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Chronic Fatigue Syndrome(CFS; Chronic Fatigue and Immune Dysfunction Syndrome)

Chronic fatigue syndrome (CFS) is a condition that causes chronic, debilitating fatigue. It continues for at least 6 months. The fatigue is not relieved by bed rest. People who have CFS perform at a significantly lower level compared to their activity prior to the onset of the illness.


The cause of CFS is unknown. Some believe there may be a link between CFS and stress, the immune system, toxins, the central nervous system, or activation of latent virus.

Central Nervous System and Organs Including Endocrine Glands

CNS and Endocrine

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Risk Factors

Women are more likely to have CFS than men. It is also more common in people between 25-55 years of age.


Symptoms vary from person to person. They include:

  • Unexplained, new onset, persistent fatigue that is not relieved with bed rest and often worsens with physical or mental activity
  • Unexplained muscle aches
  • Joint pain without swelling or redness over 6 months
  • Headaches over 6 months
  • Trouble with short-term memory or concentration a "brain fog"
  • Forgetfulness or confusion
  • Irritability, anxiety , panic attacks, mood swings, or depression
  • Sore throat over 6 months
  • Tender lymph nodes over 6 months
  • Trouble sleeping or not feeling refreshed after sleep over 6 months
  • Visual disturbances (eyes sensitive to light, blurring, pain)
  • Reduced activities (social, job-related, educational, and personal)
  • Lightheadedness, balance problems, or fainting
  • Chills and night sweats
  • Allergies or sensitivities to foods , chemicals, odors, medications, or noise

The doctor will ask about your symptoms and medical history. A physical exam will be done. There are no specific diagnostic tests for CFS. Your doctor may do several other tests to rule out other conditions that can have similar symptoms.

The doctor will look for the following signs to determine if you have CFS:

  • Severe, chronic fatigue for at least 6 months that is not due to another illness or medical cause, along with:
  • At least 4 of the following symptoms according to the International Chronic Fatigue Syndrome Study Group Criteria:
    • Impairment of short-term memory or concentration
    • Sore throat
    • Tender lymph nodes
    • Muscle pain
    • Joint pain without swelling or redness
    • Headaches of a new type, severity, or pattern
    • Unrefreshing sleep
    • Prolonged fatigue lasting 24 hours or more after exercise

The main goal of CFS treatment is to achieve symptom relief.

Treatments for CFS include:

Physical Activity

If you have CFS, avoid overexertion and physical and emotional stress. Balancing your activities throughout the day may help you to not overexert yourself. Moderate exercise that is monitored by a doctor or physical therapist may improve symptoms. Slowly increase the duration and intensity of exercise. Light exercise and stretching 4 hours before bedtime may help with sleep.

In addition, your doctor may have you work with a physical therapist. Some therapies that might be helpful for you include:

Diet and Nutrition

A well-balanced diet can help prevent nutritional deficiencies and weight fluctuations. Nutritional supplements cannot make up for an inadequate diet. Avoid foods to which you may be sensitive.


CFS can be mentally and physically debilitating. Depression is common among people with CFS. In fact, as many as half develop depression as a consequence of CFS. Psychotherapy and supportive counseling often help those with CFS cope with the disorder. Learning relaxation training and stress management techniques , as well as changing your sleep routine, may also help.

Talk with your therapist about whether cognitive behavioral therapy is right for you to reduce fatigue symptoms.


Medications used to treat specific symptoms of CFS include:

  • Antidepressants
  • Anti-anxiety drugs
  • Over-the-counter medications like acetaminophen, aspirin, and ibuprofen to treat pain and fever
  • Stimulants—mild ones may be helpful
  • Sedatives—to help with insomnia

Experimental Treatments

The following experimental treatments are sometimes used for CFS but have not been proven to be effective. Talk to your doctor before trying any experimental treatments.


There are no current guidelines for preventing CFS because the cause is unknown.


Centers for Disease Control and Prevention

Chronic Fatigue and Immune Dysfunction Syndrome Association of America


Health Canada

Women's Health Matters


Chronic fatigue syndrome. American Academy of Family Physicians Family Doctor website. Available at: Updated November 2010. Accessed December 28, 2012.

Chronic fatigue syndrome. Centers for Disease Control and Prevention website. Available at: Updated May 16, 2012. Accessed December 28, 2012.

Chronic fatigue syndrome. EBSCO DynaMed website. Available at: Updated November 10, 2012. Accessed December 28, 2012.

Craig T, Kakumanu S. Chronic fatigue syndrome: evaluation and treatment. Am Fam Physician. 2002;65(6):1083-1090.

Darbishire L, Ridsdale L, et al. Distinguishing patients with chronic fatigue from those with chronic fatigue syndrome: a diagnostic study in UK primary care. Br J Gen Pract. 2003;53(491):441-445.

Prins JB, Bleijenberg G, et al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicertre randomized controlled trial. Lancet. 2001;357(9259):841-847.

Reeves WC, Wagner D, et al. Chronic fatigue syndrome: A clinically empirical approach to its definition and study. BMC Medicine. 2005;3:19.

Reid S, Chalder T, et al. Chronic fatigue syndrome. Clin Evid. 2004;(12):1578-1593.

Rimes KA, Chalder T. Treatments for chronic fatigue syndrome. Occup Med. 2005;55:32-39.

3/3/2011 DynaMed's Systematic Literature Surveillance White P, Goldsmith K, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011;377(9768):823-826.

10/1/2013 DynaMed's Systematic Literature Surveillance Patterson E, Wan YW, et al. Nonpharmacological nursing interventions for the management of patient fatigue: a literature review. J Clin Nurs. 2013;22(19-20):2668-2678.

Last reviewed December 2014 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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