From the Guidelines
Diagnosing chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), requires a thorough clinical evaluation as there is no single test to confirm it, and diagnosis is typically made after excluding other medical conditions that could explain the symptoms, as recommended by the 2021 US Department of Veterans Affairs and US Department of Defense clinical practice guideline 1.
Key Diagnostic Criteria
The diagnosis of CFS/ME is based on the presence of severe fatigue lasting at least six months that significantly impairs daily activities, does not improve with rest, and is accompanied by at least four of the following symptoms:
- Post-exertional malaise (worsening of symptoms after physical or mental activity)
- Unrefreshing sleep
- Cognitive impairment
- Orthostatic intolerance (symptoms that worsen when standing upright)
- Either muscle pain or joint pain, headaches, tender lymph nodes, or sore throat
Diagnostic Process
The diagnosis process can be challenging and time-consuming because symptoms overlap with many other conditions, and patients often need to see multiple specialists before receiving a diagnosis. Blood tests, urinalysis, and other diagnostic tests may be performed to rule out conditions like thyroid disorders, anemia, autoimmune diseases, sleep disorders, and mental health conditions.
Importance of Early Diagnosis
Early diagnosis is important for developing appropriate management strategies, which typically include pacing activities, cognitive behavioral therapy, and sometimes medications to address specific symptoms like pain or sleep disturbances, as suggested by the clinical practice guideline 1. The guideline recommends offering cognitive-behavioral therapy for CMI and symptoms consistent with fibromyalgia, irritable bowel syndrome, or myalgic encephalomyelitis/chronic fatigue syndrome 1.
Management Strategies
Management strategies for CFS/ME may also include mindfulness-based therapies, which have been shown to be effective in improving symptoms and quality of life, as reported in a study published in the Mayo Clinic Proceedings 1. The study found that cognitive-behavioral therapy had the greatest evidence, with multiple studies consistently finding significant improvement in health function, health-related quality of life, or physical function 1.
From the Research
Diagnosis of Chronic Fatigue Syndrome
- Chronic fatigue syndrome (CFS) is characterized by persistent, medically unexplained fatigue, as well as symptoms such as musculoskeletal pain, sleep disturbance, headaches, and impaired concentration and short-term memory 2.
- The Centers for Disease Control and Prevention (CDC) criteria for CFS include severe fatigue lasting longer than six months, as well as the presence of at least four physical symptoms, such as postexertional malaise, unrefreshing sleep, impaired memory or concentration, muscle pain, polyarthralgia, sore throat, tender lymph nodes, or new headaches 3.
- Diagnosis of CFS is primarily by exclusion, with no definitive laboratory test or physical findings, and medical research continues to examine the many possible etiologic agents for CFS 4.
Diagnostic Criteria
- The 1994 CDC criteria for CFS include a comprehensive approach to its definition and study, with recommendations for the clinical evaluation of fatigued persons, a revised case definition of CFS, and a strategy for subgrouping fatigued persons in formal investigations 5.
- The diagnosis of CFS can be made only when other disease processes are excluded, and it is a clinical diagnosis that requires a thorough evaluation of the patient's symptoms and medical history 3.
Treatment and Management
- Treatment options for CFS include cognitive behavior therapy (CBT) and graded exercise therapy (GET), both of which have been shown to moderately improve fatigue levels, work and social adjustment, anxiety, and postexertional malaise 3, 6.
- Exercise therapy has been shown to be effective in reducing fatigue and improving physical functioning, sleep, and self-perceived changes in overall health, with no evidence suggesting that it may worsen outcomes 2.
- A comprehensive treatment plan for CFS should include a thorough clinical assessment, rehabilitative treatments, and collaboration with the patient to develop a personalized treatment plan 6.