Myalgic Encephalomyelitis/chronic Fatigue Syndrome: Essentials Of Diagnosis And Management
- Alison C. BestedAffiliations
- Lily ChuCorrespondenceCorrespondence: Address to Lily Chu, MD, MSHS, Independent Consultant, 16 Lorton Ave, Unit 4, Burlingame, CA 94010.
- Nancy G. KlimasAffiliationsInstitute for Neuro Immune Medicine, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
- Jose G. MontoyaAffiliationsDr Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto Medical Foundation Research Institute, Palo Alto, CA
- Irma R. ReyAffiliationsInstitute for Neuro Immune Medicine, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
Your Next Steps Towards A Proper Diagnosis
If your diagnosis came before 2015, I encourage you to book a follow-up appointment with your physician. Go through the new diagnostic procedures together. Make note of whether you still fit the diagnostic criteria.
If you no longer fit the diagnostic picture, be assertive. Ask your doctor to perform more testing that can help you identify the root cause of your fatigue. If your lab tests still come back within normal ranges, its time to find a knowledgeable functional medicine practitioner.
Now, I want to hear from you!
Did the change in diagnostic criteria affect your diagnosis?
Do you really have CFS?
Implications For Future Research And Clinical Practice
Current training and education for GPs fails to prepare them for diagnosing and managing patients with CFS/ME as recommended by current guidelines. It seems that GPs do not have a clear model for CFS/ME. Educational initiatives are needed that are aimed at providing GPs with an acceptable model of the condition, supporting them in confidently making the diagnosis and helping them to initiate management based on their model. Passive educational interventions, however, have been shown to be ineffective and more interactive educational initiatives perhaps involving patients as teachers should be considered .
Recommended Reading: Does Adrenal Fatigue Cause Weight Gain
New Name For Chronic Fatigue Syndrome
I understand that Chronic Fatigue Syndrome is being renamed. I dont get it. Why change a name that is well recognized? Can you tell me what this is all about?
Andrew Weil, M.D. |April 16, 2015
Over the years, Chronic Fatigue Syndrome has been called many things from the dismissive yuppy flu to the very technical myalgic encephalomyelitis, a medical term meaning brain and spinal cord inflammation with muscle pain. For understandable reasons that particular tongue twister never caught on among the public.
Putting the name aside, people still struggle to understand this controversial condition characterized by unexplained, long-lasting fatigue. To help clarify things, the authors of a recent report from the Institute of Medicine came up with a new name systemic exertion intolerance disease, and they endorsed new diagnostic criteria that may help physicians better identify the condition.
The new name was chosen to reflect the consensus among patients, doctors and researchers that the major characteristic of CFS is a sustained depletion of energy after minimal activity, defined medically as postexertional malaise.
The term chronic fatigue syndrome was chosen by the U.S. Centers for Disease Control and Prevention in 1988. Many physicians and researchers consider the term inadequate to describe the disorder, since prolonged fatigue can also characterize other conditions, including depression.
Andrew Weil, M.D.
Chronic Fatigue Syndrome: Treatment
Medically, there is no treatment for Chronic Fatigue Syndrome. Doctors may prescribe some painkillers or vitamin supplements to treat it, but they usually do not work.
It may benefit you to go for the following modes of treatment:
1. Psychotherapy
5. Acupuncture
6. Massage
Please note that only a healthcare expert can decide on the best course of treatment for the patient.
Update: There is a new treatment for Chronic Fatigue Syndrome in 2021. It is based on the premise that an overactive immune system in the human body can be molded to fight the underlying causes. It can be done by repeatedly exposing the patient to thermal radiation for a set time duration. Research is underway to derive more conclusive evidence about curing the medical condition.
Also Check: Shortness Of Breath And Muscle Fatigue
Recommended Reading: Does Sinus Infection Cause Fatigue
Differential Diagnosis Exclusionary Medical Conditions
Myalgic encephalomyelitis/chronic fatigue syndrome should not be diagnosed if the patient has an identifiable medical or primary psychiatric condition that could plausibly account for the presenting symptoms. If ME/CFS symptoms persist after adequate treatment of other confounding illnesses, a diagnosis of ME/CFS can be considered.
Fatigue is an early symptom in many medical conditions and can be present before the appearance of the diagnostic features of the underlying illness. Careful follow-up over time is needed in order to identify illnesses that might mimic ME/CFS in their early stages. The presence of post-exertional malaise and exacerbation of symptoms after increased cognitive or physical effort increases the likelihood that ME/CFS is the correct diagnosis. The more common conditions in the differential diagnosis are shown in Table 3. For a more comprehensive list of the less common disorders in the differential diagnosis, see Appendix B. If there is diagnostic uncertainty and referral is necessary, it should be preferably to a specialist familiar with ME/CFS.
Table 3. Common conditions in the differential diagnosis of ME/CFS.
Recommended Reading: Do Vitamins Help With Fatigue
What Is Chronic Fatigue Syndrome
Chronic fatigue syndrome is not very well understood on a number of levels. While we know that chronic fatigue syndrome causes, obviously, chronic fatigue, we dont yet know why. Some doctors have speculated that the source of the condition might be in the immune system, suggesting that it is an autoimmune disorder.
An autoimmune disorder is a condition where the bodys immune system begins to attack the body because it thinks that a persons own cells are actually an invading foreign cell. This produces conditions like celiac disease and psoriasis. Its possible that this could explain the symptoms of chronic fatigue syndrome. Fatigue is common among autoimmune disorders.
And the fact that some of the symptoms of chronic fatigue syndrome include things like muscle pain and swollen lymph nodes suggests that there may be an immune system component as well. At the moment, there simply is no solid answer to what causes chronic fatigue syndrome.
But it is still possible to get a solid chronic fatigue syndrome diagnosis.
Also Check: Short Term Disability For Chronic Fatigue Syndrome
Where Can I Get Support
Even in its mildest form, chronic fatigue can have a significant emotional and financial impact on your life. A lack of understanding and awareness about CFS/ME means patients can experience disbelief, and even discrimination, from friends, family, health and social care professionals and employers.
People need wider support in order to continue to manage aspects of their life. Information on entitlements to welfare benefits, accessing health and social care and others sources of support for patients and carers are available from Action for M.E.
Action for M.E. has a number of booklets that may be useful for people living with CFS/ME, their families and their health professionals. They also offer resources and services for children and young people affected by chronic fatigue and their families.
Fibromyalgia What Is It
Fibromyalgia is a complex pain disorder that affects the musculoskeletal system, causing widespread chronic pain, aches and tenderness to touch. Fibromyalgia pain can be located in only one part of the body at a time, moving from one area to the next, or pain may be felt all over the body at the same time.
A chronic pain disorder, fibromyalgia heightens the sense of pain in an individual, and is accompanied by sleep issues, fatigue, digestive symptoms as well as mental and social problems.
More women are at the risk of developing fibromyalgia than are men. In fact, of the approximately 10 million Americans suffering from this condition, women are affected more than men with a ratio of about 8 to 2.
Although fibromyalgia is literally translated to mean pain in the tendons, ligaments, and muscles, this condition presents as much more than just pain, with a wide range of symptoms that vary from one person to another.
Read Also: Does Type 2 Diabetes Cause Fatigue
Treatment Of Chronic Fatigue Syndrome
-
Acknowledgment of patients symptoms
-
Sometimes graded exercise, limited to avoid a setback
-
Drugs for depression, sleep, or pain if indicated
To provide effective care to patients with CFS, physicians must acknowledge and accept the validity of patients symptoms. Whatever the underlying cause, these patients are not malingerers but are suffering and strongly desire a return to their previous state of health. For successful management patients need to accept and accommodate their disability, focusing on what they can still do instead of lamenting what they cannot do.
If these measures are ineffective, hypnotic drugs and/or referral to a sleep specialist may be necessary. Patients with pain widespread tenderness of muscles, areas around read more ) can be treated using a number of drugs such as pregabalin, duloxetine, amitriptyline, or gabapentin. Physical therapy is also often helpful. Treatment for orthostatic hypotension Treatment Orthostatic hypotension is an excessive fall in blood pressure when an upright position is assumed. The consensus definition is a drop of > 20 mm Hg systolic, > 10 mm Hg diastolic read more may also be helpful.
Unproven or disproven treatments, such as antivirals, immunosuppressants, elimination diets, and amalgam extractions, should be avoided.
Read Also: What Foods Are Good For Fatigue
Impact And Prognosis Of Me/cfs
Pharmacoecon Open.
BMC Public Health.J Chronic Fatigue Syndr.
Br J Occup Ther.
- Mild: mobile and self-caring may continue working but will have reduced other activities
- Moderate: reduced mobility, restricted in instrumental activities of daily living, needs frequent periods of rest usually not working
- Severe: mostly housebound limited to minimal activities of daily living severe cognitive difficulties may be wheelchair dependent
- Very severe: mostly bedridden unable to independently carry out most activities of daily living often experience extreme sensitivity to light, sound, and other sensory input
Am J Epidemiol.Chronic Illn.
Qual Life Res.Disabil Rehabil.Occup Med .
Rehabil Psychol.Front Pediatr.Fatigue.
Also Check: 4 X 6 Anti Fatigue Kitchen Mat
What Else Should I Know
- Strong emotions can be a part of the illness, so its important to recognize and express your feelings. Feelings like sadness, anger, and frustration are completely normal and its important to acknowledge how you feel and recognize that its not your fault. Recognizing emotions can help you figure out whats behind your feelings and help you manage problems.
- It can help to keep a daily diary of feelings and energy highs and lows. This also can let you share information that might help your doctor. You can also track trends for example, if your energy is high at one time of day and low at another that will help you figure out when to exercise or do other activities.
- Give yourself more time to do things, especially activities that take concentration or physical exertion.
- Get support from family, teachers, and friends.
- Get information about CFS from reliable sources. Theres a lot of misinformation and confusion about this disease. So its important to know and trust your sources.
Most important, dont give up. Having chronic fatigue syndrome can be hard. But for most people, the symptoms are most severe in the beginning. Later, they may come and go. Teens with CFS generally get better faster and recover more completely than adults do. Most teens get partial or full recovery within 5 years after symptoms began.
Are You Tired All The Time Hyperbaric Oxygen Therapy For Chronic Fatigue Syndrome
Did you know that hyperbaric oxygen therapy helps chronic fatigue syndrome?
Tiredness, weariness, lethargy, and exhaustion are all symptoms indicating a lack of energy.
It may be accompanied by depression, diminished motivation, or apathetic mood.
In the most typical cases, inadequate sleep, overexertion, overworking, stress, lack of exercise, or boredom can all result in a lack of energy.
Issues like these are often resolved with rest, better sleeping habits, stress management, and decent nutrition.
However, a persistent lack of energy that does not alleviate with self-care may be a symptom of an underlying health or psychological issue.
Allergies and asthma, anemia, cancer, and its treatments, chronic pain, heart illness, infection, depression, eating disorders, bereavement, sleeping difficulties, thyroid problems, medication side effects, and alcohol or drug usage are also common reasons.
Constant exhaustion without a clear cause may result from a flu-like sickness known as Chronic Fatigue Syndrome .
Other typical symptoms include cognitive difficulties, prolonged weariness and illness after activity, muscle or joint discomfort, sore throat, headache, and painful lymph nodes.
Hyperbaric oxygen therapy seeks to address this by increasing cellular energy production to alleviate the general fatigue and pain that patients with Chronic Fatigue Syndrome experience.
Don’t Miss: Timberland Boots With Anti Fatigue
What Can I Do To Cope With Me/cfs
Talking about your feelings with a friend or family member can help. Sometimes it also helps to talk with people who are going through the same thing. Consider joining an ME/CFS support group. See the âME/CFS Organizationsâ section at the end of this fact sheet for a list of organizations that offer additional information on ME/CFS and can help you find ME/CFS support groups.
Cope With Depression Anxiety And Distress
When you have ME/CFS, you may not be able to do the things you would like to do. This may lead to feelings of frustration and anxiety. It can also lead to depression. Depression is not the same thing as ME/CFS. But it can make your ME/CFS symptoms worse.
- Work with your doctor to watch for signs of depression.
- If your doctor suggests an antidepressant, ask if there is one that can help control your pain and help you sleep, as well as improve your mood.
- For support and help with mood problems, you can also work with a professional counselor who understands ME/CFS.
An ME/CFS support group can be a good source of information and tips for managing your illness. It also gives you a chance to share your frustrations and problems with others who have ME/CFS.
Recommended Reading: Iv Therapy For Chronic Fatigue Syndrome
Potential Harm From The Label
Some GPs believed that the label of CFS/ME can be helpful for the patient in giving a name to their symptoms:
‘Some people like a label, some people like to know what’s causing their symptoms whether it’s the truth or not and some people are looking for a label to attach to their symptoms.’
However, this value was generally considered to be limited and short-lived:
‘At a superficial level it’s empowering because it gives them control over their life and their work, but at a deeper level it prevents them from engaging fully with the existential conditions of their life which is what they can’t cope with.’
Furthermore, the majority of GPs felt that the label of CFS/ME could be harmful because it did not offer a clear management pathway for either the GP or the patient:
‘I try to avoid it because once you give them the label you’re actually setting them off on a track which will get them nowhere.’
‘Once you start labelling a patient if you’re not careful you might have a self-fulfilling prophecy.’
What Questions Should I Ask My Doctor
- Take along a list of all the symptoms you are experiencing in case you forget some of them during your talk with the doctor or nurse.
- Talk about how much you can do at work or school and around the house.
- Ask if there are any financial supports or services you could apply for.
- Ask for help with pain, sleep and remaining active if these are problems for you.
- Ask about what you should be eating.
Also Check: Does Acid Reflux Cause Fatigue
Symptoms And Signs Of Chronic Fatigue Syndrome
Before onset of CFS, most patients are highly functioning and successful.
Onset is usually abrupt, often following a psychologically or medically stressful event. Many patients report an initial viral-like illness with swollen lymph nodes, extreme fatigue, fever, and upper respiratory symptoms. The initial syndrome resolves but seems to trigger protracted severe fatigue, which interferes with daily activities and typically worsens with exertion but is alleviated poorly or not at all by rest. Patients often also have disturbances of sleep and cognition, such as memory problems, foggy thinking, hypersomnolence, and a feeling of having had unrefreshing sleep. Important general characteristics are diffuse pains and sleep problems.
The physical examination is normal, with no objective signs of muscle weakness, arthritis, neuropathy, or organomegaly. However, some patients have low-grade fever, nonexudative pharyngitis, and/or palpable or tender lymph nodes.
Because patients typically appear healthy, friends, family, and even health care practitioners sometimes express skepticism about their condition, which can worsen the frustration and/or depression patients often feel about their poorly understood disorder.
Uncovering The Mystery Of Cfs
Some people may be genetically predisposed to the CFS, plus viruses and stress appear to play a role. A weakened or compromised immune system and hormonal imbalances have been found in conjunction with CFS diagnoses, so they may have a part in its development too.
Because CFS has been linked to several viral infections in the past, it is thought that it could be more of an end-stage symptom than a unique condition of its own. Individuals with severe infections seem to be at greater risk for developing CFS than others. However, there are also cases of CFS reported in which no viral infection has ever been identified, so it continues to be a mystery.
What doctors and scientists have been able to identify are risk factors. Along with viral infections, there seem to be certain factors that up your chances of getting CFS.
It most commonly develops later in life between the ages of 40 and 50.
Women are more likely to be diagnosed than men.
Allergies, stress, and environmental factors also seem to increase your risk.
Read Also: Best Vitamins For Fatigue And Stress
You May Like: Fatigue Symptom Of Breast Cancer
Myalgic Encephalomyelitis/chronic Fatigue Syndrome: Fact Sheet For Schools
Myalgic encephalomyelitis/chronic fatigue syndrome is characterized by the bodys inability to produce sufficient energy for the normal range of human activity and the patients energy reserves are substantially reduced. The main symptoms include:
Severe, overwhelming fatigue with loss of mental and/or physical stamina and a substantial reduction in ability to take part in personal, educational and/or social activities.
The cardinal symptom of worsening of symptoms and malaise following minimal physical or mental exertion which can persist for hours, days, or weeks and is not relieved by rest
Cognitive problems , unrefreshing or disturbed sleep and a variety of painful conditions . Cognitive problems may worsen with prolonged upright posture.
There is no medical test for the illness. The diagnosis is made from the characteristic pattern of symptoms some or all of the above symptoms must be present every day for at least 6 months, symptoms must be moderate or severe, and other fatiguing illnesses must be ruled out by history, physical exam, and medical testing
Additional symptoms are often present and include:
Orthostatic intolerance, which is the development of symptoms due to prolonged upright posture that result in lightheadedness , increased fatigue, cognitive worsening, headaches, and/or nausea.
Hypersensitivities to light, noise, touch, odors, and/or medications.
Gastrointestinal symptoms such as abdominal pain, nausea, and/or loss of appetite.
Curriculum
