Chronic Fatigue Syndrome represents an enigma. Between 850,000 and several million people are diagnosed with this condition, yet a firm diagnostic protocol remains illusive. We still lack a universally accepted definition for the Chronic Fatigue Syndrome and neither confirmatory laboratory nor imaging technique exists.

In 2015 the Institute of Medicine attempted to define Chronic Fatigue Syndrome as a condition associated with a decrease in the ability to engage in social, personnel or occupational activities lasting at least 6 months. Additional requirements were fatigue, often profound and not related to excessive exertion. Other features of Chronic Fatigue syndrome included unrefreshing sleep and malaise or weakness after almost any physical activity.

The IOM report mandated either cognitive impairment and/or worsening of symptoms while the individual was upright with some degree of improvement on lying down. Collectively these symptoms needed to be present at least 50% of the time and of moderate to severe intensity. The IOM even suggested renaming the condition Systemic Exertion Intolerance Disease instead of Chronic Fatigue Syndrome.

Now this imprecisely defined syndrome may be referred to as the medically sounding myalgic encephalomyelitis (ME), ME/CFS, CFS or SEID.

Symptoms remain as variable as the definition. They additionally include inability to sustain activities, feeling drained and lacking energy and complaints of joint pain. Some describe cognitive decline, impaired learning, difficulty finding the correct word and suffering “brain fog.” Other non-descript complaints include muscle aches, gastrointestinal symptoms, headache and night sweats. Some describe uncontrolled anxiety and panic attacks.

Recent studies suggest blurring of the distinction between Chronic Fatigue Syndrome and Fibromyalgia. Some argue that Chronic Fatigue Syndrome may be precipitated by an underlying significant infection, serious injury or psychological stress.

Of course a condition lacking a firm definition with neither confirmatory laboratory testing nor imaging studies seems destined to remain poorly treated and open to unscrupulous “practitioners” offering guaranteed treatments with hasty recovery. At present the only accepted interventions involve graded exercise therapy perhaps coupled with psychological interventions. No pharmaceuticals exist that offer widespread lessening of symptoms.