From the Guidelines
Chronic fatigue syndrome (CFS) or persistent malaise diagnosis involves a comprehensive diagnostic assessment.
Diagnostic Workup
The diagnostic workup for CFS should include:
- A focused fatigue history to identify the onset, duration, and severity of fatigue, as well as any potential contributing factors 1
- A thorough medical examination to rule out underlying medical conditions that may be contributing to fatigue
- A review of body systems to identify any potential comorbid conditions
- A mental status examination to assess for any underlying mental health conditions that may be contributing to fatigue
- A minimum battery of laboratory tests to rule out underlying medical conditions that may be contributing to fatigue, such as anemia or thyroid dysfunction 1
Screening
Patients should be screened for fatigue using brief and validated tools, such as the Numerical Rating Scale (NRS), with a cut-off value of 4 out of 10 or higher indicating moderate to severe fatigue 1.
- Patients who screen positively for fatigue should undergo a comprehensive diagnostic assessment to identify treatable contributing and comorbid conditions 1.
From the Research
Diagnostic Criteria
The diagnostic workup for chronic fatigue syndrome (CFS) or persistent malaise involves a combination of clinical evaluation and exclusion of other medical and psychiatric causes of chronic fatiguing illness 2, 3, 4. 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 of the following physical symptoms:
- Postexertional malaise
- Unrefreshing sleep
- Impaired memory or concentration
- Muscle pain
- Polyarthralgia
- Sore throat
- Tender lymph nodes
- New headaches
Diagnostic Approach
The diagnosis of CFS is primarily by exclusion, with no definitive laboratory test or physical findings 2, 3. A full clinical history and physical examination are vital in establishing the diagnosis 4. The diagnostic approach should include:
- Evaluation for concurrent depression, pain, and sleep disturbances 3
- Consideration of differential diagnoses, such as chronic infections, endocrine diseases, and allergies 5
- Individualized investigation and therapy, with a coordinated team of specialists 5
Key Considerations
- CFS is a heterogeneous disorder, possibly involving an interaction of biologic systems 2
- Similarities with fibromyalgia exist, and concomitant illnesses include irritable bowel syndrome, depression, and headaches 2
- The precise etiology of CFS remains unknown, but recent advances and research discoveries are beginning to shed light on the enigma of this disease 6
- Management of patients with CFS is supportive symptomatic treatment with a patient-centered care approach 6