Chronic Fatigue Syndrome: Diagnosis and Treatment
Chronic Fatigue Syndrome: Diagnosis and Treatment
Chronic Fatigue Syndrome: Diagnosis and Treatment
Chronic fatigue syndrome is characterized by debilitating fatigue that is not relieved with rest and is associated with
physical symptoms. 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. It is a clinical diagnosis that can be made only when other disease
processes are excluded. 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. Persons with chronic fatigue syndrome should be evaluated for concurrent depression, pain, and sleep disturbances. Treatment options 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. No
pharmacologic or alternative medicine therapies have been proven effective. (Am Fam Physician. 2012;86(8):741-746.
Copyright 2012 American Academy of Family Physicians.)
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time, are the most widely accepted diagnostic criteria for CFS (Table 2).7
The general approach to a patient with
chronic fatigue should start with a history
and physical examination, focusing on identifying the most bothersome symptoms and
Chest pain
Focal neurologic deficits
Cardiac disease
Central nervous system malignancy or
abscess, multiple sclerosis
Autoimmune disease (e.g., rheumatoid
arthritis, systemic lupus erythematosus)
Malignancy
Inflammatory signs or
joint pain
Lymphadenopathy or
weight loss
Shortness of breath
Pulmonary disease
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interact with each other. These complex factors, along with the numerous psychiatric
comorbidities of CFS, have led some experts
to question whether any organic etiology
exists. Current research on CFS focuses on
the immune and adrenal systems, genetics,
the biopsychosocial model, and sleep and
nutrition.
patients without CFS.16 This is likely secondary to impaired adrenal cortex responsiveness
to adrenocorticotropic hormones and not
to hypothalamopituitary dysfunction.17 It is
unclear if such dysfunction is caused by infection, genetics, childhood trauma, unknown
factors, or some combination of these.
IMMUNE SYSTEM
Treatment
Family physicians should focus initially
on management of symptoms that are
often comorbid with CFS, including sleep
disturbances, depression, and pain. Any
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Neurologic
Dementia
Multiple sclerosis
Narcolepsy
Parkinson disease
Psychiatric
Bipolar disorder
Eating disorder
Major depressive
disorder
Schizophrenia
Somatoform
disorders
Substance abuse
Rheumatologic
Dermatomyositis
Fibromyalgia
Rheumatologic (continued)
Polymyalgia rheumatica
Polymyositis
Rheumatoid arthritis
Sjgren syndrome
Systemic lupus
erythematosus
Temporal arteritis
Other
Celiac disease
Heart failure
Heavy metal toxicity
Pharmacologic adverse
effect
Sleep apnea
Vitamin deficiency
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PHARMACOLOGIC THERAPY
The Authors
JOSEPH R. YANCEY, MD, is a staff physician in the National
Capitol Consortiums Family Medicine Residency at Fort
Belvoir (Va.) Community Hospital, and an associate professor of family medicine at the Uniformed Services University of the Health Sciences in Bethesda, Md.
SARAH M. THOMAS, MD, is a family medicine staff physician at Fairchild Air Force Base, Wash.
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