Psychosomatics or dangerous illness. What does “chronic fatigue syndrome” hide?

If you constantly, for several months, feel an unreasonable loss of strength, debilitating fatigue, which does not go away even after a long rest, you may need the help of a specialist. Chronic fatigue syndrome (CFS) has nothing to do with a natural temporary state of fatigue after strenuous physical or mental work, which disappears after a few hours of rest.

CFS is not a diagnosis that a doctor can make, but a symptom complex that is more often used in popular science literature and in non-medical audiences, sometimes as a description of an unrecognized state of constant weakness and fatigue. In fact, or in most cases, we are talking about neurosis (neurasthenia), which is accompanied by such symptoms. (See article about asthenic neurosis - neurasthenia).

The disease is provoked by the emotional and mental stress of modern megacities, whose residents are most susceptible to chronic fatigue syndrome, deteriorating ecology and lifestyle features. For the most part, the disease affects ambitious young and middle-aged people who are building a career and loading themselves with exorbitant amounts of work and bearing responsibility for its implementation. The percentage of women among those suffering from CFS is higher than that of the stronger sex.

The clinical picture of chronic fatigue syndrome is characterized by its disguise as other pathologies. Only an experienced psychotherapist can differentiate this disease from the symptoms of other diseases.

Symptoms

A specific symptom of CFS is the inability to get rid of a debilitating loss of strength even after reducing stress or taking a long rest in the absence of diseases that could cause such a condition. The patient cannot accurately name the event after which he began to experience constant fatigue, and drug treatment does not help to get out of this state. These are the so-called major criteria for identifying the disease. The remaining symptoms of chronic fatigue (minor criteria) are characteristic of many mental and somatic disorders and pathologies of the body:

• sleep disturbances – excessive drowsiness or insomnia, which is caused by an unreasonable feeling of fear, anxiety that intensifies at night, shallow, intermittent sleep;
• frequent headaches of various types;
• pain of various locations: in muscles, throat, lymph nodes, joints;
• impairment of intelligence (mental activity) - difficulties arise with concentration, memorization, logical constructions, reflection, creative ideas and their implementation;
• changes in the emotional background - short temper, irritability, depression, apathy, hypochondria, phobias;
• muscle weakness;
• aching joints;
• impaired motor activity, hand tremors;
• susceptibility to colds and viral diseases due to decreased immunity;
• violation of body thermoregulation, low-grade fever.

Due to the fact that the clinical picture is characteristic of many diseases, a person suffering from CFS often seeks help from doctors who treat somatic diseases, and in the worst case, self-medicates, taking medications for insomnia, painkillers and sedatives. But medications without psychotherapeutic help are not able to relieve most symptoms, which is another sign of CFS.

Viruses: culprits or markers?

The pathogenesis of the disease has been little studied. But it is still generally accepted that, in addition to genetic predisposition, viral infections, primarily herpes viruses, play an important role in the development of CFS. But not simple herpes, which leads to the appearance of a “cold” on the lip, but viruses of the 4th, 6th and 7th types. Most often, the provocateur of the disease is the Epstein-Barr herpes virus type 4, which can also lead to mononucleosis and even nasopharyngeal carcinoma. However, the presence of this infection does not mean 100% development of CFS, because the herpes virus multiplies in immunocompetent cells, and therefore is activated only in immunodeficiency conditions, for example, in HIV infection.

Therefore, it still cannot be said that herpes viruses are the cause of CFS. Rather, they are simply associated with this syndrome (it activates them in the body), while the basis of the disease is changes in immunity. Pathology can be expressed in a decrease in the number of killer cells of the immune system (T-lymphocytes), which are supposed to protect us from viruses and bacteria.

Causes

With natural fatigue from mental or physical overstrain, any person can accurately identify the event that led to a temporary loss of strength followed by recovery during a short rest. One of the criteria for diagnosing chronic fatigue syndrome is the patient’s inability to determine the stressful moment at work that caused the disease. This is not surprising, since such a specific event does not exist, and the disease is caused by a combination of factors.

In some cases, the causes of chronic fatigue syndrome lie in almost insurmountable circumstances of life and work that a person is not able to eliminate, but can change his attitude towards them. Most causes of CFS are due to behavioral characteristics and habits that can be overcome if you understand their significance in the negative impact on physical and mental health.

Typically, chronic fatigue syndrome is caused by a combination of several risk factors, including:

• chronic infectious and viral diseases, inflammatory processes that reduce immunity, which weakens the physiological and mental functions of the body;
• long-term psychological disorders: frequent stress, depression, anxiety and fears caused by work or family problems, constant time pressure;
• unhealthy lifestyle: overwork and overexertion at work, lack of sleep, violation of work and rest, eating, alcohol abuse, uncontrolled use of medications, lack of physical activity, insufficient exposure to fresh air;
• unbalanced diet - lack of minerals and vitamins reduces the supply of energy needed by the body, causing loss of strength;
• poor environmental conditions at work or in the region of residence - the body spends a lot of energy on protection from external influences.

Not every person is able to independently recognize and, even more so, eliminate the listed risk factors from their lifestyle, even to the point of changing jobs. Only an experienced psychotherapist can provide effective assistance in identifying the causes of chronic fatigue syndrome and eliminating them.

Take your vitamins!

According to research, most people in our country suffer from hypovitaminosis - a lack of vitamins and microelements. This problem becomes especially acute at the end of winter - beginning of spring, when the supply of vitamins accumulated by the body over the summer and autumn has depleted, and it is difficult to obtain new ones from winter, imported, greenhouse products.

Vitamins are not produced in the human body, with the exception of vitamin D and vitamins synthesized by intestinal bacteria, and therefore must be constantly present in food. Most modern people simply physically do not have the opportunity to eat a varied and healthy diet, and it is unrealistic to obtain many vitamins and microelements from food in the required quantities. Even with the most rational nutrition, the human diet today is “understaffed” with vitamins by 20–30%. The absorption of vitamins from “artificial” preparations is often higher than from regular food. Therefore, it is necessary to take multivitamin preparations regularly.

Not all vitamins taken are absorbed by the human body. It is important what time of day you take vitamin preparations, what is included in their composition, whether the daily norm is divided into several doses, whether they are consumed with food or on an empty stomach. Since a person has always received vitamins from food, it is better to take them with meals, so they are absorbed more fully. Vitamins are better absorbed if the daily dose is divided into several doses; it is better to prescribe the main dose in the first half of the day, since in the evening and at night the metabolism in the body slows down and vitamins are absorbed worse.

The need for certain vitamins depends on the general condition of the body. During periods of illness, stress, depression, increased workload, pregnancy, smoking, alcohol abuse, and taking antibiotics, the need for vitamins increases.

The duration of their continuous use is determined by the doctor, and is usually 1–3 months; it is advisable to repeat the courses 2–4 times a year.

Diagnostics

Identification of signs of CFS and its causes is carried out in the process of collecting anamnesis based on the results of the initial examination of the patient, conversations with him and his relatives. The diagnosis is made based on the presence of a certain combination of major and minor criteria for CFS symptoms. If necessary, to differentiate from other pathologies and disorders of a somatic and mental nature, laboratory and instrumental tests are prescribed: general and biochemical blood tests, ECG, ultrasound, MRI, etc.

Dissection of the filum terminale using the Filum Sistem® method

Advantages

1. The tension on the spinal cord caused by a too short or tight filum terminale is eliminated.
2. Using the minimally invasive surgical technique of the Chiari Institute of Barcelona, ​​the surgical time is 45 minutes. Stay in the hospital for about a day. The post-operative period is short and without serious restrictions. No admission to the intensive care unit. No blood transfusion.

3. Its use reduces the risk of mortality to zero. No serious complications.

4. Improves symptoms and stops the development of pathologies associated with filum terminale disease.

Psychotherapeutic treatment

If you consult a psychotherapist at an early stage of the disease, chronic fatigue syndrome can be overcome without the use of medications. Psychotherapeutic treatment in our Center is aimed at making the patient aware of the reasons for the formation of chronic fatigue syndrome and wanting to change his lifestyle or his attitude towards the current state of affairs at work, in the family and in other areas.

A psychotherapist will help you cope with stressful situations, change priorities in life, increase self-esteem and confidence in your abilities. After all, in avid workaholics, CFS often develops against the background of depression, which is caused by the false impression that they cannot cope with work. Although in fact they simply have taken on too many responsibilities and have an excessive sense of responsibility. Among all the responsibilities, the doctor will help the patient choose those that can be abandoned without harming his career, or change his attitude towards them. This is one of the most difficult moments in the treatment of chronic fatigue syndrome.

To convince the patient to give up stress that requires excessive mental stress, hypnotherapy, auto-training methods, relaxation and other psychotherapy techniques are used. During these sessions, the psychotherapist frees the patient from unreasonable fears and anxiety, depression, and helps restore normal sleep without medications.

Exit methods: planning loads and incentives

– How to overcome the psychological consequences of Covid?

– Firstly, we try to help clients objectively assess their strengths. Convey to them that during recovery you need to lower the bar of demands on yourself: do not be active, do not grab onto everything, do not complete all the assigned tasks, as before the illness.

We also teach how to plan life here and now. We draw up a plan of action for the period of recovery - we learn to weed out the unimportant and take care of ourselves.

We start a diary where a person describes his day, plans workloads, breaks, rewards for success.

For many, this experience has become a period of reassessment of meanings, so now is a good time to talk about existential topics - what is the meaning of life, what is important, what is secondary.

With anxious people, you need to work on reducing anxiety. Basically, this is a selection of counterarguments to their concerns, thinking about the topic “what evidence is there that after Covid I will not get sick with something terrible.”

We also actively use techniques for working with trauma. You need to understand that the process of trauma itself is a situation where a person is “stuck” inside some kind of traumatic situation. In general, a traumatic situation can happen in anyone’s life, but someone manages to react, live through it and process it. And someone gets “stuck” and constantly returns to memories and the question: “Why did this happen to me?”

It is useful to remember and discuss the traumatic situation again in a calm environment. This technique is called reprocessing: the smallest details, thoughts, sensations in the body are remembered. But this is done very carefully, in small doses, so that the person has time to react and “digest” the memory.

Then the traumatic situation is incorporated into his psyche, and after a while he begins to remember the traumatic events as if from the outside, like a movie to himself.

Communication with thoughtful, caring doctors is very useful for patients who have suffered from Covid. Because everyone is interested in answers to the questions: “When will I be “fixed”? When will I be the same as before? You should communicate on this topic not on the Internet, but with qualified specialists.

At the same time, we are discussing how to regulate the information background - for example, that you cannot read about coronavirus on the Internet from morning to night.

Drug treatment

Due to the fact that the symptoms of chronic fatigue syndrome are often perceived as temporary, which will go away after rest, or as manifestations of somatic diseases, contacting a specialized specialist occurs late. In such cases, psychotherapeutic assistance is not enough, and you have to resort to the use of medications.

In our Center, the most modern drugs are used for drug therapy, the prescription of which is carried out strictly individually, depending on the physiological characteristics and mental state of the patient. Make an appointment or a free initial consultation at the Neopsy Mental Health Center using the specified phone number or through the website services.

Bibliography:

1. IACFS/ME: Primer for Clinical Practitioners. Members of the IACFS/ME Primer Writing Committee, Fred Friedberg, Ph.D., Chairperson Stony Brook, 2014, New York, USA.
2. Yunus, M. B. (2007). Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Practice & Research Clinical Rheumatology, 21(3), 481-497.
3. Nakatomi Y, Mizuno K, Ishii A, Wada Y, Tanaka M, Tazawa S, Onoe K, Fukuda S, Kawabe J, Takahashi K, et al. J Neuroinflammation in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: An C-(R)-PK11195 PET Study. Nucl Med. 2014 Jun; 55(6): 945-50. Epub 2014 Mar 24.
4. Dr. Miguel B. Royo Salvador (1996), Siringomielia , escoliosis y malformación de Arnold-Chiari idiopáticas, etiología común (PDF). REV NEUROL (Barc); 24 (132): 937-959.
5. Dr. Miguel B. Royo Salvador (1996), Platibasia , impresión basilar, retroceso odontoideo y kinking del tronco cerebral, etiología común con la siringomielia , escoliosis y malformación de Arnold-Chiari idiopáticas (PDF). REV NEUROL (Barc); 24 (134): 1241-1250
6. Dr. Miguel B. Royo Salvador (1997), Nuevo tratamiento quirúrgico para la siringomielia , la escoliosis , la malformación de Arnold-Chiari , el kinking del tronco cerebral, el retroceso odontoideo, la impresión basilar y la platibasia idiopáticas (PDF). REV NEUROL; 25 (140): 523-530
7. M. B. Royo-Salvador, J. Solé-Llenas, J. M. Doménech, and R. González-Adrio, (2005) “Results of the section of the filum terminale in 20 patients with syringomyelia , scoliosis and Chiari malformation .” (PDF). Acta Neurochir (Wien) 147:515–523.
8. M. B. Royo-Salvador (1992), “Aportación a la etiología de la siringomielia ,” Tesis doctoral (PDF). Universidad Autónoma de Barcelona.
9. M. B. Royo-Salvador (2014), “Filum System® Bibliography” (PDF).
10. M. B. Royo-Salvador (2014), “Filum System® Guía Breve.”