Chronic fatigue syndrome
Chronic fatigue syndrome (CFS) is the label applied to what are probably several conditions and has the advantage over ME - "myalgic encephalitis" - that it does describe only a demonstrable feature of the cloud of conditions. It is as symptom complex rather than a disease and this symptom complex may have multiple aetiologies.
As the symptom complex is a diagnosis of exclusion this is wide. Look in particular for:
- Localising/focal neurological signs
- Inflammatory arthritis and connective tissue disease
- Cardiorespiratory disease
- Sleep aponea
- Significant weight loss
- Lymphadenopathy or red flag symptoms of malignancy
These do not need to be excessive but usually include:
- Basic urinalysis
- Full blood count
- Electrolytes and creatinine
- Liver function tests and calcium
- Thyroid function tests
- C-reactive protein
- Random blood glucose
- Coeliac screen
- Based on presentation would also include:
There is evidence that the slightly different definitions used in the literature reflect different populations.
Chronic fatigue syndrome
Chronic disabling fatigue in the absence of an alternative diagnosis.
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)
- Overwhelming fatigue for at least 6 months with possibility of:
- Cognitive impairment
- Prolonged sore throat
- Tender lymphadenopathy
- Unrefreshing sleep
- Fatigue after exercise
Patient groups tend to recommend specialist medical care. The largest randomised controlled trial was PACE. There is an additive treatment effect to specialist medical care with:
Adaptive pacing therapy (APT) has no evidence of treatment effect which has caused controversy.
- Chronic fatigue syndrome / Myalgic encephalomyelitis (CG53)
- Occupational aspects of the management of chronic fatigue syndrome: a national guideline
- Occupational aspects of the management of chronic fatigue syndrome/myalgic encephalitis: evidence-based guidelines for employees
This article is a work in progress. Please feel free to contribute to it.
- ↑ a b Chronic fatigue syndrome / Myalgic encephalomyelitis (CG53)
- ↑ Jason LA, Brown AA, Clyne E, Bartgis L, Evans M, Brown M. Contrasting Case Definitions for Chronic Fatigue Syndrome, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Myalgic Encephalomyelitis. Evaluation & the health professions. 2011 Dec 7.(Epub ahead of print) (Link to article – subscription may be required.)
- ↑ Prins JB, van der Meer JW, Bleijenberg G. Chronic fatigue syndrome. Lancet. 2006 Jan 28; 367(9507):346-55.(Link to article – subscription may be required.)
- ↑ Taylor RR, O'Brien J, Kielhofner G, Lee SW, Katz B, Mears C. The occupational and quality of life consequences of chronic fatigue syndrome/myalgic encephalomyelitis in young people. The British journal of occupational therapy. 2010 Nov 1; 73(11):524-530.(Link to article – subscription may be required.)
- ↑ White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, Baber HL, Burgess M, Clark LV, Cox DL, Bavinton J, Angus BJ, Murphy G, Murphy M, O'Dowd H, Wilks D, McCrone P, Chalder T, Sharpe M. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011 Mar 5; 377(9768):823-36.(Link to article – subscription may be required.)