What is Chronic fatigue syndrome (CFS) and Its Treatment Options

CFS is a syndrome, meaning there is an association between a given symptom or condition and a distinct group of medical and psychiatric conditions. Usually the underlying condition affects a specific system in the body. The condition can involve one or more of the following symptoms:

  • Fatigue
  • Exhaustion
  • Muscle and joint aches
  • Anxiety and depressed mood
  • Dizziness
  • Confusion
  • Difficulty concentrating
  • Irritability
  • Insomnia or hypersomnia
  • Elevated temperature
  • Feeling of being sick or having a flu-like illness

The similarity between the symptoms of CFS and the illness known as the Epstein-Barr virus (EBV) mononucleosis in adults, or glandular fever in children, is remarkable. CFS has been known as the “winged angel syndrome” since the time of Thomas Willis. His patients’ symptoms led him to conclude that the illness was caused by an “infection of the blood”

Overview & Symptoms

Among other symptoms, Epstein-Barr virus has been linked to CFS. But that is not the only virus that can cause CFS:

Many people with CFS have myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS). The term CFS is not well-defined and different people use it to describe different things.

The Centers for Disease Control (CDC) and the National Institutes of Health (NIH) used to diagnose CFS by a clinical diagnosis of symptoms with exclusion criteria. But now the CDC and NIH use the term CFS based on specific diagnostic criteria, which focus on the presence of fatigue, muscle and joint pain, difficulty sleeping and digestive problems.

The National Institute for Health and Care Excellence (NICE), the United Kingdom’s health care regulatory agency, also now uses the CFS based on the DSM-5 diagnostic criteria, a diagnostic system for mental disorders and psychiatric disorders, proposed and developed by the World Health Organization.

Epstein-Barr virus is associated with CFS

According to the CDC, in children, and to a lesser extent, adults, EBV causes a common illness called acute respiratory disease, which can be characterized by a fever and a cough lasting a few days.

When people are infected with EBV, the virus can enter their bloodstream, travel to their nervous system, and infect and damage cells of the nervous system. The virus can also cause a spectrum of other neurological symptoms.

A cold or mild flu may not make you as ill as someone who has CFS. According to Dr. Pia Pilat, writing in the Medical News Today website:

“Most patients with CFS will never experience a full-blown, severe, and debilitating infection. Many patients with CFS are diagnosed because of their frequent, unexplained fatigue and the presence of a mild rash.”

Like most viral infections, there may be no noticeable physical illness or sign of infection (like high fever, body aches, sore throat, vomiting, diarrhea, and neck stiffness). Some people also report a sense of being “blocked” and unable to move.

How does CFS affect daily life?

To effectively treat a patient, it is important to diagnose CFS, so the physician can make treatment and prognosis decisions.

“It is not uncommon to make the mistake of only treating the CFS symptom, without considering the important ongoing and disabling nature of the underlying neurologic effects of the disease,” says Dr. Thomas Hass, professor and Chair of the Department of Neurology at the University of Michigan in Ann Arbor.

Many people with CFS will go years without experiencing a severe bout of illness or falling ill at all. Other CFS patients may need to take some medications long term, but they usually have only mild symptoms.

Dr. Hass says that patients can experience flare-ups, including periods of extremely high symptoms such as muscle and joint pain, extreme fatigue, and cognitive problems.

A flare-up may last several days, weeks, or months, and many CFS patients go through many flare-ups throughout their lifetime.

Other symptoms of CFS include:

  • difficulty concentrating
  • mental fatigue
  • weakness
  • sleep disorders
  • difficulty with cold
  • typing, writing, or reading
  • short attention span
  • insomnia

Many patients may have one of the above symptoms for many years without being diagnosed with CFS. They may seek medical attention only when they have a significant episode of these symptoms, or when they are concerned about their future health.

What do CFS symptoms look like?

The most common signs and symptoms of CFS are fatigue and sleep disturbances, including problems with memory, concentration, and muscle coordination.

Researchers do not fully understand what causes CFS, although most of the cases seem to be due to an auto-immune response. The current theory of CFS is that an infection triggers an autoimmune response that damages the body’s own cells.

In severe cases of CFS, symptoms may include:

  • lack of coordination
  • fatigue
  • muscle weakness
  • restlessness
  • itchy skin
  • cough
  • frequent infections

Risk factors for developing CFS include:

  • being female
  • having a close family member with CFS
  • being diagnosed with an autoimmune disease
  • being over the age of 40
  • living in warmer climates

Younger children and older adults are also more likely to have CFS, although scientists do not yet understand why.

It is thought that because children and older adults develop their health in a slower manner than adults, they have a greater risk of having symptoms of CFS or other health problems, or developing complications.

How can CFS be treated?

There is no known cure for CFS, and many people go for years without experiencing any major symptoms or health issues.

Treatment options for CFS vary depending on the severity of the symptoms. People can try physical therapy, exercises, and nutritional supplements to treat their symptoms.

In severe cases of CFS, which may involve a higher level of disability, medications and physical therapy may be required.

Medical treatments

Antibiotics may be used to treat some symptoms of CFS. Antibiotics may be used to treat some symptoms of CFS.

Some medical treatments for CFS include:

  • physical therapy
  • personal physical exercise programs
  • holistic and non-pharmaceutical treatments
  • antibiotics for infections
  • anti-viral and anti-bacterial medications for viruses
  • anti-depressant medications for depression
  • anti-seizure medications to treat the condition

Therapy and exercise

Many doctors recommend exercise for people with CFS.

According to a 2016 review of the literature on exercise for chronic fatigue syndrome, aerobic exercise is a first-line treatment for the condition.

Low-intensity aerobic exercise has the most evidence to support its effectiveness for CFS. Activities like swimming, walking, and water aerobics may be able to help improve symptoms.

Exercise is also recommended to help with exercise-induced muscle soreness (EIMS) and sleep problems.

Some studies indicate that aerobic exercise may actually improve quality of life for people with CFS, and may help people feel less depressed.

Some types of aerobic exercise, such as aerobic dancing, may be helpful for those with higher muscle tension.

Scientific research indicates that an exercise program based on body weight exercises can be effective.

Other types of exercise, such as biking or dancing, can also help people with CFS who have sleep problems, such as insomnia.

Physical therapy

In addition to physical therapy, many people with CFS also have muscle tension, fatigue, and a range of other symptoms. Physical therapists can help people with these issues.

People should see their physical therapists regularly, in addition to their exercise and eating plans.

Research has found that one form of physical therapy, called intensive functional muscle training, may be more effective than the usual range of exercises for people with CFS.

This type of therapy is designed to provide targeted exercises that target specific muscle groups that may be overworked due to overuse or when the muscles are stressed by an illness.

Other therapies

Other types of therapies that may help people with CFS include:

  • art therapy
  • hypertrophy exercise (exercises designed to improve muscle strength)
  • acupuncture
  • environmental therapy, such as massage therapy
  • entertainment therapy
  • strain tolerance exercises
  • reiki, a type of therapy based on the concept of meridian energy healing

Eating a healthful diet

Good nutrition is important to help the body support physical activity. A healthy diet can also help people who are experiencing a variety of symptoms from CFS or other health problems.

Doctors often recommend an anti-inflammatory diet for people with CFS, as inflammation may be one of the main causes of the condition.

A 2015 review of 31 studies about food and nutrition for people with CFS found that certain foods could help improve symptoms, including:

Fruits and vegetables

  • green leafy vegetables, such as broccoli
  • nuts
  • legumes
  • almonds
  • lentils
  • chickpeas
  • spinach

If the cause of CFS is a virus, food such as fermented foods and probiotics may help the body fight off illness.

People should try to eat a varied diet, and aim to include foods that are high in protein, fiber, and vitamins, as well as healthy fats, such as olive oil and fish.

Making food at home

Making food at home can help people with CFS by being less expensive and a lot healthier.

According to a 2016 review, cooking at home may reduce people’s need to go out to eat, but it may also increase people’s food waste.

Someone with CFS may want to consider following recipes for cooking, which can help them feel less dependent on store-bought food.

How to cook at home

Home-cooked food can be delicious and satisfying, and it can help people who are experiencing any of the following symptoms, including:

  • headaches
  • fatigue
  • sleeplessness
  • weight gain
  • cough
  • trouble concentrating
  • ausea

Staying hydrated

Some studies indicate that people with CFS may not get enough liquids, and that they may have a higher risk of dehydration than people without the illness.

couple water

A 2015 review found that people with CFS should drink at least 1.5 liters (about 2.2 cups) of water a day.

Although people with CFS should drink plenty of water, people can also help ensure they are getting enough by drinking sweetened beverages such as tea or coffee less frequently.

Getting enough sleep

People with CFS may need to sleep more than usual. Some research indicates that people with CFS may need to sleep for an extra 4.5 hours per night.

sleep apnea

This extra time might help someone with CFS relax and feel less tired. The additional hours can also help a person lose weight and gain more energy, which can help them exercise more and feel less fatigued.

Getting counseling or support

As a person with CFS is likely to be ill for a long time, it is helpful to have support in place to help them cope with the symptoms and the changes they are experiencing.

People who are experiencing significant distress or who are having difficulties with aspects of the illness should speak to a doctor, friend, or family member, who can help them with the management of symptoms.

Home remedies

A person with CFS may find home remedies helpful in managing symptoms. A person with CFS may find home remedies helpful in managing symptoms.

Some people with CFS find that home remedies can help them manage symptoms and the resulting fatigue.

For example, a person might choose to take glucosamine supplements to help their joints and reduce inflammation.

Some people find that listening to music can help with the symptoms.

Alternative therapies, such as acupuncture and massage, are also available for people with CFS.


CFS may involve many symptoms and treatments, including:

  • eating a balanced diet
  • reducing stress
  • relaxing
  • being active
  • Drinking plenty of water
  • washing hands
  • getting adequate sleep

Having a balanced diet can help people with CFS reduce symptoms, but it is not a cure.

It is essential that people with CFS consult with a doctor to discuss the best ways to manage their symptoms and achieve an improved quality of life.