Singapore Thong Chai Medical Institution

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Chronic fatigue syndrome (CFS), otherwise known as myalgic encephalomyelitis, is a condition characterized by unexplained extreme fatigue that lasts for at least 6 months. The fatigue deteriorates with physical or mental activity, but does not recover with sufficient rest.  Fatigue can be so severe that it affects daily activities and even the simplest task like brushing teeth can get extremely demanding. However, such symptoms cannot be fully explained by an underlying medical condition.

Although the cause of CFS remains largely unknown, some experts believe that it is often triggered by a combination of factors, such as stress, prolonged lack of sleep, hormonal imbalances and weakened immune system. While CFS can affect anyone, it is most commonly seen among women aged 40 to 50. As there is no definitive test for CFS, its diagnosis is usually derived from the exclusion of other possible medical reasons.

Symptoms of CFS vary from person to person, and from time to time. Apart from the extreme fatigue that results in a significant decrease in activity tolerance, other accompanying symptoms can include:

  • Decreased memory and concentration
  • Unexplained muscle or joint pain
  • Insomnia
  • Dizziness or lightheadedness
  • Low-grade fever
  • Enlarged lymph nodes in neck or armpit regions
    • One unique identity of this condition is the vicious cycle of worsening fatigue after even minor physical or mental activity, also known as post-exertional malaise (PEM). With the desire to make up for lost time during the down periods, many patients tend to overexert themselves once they feel better. However, after 12 to 48 hours of overexertion, fatigue starts to kick in and deteriorate, often described as a “crash”, which can last for days or even weeks. Therefore, to break out of this vicious cycle, it is important that one should practice moderation in pacing their activity intensity.

    Unfortunately, there is currently no cure for CFS. As everyone experience different symptoms, the key treatment plan is to manage the symptoms. Of which, one of the main concerns is to address PEM. Examples on how you can manage include:

    1. Make a daily record of activity intensity level (utilize pedometer, heart rate monitor etc.)
    2. Start small and find out your personal limits; daily activity should not result in excessive fatigue
    3. Maintain daily activity level within tolerance level (including physical, emotional, and mental exertion)
    4. Take regular breaks throughout the day
    5. Increase activity intensity slowly without causing symptom flare
    The ultimate goal of pacing is to learn to balance rest and activity. It is important to be mindful of personal limits and listen to the body so as to avoid overexertion. Repeated flares can aggravate the condition and result in more severe and long-lasting relapses. Other self-care tips to help cope with the condition include:
    1. Slow down pace of life
    2. Learn to relax
    3. Establish regular break times throughout the day and create a sleep routine
    4. Engage in light exercise
    5. Make lifestyle modifications to reduce unnecessary energy exertion
    6. Adopt a balanced diet (avoid processed, high sugar and refined carbohydrate)
    Acupuncture has been known to help reduce stress and relieve pain associated with CFS. In the comfort of your own home, you can apply acupoint massage to manage the symptoms. Some acupoints commonly used are:
    1. Bai Hui: At the top of the head
    2. Guan Yuan: 4 fingers-width below the belly button
    3. Zu San Li: 4 fingers-width below the knee, 1 finger-width distance outwards from the shin bone
    4. San Yin Jiao: 4 fingers-width above the inner ankle, behind the tibia bone
    5. Tai Chong: On the top of the foot, between the first two toes
    CFS creates unique challenges for people living with the condition and for those around them. It is especially so when they have no underlying medical conditions and appear healthy and fit on the outside. Misunderstandings that surround this condition might add on to the mental stress of the patients, resulting in further deterioration. Therefore, emotional support and counselling may also help in dealing with the debilitating symptoms of this condition.
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