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By Joyce Frieden
WASHINGTON, Mar 21 (Reuters Health) - Stress by itself does not appear to cause chronic fatigue syndrome (CFS), according to a consensus panel convened Tuesday by the Centers for Disease Control and Prevention and the Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America.
"It's highly probable that an infection could (trigger) CFS," said panel chair Dr. Dimitris A. Papanicolaou, assistant professor of medicine at Emory University in Atlanta, Georgia. "But there's a lot of evidence that stress can exacerbate CFS if it's already there."
Chronic fatigue syndrome is diagnosed if a patient has a number of particular symptoms for at least 6 months that cannot be explained by other medical or psychological conditions.
The symptoms include short-term memory impairment; sore throat; tender lymph nodes; muscle pain; joint pain without swelling or redness; headaches of a new type, pattern, or severity; unrefreshing sleep; and tiredness after exercise that lasts more than 24 hours.
The panel explored the question of whether problems with the neuroendocrine system can contribute to the development of chronic fatigue syndrome. A previous CFIDS Association panel discussed the disease's neurological factors; future panels to be held in coming months will discuss immunological issues as well as controversies regarding the chronic fatigue syndrome diagnosis.
Although stress does not appear to cause chronic fatigue syndrome, many patients do have major stress in their lives, whether emotional or physical, the panel noted. But they also have other things in common, such as abnormalities along the hypothalamic-pituitary-adrenal (HPA) axis, the part of the nervous system that regulates people's response to stress. The HPA axis also controls the release of cortisol, a stress hormone that regulates both blood pressure and blood sugar metabolism.
Earlier studies have shown that patients suffer from decreased production of cortisol, suggesting a possible cause of the condition. However, the panel noted, "more recent studies have failed to replicate these findings. In fact, in at least one study, CFS patients were found to have higher cortisol levels than in normal (healthy) controls."
These inconsistent results may be due to the fact that CFS patients sometimes go into remission, which could make their test results mimic those of healthy patients. Poor study design and co-existing illnesses may also explain the results, the panel said.
Another common problem among patients is orthostatic intolerance, a condition in which standing up produces dramatic changes in heart rate and blood pressure. Many patients feel as if they are going to faint. The panel called for more studies to be done to learn more about the link between chronic fatigue syndrome and orthostatic intolerance.
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