Chronic Fatigue Syndrome – Fibromyalgia Syndrome

“I feel exhausted all the time !”

I feel exhausted

Tiredness is common to all of us at times – but exhaustion every day for months and years is debilitating and often these sufferers have few outward signs and indeed few if any abnormal routine blood tests. So you can imagine how quickly the Prozac prescription gets handed out!
CFS or Chronic Fatigue Syndrome has fatigue as the key problem but many CFS sufferers have multiple symptoms involving many organ systems. Hence the difficulty they face when trying to get recognition and help. Also called ME (Myalgic encephalomyelitis) because of the brain, nervous system and muscle involvement in some cases.
Fatigue is a very common complaint with multiple causes. Here we will confine the page to the spectrum of CFS   and FMS. Throughout the world there are various classification systems with criteria. 

Criteria vary 

CDC Criteria

  • chronic fatigue (CF) for 6 months or more excluding other diseases
  • plus 4 of more of the following that have been present for previous 6 months:
    1. impaired memory or concentration
    2. sore throat
    3. tender lymph nodes
    4. muscle tenderness (myalgia)
    5. joint pain without swelling
    6. headaches of a new type or pattern
    7. unrefreshing sleep – loss of deep ‘slow wave’ sleep stages 3 and 4
    8. fatigue after exertion lasting 24 hours or more

Homes and Canadian Criteria

  1. mild fever or chills
  2. neuropsychiatric symptoms – light sensitive, visual disturbances, irritability, confusion, mind fog, depression,     sleep disturbances, confusion, disorientation.
  3. muscle fasciculations (twitching)
  4. pharyngitis
  5. enlarged lymph nodes
  6. Low blood pressure standing, delayed postural hypotension
  7. postural tachycardia, palpitations, shortness of breath
  8. lightheaded
  9. pale, nausea, irritable bowel, bladder frequency

About CFS and FMS

Symptoms according to systems:

Central Nervous System (CNS)

  • fatigue, irritability, depression, apathy, listlessness, impaired memory and concentration, ‘brain fog’, anxiety,  insomnia, waking from pain.

Musculoskeletal system:

  • Pain and morning stiffness in muscles-tendons-ligaments in areas: neck and shoulders, upper and lower back,     hips, inner and outer elbows, inner knees, wrists and chest. Can get actual joint pains sometimes- various arthritis types can coexist.

Intestinal   System:

  • Irritable bowel syndrome (spastic colon etc), nausea waves, spasms, pain, bloating, gas, erratic bowel function.

Genitourinary System:

  • frequency, bladder spasms, burning, interstitial cystitis, vaginal pain syndrome, intercourse pain, PMS. Fibromyalgia is usually worse PM.


  • Various rashes, hives, blisters. Sensations like burning, cold/hot, tingling, electric vibrations, prickling, crawling and flushing.


  • headaches, dizziness, vertigo, spinning sensation, numbness, tingling, weight gain, fluid retention, sensitivity to light or noise even tastes and smells, restless legs

CFS can have other names where there are overlapping symptoms: FMS, ME (myalgic encephalomyelitis), neurasthenia,  multiple chemical sensitivities (MCS), chronic glandular fever (EBV), post-viral syndrome.
Other conditions with tiredness as a feature:
These need to be excluded for example:

  • hypothyroidism
  • adrenal insufficiency
  • sleep apnoea (several types and causes) and narcolepsy
  • poor sleep habits
  • depression, bipolar disorder
  • cancer
  • autoimmune disorders
  • infection
  • toxic exposure
  • substance abuse
  • medication side-effects
  • and many other conditions can cause tiredness

pmsNo one cause has been found. Currently there are multiple theories and its likely that many factors produce CF such as altered immune status, toxin exposure and reduced detoxification process, exposure to certain infections, exposure to vaccinations, genetic predisposition, stress exposure, endocrine (hormone) malfunction, oxygen to cell disruption, age and sex, dietary health and micronutritional state (vitamins, minerals, trace elements and essential fatty acids).

Looking at it globally, it appears that there is central disruption to mitochondrial cell energy functioning ie the production of the body’s energy currency – ATP –  triggered by toxin or stress to the system.

Here is one European Lab take on CFS – Read more>> it will take you away from this page though.
There are dozens of books and theories and  treatments.
I will delve more into the causes and theories – see the links area to the right.

Medical History and Examination
dr examMost important is the Medical History ! For it almost certain that the key clues are here.

I strongly urge patients to write a logical timeline either by years or by age – showing the significant events, tests done and treatments plus results. 

Lab Testing
Various levels of investigations are possible – availability and cost determines how thorough it can   be done. Logic and common sense indicates one should start with basic local lab testing for common causes and then proceed to the more obscure.
Here is the flow, the details are on separate pages for patient access. Refer to Downloads Page.

  1. Medical History General Health Questionnaire
  2. CFS Criteria Questionnaire
  3. Physical Examination
  4. Investigations: Workup – Level 1 – 2 – 3

Complicated often, simple solution sometimes – need investigations and patience – both of which most patients have little patience left! Important to go step by step and try to avoid doing everything at once.
Investigate, exclude, investigate – positive finding – treat and observe. Repeat.

Treatments can be specific to a suspected, hopefully confirmed single cause like infection for example Glandular Fever or non-specific to cover the consequences manifesting as symptoms – for example correcting sleep, using anti-inflammatory meds or supplements or stabilising hormones. 

Here is a basic flow plan by no means complete as new treatments and ideas occur constantly. And depending on likely cause or triggers for the CFS or FMS

  1. GUT most important – the centre of the human universe!! Strict correction of diet and optimisation of intestinal tract – eliminate toxins, microbial infection, correct dysbiosis, remove food allergens or intolerance’s. Refer to GIT-Liver Detox
  2. Treat any identified or suspected infection – maybe long term, with probiotic cover.
  3. Correct any endocrine imbalance especially thyroid and adrenal.
  4. Refer to the thyroid goitreresistance theory and adrenal stress syndrome.
  5. Correct sleep disorders
  6. Manage STRESS !
  7. Identify possible hypoglycaemia – common in CFS – symptoms of  hypoglycaemia >>>
  8. Detox or chelate out heavy metals.
  9. Identify and correct oral-dental amalgam issues, root infections.
  10. Consider series of intravenous ascorbic acid infusionsinfusion
  11. Target intra-cellular mitochondria with specific energy enhancing agents. – NT Lipid Factor.
  12. Medical ozone and/or UVBI – see page.
  13. General nutrient support, herbal tonics
  14. Massage, Far infrared saunas to detox.
  15. Careful exercise programs.
  16. CBT may be appropriate for some (cognitive behavioural therapy)
  17. Antidepressants – I am not an advocate for drug treatment. If major depression is not responding to natural neurotransmitter enhancing agents then AD’s may have a place. For example amitryptiline may help some sufferers with pain and sleep disturbance. Low dose Dothiepin and ** can be very useful for serious insomnia – with minimal side-effects and non-addicting.

More Reading

Full Page CFS Flow Planyou will need to rotate to view