reach a diagnosis of chronic fatigue syndrome.
Because the length of time the person experiences
symptoms is a crucial element of the diagnosis, the
diagnostic journey is often frustrating.
Treatment Options and OutlookBecause doctors do not know what causes chronic
fatigue syndrome, treatment targets symptoms
and is generally a combination of approaches tai-
lored to the individual’s responses and improve-
ments. Treatment options include
- low-DOSE ANTIDEPRESSANT MEDICATIONS, which
may relieve pain as well as improve the quality
of sleep - ANTIANXIETY MEDICATIONS, which may relieve
symptoms of anxiety, panic attacks, abnormal
SKINsensations, and dizziness - ANTIHISTAMINE MEDICATIONS, which may relieve
symptoms such as runny NOSEand nasal con-
gestion - modafinil, a nonamphetamine stimulant med-
ication doctors commonly prescribe to treat
NARCOLEPSY, which improves alertness and cog-
nitive function in some people who have
chronic fatigue syndrome - NONSTEROIDAL ANTI-INFLAMMATORY DRUGS(NSAIDS),
which may relieve JOINTpain and generalized
discomfort - daily physical activity at a level that is consis-
tent but does not trigger a worsening of fatigue
or other symptoms - alternative methods such as ACUPUNCTURE,
BIOFEEDBACK, MASSAGE THERAPY, CRANIOSACRAL
MASSAGE, HYPNOSIS,REIKI, and therapeutic touch - MEDITATION, relaxation techniques, and stress-
relief methods
Treatment often but does not always relieve
symptoms enough to allow participation in the
normal activities of living. For many people who
have chronic fatigue syndrome, the fatigue is so
overwhelming that it prevents virtually any level
of activity despite treatment for other symptoms.
Some people experience continued symptoms that
wax and wane in severity. For most people who
have the disorder, chronic fatigue syndrome is a
long-term condition that does eventually improve
or go away. The timeline for improvement is
widely variable though typically spans several
years. Many communities have SUPPORT GROUPSin
which people who have chronic fatigue syndrome
can share their experiences and concerns.Risk Factors and Preventive Measures
Again because doctors do not know what causes
chronic fatigue syndrome, there are no specific
measures to prevent it. Doctors diagnose chronic
fatigue syndrome in about four times as many
women as men. For the most part chronic fatigue
syndrome is relatively indiscriminate, affecting
people across the spectrum of age and health status.
See also AUTOIMMUNE DISORDERS; COGNITIVE FUNC-
TION AND DYSFUNCTION; FIBROMYALGIA; GENERALIZED
ANXIETY DISORDER; LYMPH NODE; QUALITY OF LIFE; STIM-
ULANTS.chronic pain PAINthat persists longer than three
months or beyond the point of HEALINGfor the
condition that causes it. Chronic pain is very com-
mon, affecting the daily lives and activities of an
estimated one in six Americans—about 60 million
people. The most prevalent causes of chronic pain
in the United States are low BACK PAIN, arthritis,
and HEADACHE.
Pain experts differ in their definitions of what
constitutes chronic pain. Research in the past
decade has provided new understanding about the
mechanisms of functional and dysfunctional pain.
Some pain specialists view all chronic pain as dys-
functional because it no longer serves the purpose
of warning the body. In this view the pain itself
becomes the disorder, called MALDYNIA, and treat-
ment targets pain relief.
Other pain specialists consider some kinds of
chronic pain (that which accompanies chronic
health conditions such as RHEUMATOID ARTHRITIS) to
remain symptomatic rather than dysfunctional.
The pain persists because the underlying condition
that causes it persists or progresses. In this view
treatment targets the underlying condition, which
often includes therapies to relieve pain as well as
the pathology of the condition and its other symp-
toms. In rheumatoid arthritis, for example, treat-
ment attempts to slow the inflammatory process370 Pain and Pain Management