the smartest thing you can do for yourself, so start today. Buying MonaVie through our company guarantees you support 7 days a week and, if you would like to share MonaVie with your family and friends we will guide you from start to finish.
1. Click on Enroll Now (30 - 55% off retail price)
2. Pay $39 for your Wholesale ID number.
3. NO minimum order required.
4. MonaVie is delivered to your door in 3 to 5 days.