From the Guidelines
The diagnostic workup for chronic fatigue or malaise should start with a focused fatigue history and physical examination to identify potential underlying causes.
Key Components of Diagnostic Workup
- History:
- Onset, pattern, and duration of fatigue
- Change over time
- Associated or alleviating factors
- Disease Status Evaluation:
- Risk of recurrence based on stage, pathologic factors, and treatment history
- Review of systems to determine if other symptoms substantiate suspicion for recurrence
- Assessment of Treatable Contributing Factors:
- Comorbidities: cardiac dysfunction, endocrine dysfunction, pulmonary dysfunction, renal dysfunction, anemia, arthritis, neuromuscular complications, sleep disturbances, pain, emotional distress
- Medications: persistent use of sleep aids, pain medications, or antiemetics
- Lifestyle Factors: alcohol/substance abuse, nutritional issues, weight/caloric intake changes, deconditioning
Laboratory Evaluation
Consider performing laboratory evaluation based on the presence of other symptoms and the onset and severity of fatigue 1.
Referral to Specialist
The clinical team should decide when referral to an appropriately trained professional (e.g., cardiologist, endocrinologist, mental health professional, internist) is needed 1.
Evaluation for Moderate to Severe Fatigue
For moderate to severe fatigue, a more focused history and physical examination should be conducted, including a thorough assessment of the patient's current disease status, treatment history, and potential contributing factors 1.
From the Research
Diagnostic Workup for Chronic Fatigue
The diagnostic workup for chronic fatigue, also known as persistent tiredness or malaise, involves a comprehensive approach to identify the underlying cause of the condition. According to 2, 3, 4, 5, 6, the following steps are involved in the diagnostic workup:
- A comprehensive history to guide the workup and diagnosis
- Cardiopulmonary, neurologic, and skin examinations to identify any underlying medical conditions
- Classification of fatigue as physiologic, secondary, or chronic to determine the appropriate treatment approach
- Investigation of common causes of fatigue, such as sleep disorders, depression, and excessive psychosocial stress
- Simple laboratory tests, such as complete blood count and electrolyte panel, to rule out underlying medical conditions
- Watchful waiting and regularly scheduled follow-up to prevent an excessive focus on somatic causes and overdiagnosis
Common Causes of Chronic Fatigue
The common causes of chronic fatigue include:
- Sleep disorders and sleep-related disorders of breathing
- Depression and anxiety disorders
- Excessive psychosocial stress
- Previously undiagnosed cancer (rare)
- Anemia and other organic causes (rare)
- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a chronic and potentially debilitating disorder with demonstrated inflammatory, neurologic, immunologic, and metabolic abnormalities
Treatment Approach
The treatment approach for chronic fatigue depends on the underlying cause of the condition. According to 2, 3, 4, 5, 6, the following treatment approaches may be effective:
- Cognitive behavior therapy, exercise therapy, and acupuncture for ME/CFS and other chronic conditions
- Psychoeducative and psychotherapeutic approaches to address underlying psychiatric conditions
- Individually adapted exercise programs to improve physical function and reduce fatigue
- Treatment of underlying medical conditions, such as sleep disorders and depression, to alleviate fatigue symptoms
- Pacing activity to avoid exceeding limited energy capacity in patients with ME/CFS