From the Guidelines
Chronic fatigue syndrome (CFS) diagnosis involves a comprehensive laboratory evaluation to rule out other conditions that could cause similar symptoms, with a focus on complete blood count, comprehensive metabolic panel, and endocrinologic evaluation, as recommended by the American Society of Clinical Oncology clinical practice guideline adaptation 1. When evaluating chronic fatigue, it's essential to consider the presence of other symptoms, onset, and severity of fatigue to guide the laboratory evaluation.
- Key laboratory tests include:
- Complete blood cell count with differential to compare end-of-treatment hemoglobin/hematocrit with current values and assess other cell lines (WBC and platelets) 1.
- Comprehensive metabolic panel to assess electrolytes, hepatic, and renal function 1.
- Endocrinologic evaluation, including thyroid-stimulating hormone (TSH), and considering a more comprehensive evaluation or referral to a specialist if other symptoms are present 1. Additional testing may be necessary based on individual patient factors, but these core laboratory evaluations provide a foundation for diagnosing and managing chronic fatigue.
- It's crucial to interpret laboratory results in the context of clinical criteria, including persistent, unexplained fatigue lasting at least six months that isn't relieved by rest, post-exertional malaise, unrefreshing sleep, and cognitive difficulties, as normal lab results do not rule out CFS/ME. Working with healthcare providers familiar with CFS/ME is vital for proper evaluation and management, as they can help navigate the complex diagnostic process and develop an effective treatment plan.
From the Research
Chronic Fatigue Syndrome Diagnosis
- Chronic fatigue syndrome is characterized by debilitating fatigue that is not relieved with rest and is associated with physical symptoms 2
- The Centers for Disease Control and Prevention criteria for chronic fatigue syndrome include severe fatigue lasting longer than six months, as well as 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; or new headaches 2, 3
- A comprehensive history and cardiopulmonary, neurologic, and skin examinations help guide the workup and diagnosis of fatigue 4
Chronic Fatigue Syndrome Management
- Treatment options for chronic fatigue syndrome include cognitive behavior therapy and graded exercise therapy, both of which have been shown to moderately improve fatigue levels, work and social adjustment, anxiety, and postexertional malaise 2
- Cognitive behavior therapy, exercise therapy, and acupuncture may help with some of the fatigue associated with chronic conditions 4
- Management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) should prioritize comorbidities and symptoms based on severity, and patients should be educated about pacing their activity not to exceed their limited energy capacity 4
- Minimally invasive management involving transcutaneous electrical acupoint stimulation of target points has demonstrated significant improvement in fatigue and associated symptoms in a 2017 randomized controlled study 3
Chronic Fatigue Syndrome Etiology
- The etiology of chronic fatigue syndrome is unclear, is likely complex, and may involve dysfunction of the immune or adrenal systems, an association with certain genetic markers, or a history of childhood trauma 2
- There is a potential association between dysfunction of the autoimmune, neuroendocrine, or autonomic nervous systems and the development of chronic fatigue syndrome 3
- Possible triggering events, such as infections followed by an immune dysregulation resulting have also been proposed 3