Sleep disorders, an increasingly common “epochal illness,” are a permanent topic of consultation. However, sometimes, we may be in the presence of a more complex disorder:
chronic fatigue syndrome
(CFS), which is more related to disorders such as fibromyalgia than to sleep disorders.
A new study provides statistical information to take into account: according to its authors, the number of patients is expected to
double
due to the long-term effects of the COVID-19 pandemic.
What is chronic fatigue syndrome
“Chronic fatigue syndrome, also known as myalgic encephalomyelitis (ME), is a
complex multisystem disease
, commonly characterized by significant physical and/or mental fatigue, which usually affects the ability of patients to perform activities of the body. daily life,”
Jessica Borenstein, a psychiatrist and master in psychoneuroimmunoendocrinology, tells
Clarín .
So much so that, according to the recent study published in the Journal of Clinical Medicine
,
around 25% of patients with ME/CFS are bedridden and
60% of patients
cannot work at night. full time.
Borenstein, who is also a member of the Argentine Association for the Study of Pain, states that chronic fatigue belongs to the group of pathologies called Central Sensory Syndromes (CSS), which also includes fibromyalgia, “with which it
usually coexists
” .
This means that the main problem is in the
nervous system.
“For this reason, we explain to patients that they have a hypersensitive nervous system,” he explains.
Like the other SSCs, this is a condition that generally occurs in young people, especially
women
, adds Borenstein.
Symptoms of chronic fatigue
The professional specifies that the most characteristic symptom is what is called
post-exertional malaise
(PEM) or the exacerbation of post-exertional symptoms.
“Post-exertional discomfort is a worsening of symptoms or the appearance of these after
physical or mental effort
or sensory overload; and it can manifest after a characteristic delay of 24 hours,” he adds.
It also indicates that another characteristic symptom is that intense fatigue
does not usually improve
after rest, which generates a lot of frustration in patients.
“Sleep disorders, cognitive dysfunction with alterations in attention, concentration and memory, are also common symptoms. We know that there are
neuroinflammation processes
,” says the specialist.
Additionally, there may be muscle and joint
pain
(although this is not central, as occurs in fibromyalgia), headache, muscle weakness, changes in body temperature, sore throat and swollen glands. Patients report feeling like they have the “flu.”
“To these symptoms other symptoms of the autonomic nervous system can be added: dizziness, postural hypotension, various
digestive symptoms
. And of course also anxiety and depression,” he adds.
Diagnosis and treatment
Both the diagnosis and treatment of this syndrome represent
challenges
for doctors and patients.
In the first case, speaking of the diagnosis, because there are no specific biomarkers. And in the second, because the treatment is individualized, and
pharmacological and non-pharmacological tools must be
combined .
“We always have to study the patients, to rule out what are called
differential diagnoses
, that is, other diseases that could present similar symptoms,” he adds.
For this reason, we work as a team, referring to
other specialists
; rheumatologists, neurologists, gastroenterologists, endocrinologists.
At this point, the study published in the Journal of Clinical Medicine - in which Borenstein did not participate - becomes relevant since it aims to sharpen the gaze a little in patients who
do not have altered
immune functions.
According to its authors, although patients suffering from immunodeficiencies are characterized by altered innate immune function, in ME/CFS patients with an intact immune system,
intestinal barrier
function is reduced.
The researchers maintain that these findings not only provide more detailed insight into the different mechanisms of the disease, but suggest that, depending on the patient's immunological competence, some
treatment approaches
may be more suitable than others.
“Although there is no single, specific treatment, there is much to do and improve. Having an optimistic outlook is essential. Diagnoses today are not a sentence. I avoid talking about chronicity and what we are looking for is the stabilization of the clinical picture, for the person
to return
to the healthy part of themselves,” encourages Borenstein.
Specifically, the therapeutic objectives aim to
reduce symptoms
, maintain functional capacity, and quality of life through a program adapted to each patient.
In those with depression and/or anxiety, antidepressants or anticonvulsants are usually used to reduce pain, stimulants for fatigue or various types of drugs to improve sleep.
“
We now know that
non-pharmacological tools
are more important than the previous ones and include psychotherapy, which can be cognitive behavioral, or mind-body therapies. Somatic therapy that works from corporality is also very useful,” he maintains.
The
anti-inflammatory diet
, gradual and progressive exercise and nutritional supplementation are also "very important," the professional stressed.
“Everything that includes the MEV (Lifestyle Medicine) is going to be essential to
work with habits
, be able to sustain them and channel clinical improvement,” he closes.
More cases
The psychiatrist admits that in recent years cases have increased. “We see it at a clinical level and it is also described
at a statistical level
,” she confirms.
According to him, this may be related to greater specialization of health professionals, which translates into an increase in the number of
diagnosed cases
, as well as the existence of increasingly more informed patients.
“I think that on the one hand, we professionals are more trained in being able to diagnose and there is more visibility of these conditions worldwide. In 2022, an
important milestone
was achieved
with the update of the International Coding of Diseases (ICD-10-CM) that includes a specific diagnosis code for myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS), ”he analyzes.
“On the other hand,” he adds, “patients no longer have a passive role with respect to what happens to them. I consider this progress. And many times they come to the consultation with their
presumptive diagnosis
because they were looking for information."
The role of COVID
The aforementioned study, which aims to elucidate the relationship between immunological characteristics and the function of the intestinal barrier in patients with ME/CFS, shows an alarming figure: the number of patients is expected to
increase drastically
due to the long-term effects of the COVID-19 pandemic.
Led by Eva Untersmayr-Elsenhuber and her team from the Center for Pathophysiology, Infectiology and Immunology at MedUni Vienna; It is based on previous research on immune disorders and intestinal barrier function in patients with this syndrome.
"Since the pandemic, there has been
increased interest
in investigating chronic fatigue syndrome due to its significant overlap with post-COVID syndrome, and several studies estimate that half of patients with post-COVID syndrome meet criteria for chronic fatigue." Borenstein reports.
“There are
notable similarities
between the presentation and symptoms of both conditions. “Chronic fatigue could have an infectious trigger, and we know that is also the case with
long COVID
,” he ponders.
In turn, it indicates that the findings of studies on long COVID, its causes and therapies that could work,
can potentially be investigated
and applied to patients who present chronic fatigue syndrome. "Long COVID increased awareness of this condition," he concluded. .
***
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