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Chronic Fatigue Syndrome

Benjamin H. Natelson, MD
JAMA. 2001;285(20):2557-2559. doi:10.1001/jama.285.20.2557.
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Chronic fatigue syndrome (CFS), like fibromyalgia and multiple chemical sensitivity, comprises a number of poorly understood signs and symptoms, and whether a patient receives the diagnosis for one or another of these symptom clusters may depend on the specialty of the physician making the diagnosis.1 Patients with CFS also often fulfill case definitions for these other illnesses.1 This overlap suggests that these "functional somatic illnesses" may be variants of one another.2 However, this does not necessarily mean that these syndromes share the same pathobiological processes or causes. For example, patients with fibromyalgia have been found to have elevated levels of substance P in spinal fluid3 and reduced pain thresholds, while patients with CFS have not.4 Similarly, the fatigue reported by patients with fibromyalgia may be secondary to chronic sleep disruption because of pain, while fatigue may be primary in CFS.


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