From ifaonline.co.uk, 11 October 2010 (Story by Fergus Bescoby, contains useful information at the end about underwriting considerations for life insurance applications).
A possible life changing illness, Fergus Bescoby examines the ramifications
Myalgic encephalomyelitis or chronic fatigue syndrome, also known as ME, CFS or post-viral fatigue syndrome (PVFS), is a condition that causes extreme physical and mental tiredness that seriously interferes with a person’s daily life.
This is a contentious illness because for years medical professionals refused to recognise it – often being dismissed as ‘yuppie flu’, despite causing years of complex problems.
During the 1990s, the term ‘chronic fatigue syndrome’ (CFS) came into vogue. Since there was no specific diagnostic test for ME, and since post-exercise ‘fatigue’ was one of its prominent symptoms, people with ME began to be diagnosed with CFS. In recent years, however, there has been a growing recognition that the diagnosis ‘CFS’ – based on a list of vague non-specific symptoms – is so broad that it encompasses a range of diverse patient groups.
ME is characterised by a range of neurological symptoms and signs, muscle pain with intense physical or mental exhaustion, relapses, and specific cognitive disabilities. Early reports dating from 1934 described epidemics of the illness, such as the 1955 outbreak at the Royal Free Hospital in London but nowadays it is more common for endemic (sporadic) cases to be identified. It is believed that certain historical figures such as Florence Nightingale suffered with the illness.
The World Health Organisation’s International Classification of Disease lists ME as a disorder of the nervous system, under Post-Viral Fatigue Syndrome.
The syndrome leaves a chronic aftermath of debility in a large number of cases. The degree of physical incapacity varies greatly, but the dominant clinical feature of profound fatigue is directly related to the length of time the sufferer persists in physical effort after its onset. It is felt that people who are given a period of enforced rest from the onset have the best prognosis.
Although the onset of the disease may be sudden and without apparent cause, there is practically always a history of recent virus infection associated with upper respiratory tract symptoms. As with many chronic illnesses, fatigue may be present, but in ME patients the fatigue is post-exertional, often delayed, and quite unlike the ‘fatigue’ experienced by healthy people. Instead of making a normal recovery, the patient is dogged by persistent profound fatigue accompanied by a variety of symptoms, including the following:
- Muscle fatigue, muscle pain, cramps, pins and needles;
- A general ‘flu like’ feeling;
- Wildly fluctuating body temperature;
- Abnormal exhaustion – unrelieved by sleep
- Headaches and migraines;
- Some disturbance in brain function – including: loss of concentration, loss of short term memory, acquired dyslexia;
- Nausea, vertigo/dizziness;
- Clumsiness and disturbed balance, misjudgement of distance;
- Sensitivity to light or other problems with vision;
- Sensitivity to noise, Tinnitus (ringing in the ears);
- Allergies or sensitised reactions to foods, chemicals or touch;
- Digestive/bowel problems;
- Mood swings, anxiety and depression.
What is the cause?
The cause of ME is still unknown, but there is unlikely to be one single causative agent. Several early epidemics appear to have been triggered off by an outbreak of an infection with enteric organisms or poliovirus which then subsided, and many patients report an infectious onset to their illness. However, in others, there may have been a variety of contributing factors — infectious, traumatic, environmental and endogenous — all of which can lead on to a condition which shares a set of common symptoms.
There is no known cure for ME/CFS although treatment may help to manage and ease the symptoms. There is no one specific treatment that works for everyone. Most treatments are aimed at people with mild to moderate symptoms.
The following options are available:
Doctors suggest lots of rest during an attack or relapse along with maintaining a regular routine. Pacing is a way of managing lifestyle in order to find a level of physical and mental activity that is comfortable for the patient. Massage and stretching may help to relieve muscle pain.
Painkillers such as paracetamol or ibuprofen may help relieve muscle and joint pain, headaches and other physical symptoms. Antidepressants will be prescribed for depression.
Cognitive behavioural therapy (CBT) is a short-term psychological treatment that helps to challenge negative thoughts, feelings and behaviour which can often be associated with ME.
Graded exercise therapy means starting with an activity that can be done comfortably, such as walking, and increasing levels of activity every few days.
Complementary therapies such as relaxation therapy, acupuncture, homeopathy or supplements such as coenzyme Q10 are sometimes recommended for people with ME/CFS. However, although some people may find them useful, there is very little scientific evidence to show that these are effective.
Life cover can generally be accepted at standard rates once the underwriter is certain that the client has made a full and documented recovery and no residual neurological disability exists.
ME can be a significant morbidity problem though, with the condition frequently resulting in long periods of disability. This can be put down to the nature of the illness, lack of appropriate treatment and the reluctance of those affected to accept this. The natural course of the illness is a slow recovery with many individuals remaining disabled for years with no apparent signs of recovery. Depression can often play a large part in this illness and needs to be taken into account in the overall assessment.
The underwriter must be sure that the client is capable of working full time and that a definite diagnosis has been made before considering any form of disability cover.
Fergus Bescoby is underwriting development manager at PruProtect