Chronic Fatigue Syndrome: Diagnosis to Management

Nisenbaum R, Jones JF, Unger ER, Reyes M, Reeves WC. A population based study of the clinical course of chronic fatigue syndrome. Health Qual Life Outcomes. 2003;1:49.
Buchwald D, Pearlman T, Umali J, Schmaling K, Katon W. Functional status in patients with chronic fatigue syndrome. Am J Med. 1996;101:364-370.
Christodoulou C, DeLuca J, Lange G, et al. Relation between neuropsychological impairment and functional disability in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatr. 1998;64:431-434.
Reeves WC, Jones JF, Maloney E, et al. Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia. Popul Health Metr. 2007;5:5.
Kennedy CL, Song S, Johnson D, Torres S. Chronic fatigue syndrome: occupation, medical utilization, and subtypes in a community-based sample. J Nerv Ment Dis. 2000;188:568-576.
Reyes M, Nisenbaum R, Hoaglin DC, et al. Prevalence and incidence of chronic fatigue syndrome in Wichita, Kansas. Arch Intern Med. 2003;163:1530-1536.
Jason LA, Benton MC, Valentine L, Johnson A, Torres-Harding S. The economic impact of ME/CFS; individual and societal costs. Dyn Med. 2008;7:6.
Jones JF, Nisenbaum R, Solomon L, Reyes M, Reeves WC. Chronic fatigue syndrome and other fatiguing illnesses in adolescents: a population based study. J Adolesc Health. 2004;35:34-40.
Johnson SK, DeLuca J, Nateslon BH. Chronic fatigue syndrome: reviewing the research findings. Ann Behav Med. 1999;21:258-271.
Moss-Morris R, Petrie KJ. Discriminating between chronic fatigue syndrome and depression: a cognitive analysis. Psychol Med. 2001;31:469-479.
Lapp CW. Differentiating CFS from depression. CFS Res Rev. 2006;7:4-7.
Erdman KM. How biological abnormalities separate CFS from depression. JAAPA. 2008;21:19-23.
Bowen J, Pheby D, Charlett A, McNulty C. Chronic fatigue syndrome: a survey of GP's attitudes and knowledge. Fam Pract. 2005;22:389-393.
Harmon M. Developing an individualized treatment plan for chronic fatigue syndrome. CFS Res Rev. 2007;8:4-7.
Shlaes JL, Jason LA, Ferrari JR. The development of the Chronic Fatigue Syndrome Attitudes Test: a psychometric analysis. Eval Health Prof. 1999;22:442-465.
Cairns R, Hotopf M. A systematic review describing the prognosis of chronic fatigue syndrome. Occup Med (Lond). 2005;55:20-31.
Reyes M, Gary HE Jr, Dobbins JG, et al. Surveillance for chronic fatigue syndrome -- four U.S. cities, September 1989 through August 1993. MMWR CDC Surveill Summ. 1997;46:1-13.
Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121:953-959.
Reeves WC, Wagner D, Nisenbaum R, et al. Chronic fatigue syndrome -- a clinically empirical approach to its definition and study. BMC Med. 2005;15:19.
Dobbins JG, Randall B, Reyes M, Steele L, Livens EA, Reeves WC. Prevalence of chronic fatiguing illness among adolescents in the United States. J Chronic Fatigue Syndr. 1997;3:15-28.
Jason LA, Jordan K, Miike T, et al. A pediatric case definition for myalgic encephalomyelitis and chronic fatigue syndrome. J Chronic Fatigue Syndr. 2006;13:1-44.
Nisenbaum R, Reyes M, Unger ER, Reeves WC. Factor analysis of symptoms among subjects with unexplained chronic fatigue: what can we learn about chronic fatigue syndrome? J Psychosom Res. 2004;56:171-178.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473-483.
Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39:315-325.
Melsack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975;1:277-299.
Bell DS. The Doctor's Guide to Chronic Fatigue Syndrome. Reading, Mass: Addison-Wesley Publishing Co; 1995:122-123.
Lapp C. Subjective Functional Capacity Assessment Scale. Hunter-Hopkins Center, Charlotte, NC. Available at the CFIDS Association of America, e-mail [email protected]
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193-213.
Wagner D, Nisenbaum R, Heim C, Jones JF, Unger ER, Reeves WC. Psychometric properties of the CDC Symptom Inventory for assessment of chronic fatigue syndrome. J Mental Health. 2005;14:213-221.
Aaron LA, Buchwald D. A review of the evidence of overlap among unexplained clinical conditions. Ann Intern Med. 2001;134:868-881.
Cullen W, Kearney Y, Bury G. Prevalence of fatigue in general practice. Ir J Med Sci. 2002;171:10-12.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-370.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
Zung W. A self-rating depression scale. Arch Gen Psychiatry. 1965;12:63-70.
Lutgendorf SK, Antoni MH, Ironson G, et al. Physical symptoms of chronic fatigue syndrome are exacerbated by the stress of Hurricane Andrew. Psychosom Med. 1995;57:310-323.
Alonzo AA. The experience of chronic illness and posttraumatic stress disorder. Soc Sci Med. 2000;50:1475-1484.
Klausner E, Koenigsberg H, Skolnick N, Chung H. Perceived familial criticism and glucose control in insulin-dependent diabetes mellitus. Int J Ment Health. 1995;42:64-75.
Cohen S. Psychosocial models of the role of social support in the etiology of physical disease. Health Psychol. 1998;7:262-297.
Thoits PA. Social support as coping assistance. J Consult Clin Psychol. 1986;54:416-423.
Umberson D. Gender, marital status and the social control of health behavior. Soc Sci Med. 1992;34:907-917.
Taggart HM, Arslanian CL, Bae S, Singh K. Effects of T'ai Chi exercise on fibromyalgia symptoms and health-related quality of life. Orthop Nurs. 2003;22:353-360.
Afari N, Buchwald D. Chronic fatigue syndrome: a review. Am J Psychiatry. 2003;160:221-236.
Friedberg F, Leung DW, Quick J. Do support groups help people with CFS and FM? A comparison of active and inactive members. J Rheumatol. 2005;32:2416-2420.
Evengard B, Klimas N. Chronic fatigue syndrome: probable pathogenesis and possible treatments. Drugs. 2002;62:2433-2446.
Grant JE, Veldee MS, Buchwald D. Analysis of dietary intake and selected nutrient concentrations in patients with chronic fatigue syndrome. J Am Diet Assoc. 1996;96:383-386.
Werbach MR. Nutritional strategies for treating chronic fatigue syndrome. Altern Med Rev. 2000;5:93-108.
Jones JF, Nisenbaum R, Reeves WC. Medication use by persons with chronic fatigue syndrome: results of a randomized telephone survey in Wichita, Kansas. Health Qual Life Outcomes. 2003;1:74.
Unger ER, Nisenbaum R, Moldofsky H, et al. Sleep assessment in a population-based study of chronic fatigue syndrome. BMC Neurol. 2004;4:6.
Vercoulen JH, Swanink CM, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G. Dimensional assessment of chronic fatigue syndrome. J Psychosom Res. 1994;38:383-392.
Bell DS. Sleep in CFS. Lyndonvillle News. 2005;2:1-9.
Harmon M. Clinical care for chronic fatigue syndrome. CFIDS Chronicle. 2006;19:48-59.
Bateman L. Pearls of wisdom from a CFS physician. CFIDS Chronicle. 2008;21:24-27.
Spanos A. What a pain. CFIDS Chronicle. 2005;18:10-13.
Spanos A. Treating the pain in CFIDS: effective pain relief is hard to get. CFIDS Chronicle. 1998;11:9-12.
Rowe PC, Bou-Holaigah I, Kan JS, Calkins H. Is neurally mediated hypotension an unrecognised cause of chronic fatigue? Lancet. 1995;345:623-624.
Freeman R, Komaroff AL. Does the chronic fatigue syndrome involve the autonomic nervous system? Am J Med. 1997;102:357-364.
Stewart JM, Gewitz MH, Weldon A, Arlievsky N, Li K, Munoz J. Orthostatic intolerance in adolescent chronic fatigue syndrome. Pediatrics. 1999;103:116-121.
Tiersky L, DeLuca J, Hill N, et al. Longitudinal assessment of neuropsychological functioning, psychiatric status, functional disability and employment status in chronic fatigue syndrome. Appl Neuropsychol. 2001;8:41-50.
de Lange FP, Kalkman JS, Bleijenberg G, et al. Neural correlates of the chronic fatigue syndrome -- an fMRI study. Brain. 2004;127:1948-1957.
DeLuca J, Johnson SK, Ellis SP, Natelson BH. Cognitive functioning is impaired in patients with chronic fatigue syndrome devoid of psychiatric disease. J Neurol Neurosurg Psychiatry. 1997;62:151-155.
Taylor RR, Kielhofner G. An occupational therapy approach to persons with chronic fatigue syndrome: part two, assessment and intervention. Occup Ther Health Care. 2003;17:63-87.
Krupp LB, Jandorf L, Coyle PK, Mendelson WB. Sleep disturbance in chronic fatigue syndrome. J Psychsom Res. 1993;37:325-331.
Fossey M, Libman E, Bailes S, et al. Sleep quality and psychological adjustment in CFS. J Behav Med. 2004;27:581-605.
Rimes KA, Chalder T. Treatments for chronic fatigue syndrome. Occup Med (Lond). 2005;55:32-39.
Whiting P, Bagnall A, Sowden A, Cornell J, Mulrow C, Ramirez G. Interventions for the treatment and management of chronic fatigue syndrome. JAMA. 2001;286:1360-1368.
Komaroff AL, Buchwald D. Symptoms and signs of chronic fatigue syndrome. Rev Infect Dis. 1991;13(suppl 1)S8-S11.
Bailey SP. Chronic fatigue syndrome. In: ACSM's Guidelines for Exercise Testing and Prescription. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:186-191.
McCully KK, Sisto SA, Natelson BH. Use of exercise for treatment of chronic fatigue syndrome. Sports Med. 1996;21:35-48.
Lloyd AR. To exercise or not to exercise in chronic fatigue syndrome? No longer a question. Med J Aust. 2004;180:437-438.
Goshorn RK. Chronic fatigue syndrome: a review for clinicians. Semin Neurol. 1998;18:237-242.
Emms TM, Roberts TK, Butt HL, Buttfield I, McGregor NR, Dunstan, RH. Food intolerance as a co-morbidity in chronic fatigue syndrome [Abstract No. 15]. Program and abstracts of the Fifth International Research, Clinical and Patient Conference; American Association for Chronic Fatigue Syndrome; January 26-29, 2001; Seattle, Washington.
Logan AC, Bested AC. Chronic fatigue syndrome; an assessment of dietary/herbal intake by patients in a clinical setting. Program and abstracts of the Sixth International Conference on Chronic Fatigue Syndrome, Fibromyalgia and Related Illnesses; January 30-February2, 2003; Chantilly, Virgina.
Verrillo EF, Gellman, LM. Chronic Fatigue Syndrome: A Treatment Guide. New York, NY: St. Martin's Griffin; 1997.
Wallman, KE, Morton AR, Goodman C, Grove R, Guilfoyle AM. Randomized controlled trial of graded exercise in chronic fatigue syndrome. Med J Aust. 2004;180:444-448.
Taylor RR, Friedberg F, Jason LA. A Clinician's Guide to Controversial Illnesses: Chronic Fatigue Syndrome, Fibromyalgia and Multiple Chemical Sensitivities. Sarasota, Fl: Professional Resource Press; 2001:63-86.
Bleijenberg G, Prins J, Bazelmans E. Cognitive-behavioral therapies. In: Jason LA, Fennell PA, Taylor RR, eds. Handbook of Chronic Fatigue Syndrome. 1st ed. Hoboken, NJ: John Wiley and Sons; 2003:493-526.
Pesek JR, Jason LA, Taylor RR. An empirical investigation of the envelope theory. J Human Behav Soc Environ. 2000;3:59-77.
Stevens S. A realistic approach to exercise and exercise rehabilitation in CFS. Program and abstracts of the Advances in Understanding and Treating CFS and FM Conference; May 15, 2004; Salt Lake City, Utah.
Fulcher KY, White PD. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. BMJ. 1997;314:1647-1652.
VanNess JM, Snell CR, Trayer DR, Dempsey L, Stevens SR. Subclassifying chronic fatigue syndrome through exercise testing. Med Sci Sports Exerc. 2003;35:908-913.
Kopp WJ, Lyden A, Berlin AA, et al. Ambulatory monitoring of physical activity and symptoms in fibromyalgia and chronic fatigue syndrome. Arthritis Rheum. 2005;52:296-303.
Deale A, Husain K, Chalder T, Wessely S. Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study. Am J Psychiatry. 2001;158:2038-2042.
Reid S, Chalder T, Cleare A, Hotopf M, Wessely S. Extracts from clinical evidence: chronic fatigue syndrome. BMJ. 2000;320:292-296.
Prins JB, Bleijenberg G, Bazelmans E, et al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet. 2001;357:841-847.
Edmonds M, McGuire H, Price J. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2004;(3):CD003200.
Natelson BH. Your Symptoms Are Real: What to Do When Your Doctor Says Nothing Is Wrong. Hoboken, NJ: John Wiley & Sons; 2007.

As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Author(s)

Marcia Harmon

Director of Communications, CFIDS Association of America, Charlotte, North Carolina

Disclosures

Disclosure: Marcia Harmon has disclosed no relevant financial relationships.

Lucinda Bateman, MD

Director, Fatigue Consultation Clinic, Salt Lake Regional Hospital, Salt Lake City, Utah

Disclosures

Disclosure: Lucinda Bateman, MD, has disclosed that she serves as principal investigator for a phase 3 drug trial for Hemispherx Biopharma.

Charles Lapp, MD

Assistant Consulting Professor, Duke University Medical Center, Durham, North Carolina; Medical Director, Hunter-Hopkins Center, Charlotte, North Carolina

Disclosures

Disclosure: Charles W. Lapp, MD, has disclosed that he has received grants for clinical research from Pfizer, Eli Lilly, Schwarz, and Boehringer Ingelheim. Dr. Lapp has also disclosed that he has served as a speaker for Pfizer and Eli Lilly.

K. Kimberly McCleary

President and CEO, The CFIDS Association of America, Charlotte, North Carolina

Disclosures

Disclosure: K. Kimberly McCleary has disclosed no relevant financial relationships.

Reviewer

Laurie E. Scudder, MS, NP-C

Nurse Planner, Medscape; Adjunct Assistant Professor, School of Health Sciences, George Washington University, Washington, DC; Curriculum Coordinator, Nurse Practitioner Alternatives, Inc., Ellicott City; Nurse Practitioner, Baltimore City School-Based Health Centers, Baltimore, Maryland

Disclosures

Disclosure: Laurie E. Scudder, MS, NP-C, has disclosed that she has no relevant financial relationships.

Editor

Susan Yox, RN, EdD

Editorial Director, Medscape Nurses

Disclosures

Disclosure: Susan Yox, RN, EdD, has disclosed no relevant financial relationships.

processing....

Conclusion

The prevalence of CFS and the level of debilitation and disability that can accompany the illness -- and the cost to our healthcare system and economy -- result in a burden of illness of considerable dimensions. Although CFS is complex, and there is no cure, clinicians and the broader healthcare community can help reduce the burden of this illness through early diagnosis and intervention.

Diagnosing CFS can be time-consuming because symptoms are common to other diseases, and there is no diagnostic test. However, the process of sorting through symptoms and assessing abnormalities is no different from clinical assessment of other conditions. Like many other diseases, CFS symptoms form a specific pattern that, when combined with exclusionary laboratory tests, are diagnostic.

Effectively managing CFS is more challenging than diagnosing the illness, but there are many treatment options that can help. Working together, clinicians and patients can develop individualized treatment plans to reduce symptoms, improve function, and enhance quality of life. Establishing a good patient/provider partnership can also help break the cycle of frustration that often occurs between clinicians and patients who have difficult-to-manage chronic illnesses.

Post-Assessment: Measuring Educational Impact

Thank you for participating in the CME/CE activity. Please take a few moments to read the following cases and complete the questions that follow to help us assess the effectiveness of this medical education activity.

« Back

Page 9 of 10

References

Faculty and Disclosures

Author(s)

Marcia Harmon

Lucinda Bateman, MD

Charles Lapp, MD

K. Kimberly McCleary

Reviewer

Laurie E. Scudder, MS, NP-C

Editor

Susan Yox, RN, EdD

Chronic Fatigue Syndrome: From Diagnosis to Management

Conclusion

Post-Assessment: Measuring Educational Impact