Chronic fatigue syndrome

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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.

Info bulb.pngCulture bound syndromes
Several cultures and periods have exhibited particular conditions or behaviours which have been regarded as much as sociological phenomena as organic disease. It has been suggested that CFS has elements of this.


Differential Diagnosis

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[1]:


There is evidence that the slightly different definitions used in the literature reflect different populations[2].

Chronic fatigue syndrome

Chronic disabling fatigue in the absence of an alternative diagnosis.[3]

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)

  • Overwhelming fatigue for at least 6 months with possibility of[4]:
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NICE recommends[1]:A diagnosis should be made after other possible diagnoses have been excluded and the symptoms have persisted for:

  • 4 months in an adult
  • 3 months in a child or young person; the diagnosis should be made or confirmed by a


    1. Cognitive impairment
    2. Prolonged sore throat
    3. Tender lymphadenopathy
    4. Myalgia
    5. Arthralgia
    6. Headaches
    7. Unrefreshing sleep
    8. Fatigue after exercise


Patient groups tend to recommend specialist medical care. The largest randomised controlled trial was PACE[5]. There is an additive treatment effect to specialist medical care with:

  1. Cognitive behaviour therapy(CBT)
  2. Graded exercise therapy (GET)

Adaptive pacing therapy (APT) has no evidence of treatment effect which has caused controversy.

External links

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