Are you always tired?

Fatigue can be a symptom of many illnesses.  You should consult your doctor if you are experiencing persistent or excessive fatigue.  


Do you feel tired all the time? Is it hard waking up every morning? Do you feel like you need a pick-me-up multiple times during the day?  It could be due to a variety of causes.  Poor nutrition, not sleeping well due to an old mattress, chronic dehydration, or any number of other circumstantial causes.  Some people, however, may experience a profound fatigue, which is all encompassing, affecting daily routines, and not alleviated with rest [1].  This tiredness is called “chronic fatigue syndrome,” commonly abbreviated to CFS.

Chronic fatigue syndrome is characterized by fatigue which affects daily life and is not alleviated with rest. / Photo available via CC0

What is it?

Chronic Fatigue Syndrome (CFS) was named in 1988 by the Center for Disease Control [2].  It is a profound fatigue that doesn’t improve with rest, and worsens with physical or mental exertion [1].  CFS affects different people in different ways in a variety of systems of the body and can vary from mildly limiting to completely debilitating [2].  CFS affects twice as many women as it does men, however, this may be a reflection of who seeks help [3].

The major symptom is fatigue, but can also include a variety of signs and symptoms which affect multiple areas of the body.  Additional symptoms include poor short-term memory, sore throat, muscle and or joint pain, poor quality sleep, poor concentration, enlarged lymph nodes, headache in a new pattern, excessive pain after mild exercise,  abdominal bloating, nausea, diarrhea, cramping, chest pain, irregular heartbeat, coughing, dizziness, dry eyes and mouth, weight loss, jaw pain, morning stiffness, night sweats, a persistent slight fever, and psychological patterns like depression or anxiety [2].

CFS is described as a persistent relapsing fatigue that impairs your daily routine for 6 months or more [4].  It is diagnosed by eliminating other diseases like hypothryroidism, postpolio syndrome, cancer, bipolar disease, reactions to medication, chronic, subacute infection, hepatitis B or C, Lyme disease, diabetes, alcohol or substance abuse, general autoimmune dysfunction, schizophrenia, lupus, sleep apnea or narcolepsy, eating disorders, severe obesity, and dementia.  The cause for CFS is unknown but is sometimes comorbid or a direct result of the above diseases.  Other culprits might be a variety of viruses (Epstein-Barr, human herpes 6, and mouse leukemia [5]), mentally or emotionally stressful events, and endocrine dysfunction [2].

CFS is a noncontagious disease in which the causes are unknown and the treatments vary widely.  There is no cure, and the majority of the treatment options focus on improving the quality of human life [3] by treating the symptoms.  

CFS is a noncontagious disease and the treatments vary widely. / Photo available via CC0.

How to manage

People that have CFS encounter issues when coping with the disease.  The symptoms change and are unpredictable.  A decrease in stamina makes normal daily activities sometimes insurmountable, and a loss in memory and concentration can seriously impact work and school performance.  Additionally, the symptoms can lead to a loss of independence, livelihood and economic security, and changes in family and friend relationships.  Coping with CFS can lead to feelings of anger, guilt, anxiety, isolation and abandonment.  The feelings can lead to an increased stress level and exacerbated symptoms, which can make management and recovery more difficult [1].

Treatment for CFS include drug therapies (antidepressants, antihistamines, and anti-anxiety, pain relievers and anti-inflammatories), alternative therapies (acupuncture and massage), lifestyle changes [3] and cognitive behavior therapy.  The lifestyle changes could include changes in sleeping and eating habits, exercising gently and consistently [6],  and attempting to reduce overall stress and chemical stimulants [1].   

One treatment that can be beneficial to sufferers of CFS is massage.  This can help to reduce physical and emotional stress [3], and help the body to relax into a parasympathetic state.  Additionally, massage cleanses tissues and stimulates the circulatory system [2].  This is especially important when exercise is just too much to handle [6].  Additionally, massage can relieve joint and muscle pain and improve the quality and quantity of sleep [6].  

Massage provides numerous benefits that are especially helpful to people with CFS. / Photo available via CC0

If you decide you would like to try massage to help manage CFS symptoms, make sure the massage therapist is not deep, fast, or vigorous.  Massage can sometimes be taxing on the body, so emphasize a relaxation-focused massage [7].  Choose a massage shorter in duration initially–no more than 60 minutes, and maybe shorter if you can find that option.  See how your body reacts and then decide if your body can handle a longer massage.  A massage that includes stretching and joint mobility will help to maintain flexibility [7], in addition to being relaxing and therapeutic.        

CFS is a debilitating disease with devastating fatigue.  Learning how to manage the symptoms can greatly increase the quality of life.  Massage can help the patient immensely and reduce emotional stress in addition to the numerous physical benefits.  


References Cited

[1] “Chronic Fatigue Syndrome.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Jan. 2012. Web. 27 Feb. 2012.

[2] Werner, Ruth. “Chronic Fatigue Syndrome.” A Massage Therapist’s Guide to Pathology. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2005. 421-24. Print.

[3] Ehrlich, NMD, Steven D. “Chronic Fatigue Syndrome.” University of Maryland Medical System. University of Maryland Medical Center, 15 Jan. 2012. Web. 27 Feb. 2012. <>.

[4] Etzioni, M.D., Amos. “Chronic Fatigue Syndrome: Still a Long Way to Go.” Israel Medical Association Journal 13 (Dec 2011). Print.

[5] Mayo Clinic Staff. “Chronic Fatigue Syndrome Causes.” Mayo Clinic. Mayo Foundation for Medical Education and Research. Web. 01 Mar. 2017

[6] “Massage Therapy Eases Chronic Fatigue Syndrome.” Massage Therapy Eases Chronic Fatigue Syndrome. Absolutely Spahhhvelous, 22 Apr. 2010. Web. 27 Feb. 2012. <>.

[7] Rattray, Fiona S., and Linda Ludwig. “Chronic Fatigue Syndrome.” Clinical Massage Therapy: Understanding, Assessing and Treating over 70 Conditions. Toronto: Talus, 2000. 988-90. Print.


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