Chapter One
A Framework for Understanding CFS
Although CFS has been studied internationally for almost two decades, there are still many questions and few definitive answers. This uncertainty is often a source of stress and anxiety as patients seek to understand their illness and its impact. Considerable information about CFS is available, especially on the Internet, but it is often not credible or accurate. Health professionals participating in the care and rehabilitation of people with CFS can assist them in developing a framework for understanding CFS, its contributing factors, possible causes and prognosis, all of which can facilitate feelings of control and hopefulness.
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Causes and Contributing Factors: Many hypotheses concerning the causes and pathophysiology have been raised, but no conclusive evidence in support of any single cause of CFS has been found. Explanations have included central nervous system aberrations, immune system dysfunction, infectious diseases, psychiatric disorders, stress, hormonal disturbances and cardiovascular aberrations (Afari and Buchwald, 2003). One current view is that CFS has a variety of predisposing or associated factors that result in a recognizable pattern of symptoms and impairment. Proponents of this view have sought to study the origins of CFS by using a biopsychosocial model in which the body and mind influence each other’s function and activity. This model includes three general factors involved in the onset and clinical course of CFS:
- Predisposing/risk factors are those that make a person more susceptible to CFS.
- Triggering factors are those which, when experienced by a susceptible person, lead to the onset of CFS.
- Perpetuating factors are those that delay or prevent improvement.
Essentially all studies have shown that women are more likely to develop CFS than are men. Physical and mental stress and acute infectious diseases have been associated with CFS, but the specific nature of their association (risk vs. triggering factors) is unknown. How risk factors impact responses to infections or other stressors that precede chronically fatiguing illnesses remains unclear. Finally, other conditions that occur in many individuals with CFS (e.g., sleep disorders, hormonal disturbances or psychiatric conditions) may represent comorbid illness unrelated to CFS, may result from CFS, may be causally associated with risk of CFS or could share the same pathophysiologic pathways. - Effects of Exertion: Exacerbation and prolonged duration of symptoms following physical or mental exertion is one defining symptom of CFS, is reported by most patients, and is of particular importance to those responsible for therapy and rehabilitation of people with CFS. As discussed later in this text, carefully designed and supervised rehabilitative therapy is important in the care management of CFS patients. Patients can learn to modify their activities to avoid postexertional malaise and therefore improve their health status and function. Postexertional exacerbation of the illness must be considered when developing intervention strategies for people with CFS. It is essential that rest and activity are balanced to avoid both deconditioning from lack of activity and flare-ups of illness due to overexertion.
Page last modified: December 9, 2007
Content Source: National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ZVED)
Content Source: National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ZVED)