BMJ Best Practice Guide, updated Nov 2017: Chronic fatigue syndrome
Written by Dr James N Baraniuk
Reviewed by Dr Rosemary Vallings, Dr Abijhit Chaudhuri
Summary:
Chronic fatigue syndrome (CFS) is characterised by a sudden or gradual onset of persistent disabling fatigue, post-exertional malaise (PEM, exertional exhaustion), unrefreshing sleep, cognitive and autonomic dysfunction, myalgia, arthralgia, headache, and sore throat and lymph nodes, with symptoms lasting at least 6 months.
Exertional exhaustion is the critical aspect that distinguishes myalgic encephalomyelitis/CFS from other nociceptive, interoceptive, and fatiguing illnesses.
The lack of energy may be caused by autoimmune and metabolomic dysfunction that reduces mitochondrial ATP production.
The primary goals of management are to provide a supportive healthcare environment with a team of occupational, physio, and other appropriate therapists who will manage symptoms and improve functional capacity.
The chronic but fluctuating disabilities require substantial lifestyle changes to plan each day’s activities carefully, conserve energy resources for the most important tasks, schedule rest periods to avoid individuals overtaxing themselves, and to improve the quality of sleep.
Medications are not curative. Pharmacotherapy is indicated to treat pain, migraine, sleep disturbance, and comorbid conditions such as irritable bowel syndrome, anxiety, or depression.
More information (mostly behind a paywall) on:
Definition
Theory: Epidemiology; Aetiology; Case history
Diagnosis: Approach; History and exam; Investigations; Differentials; Criteria
Management: Approach; Treatment algorithm; Emerging; Patient discussions
Follow up: Monitoring; Complications; Prognosis
Resources: Guidelines; References; Patient leaflets; Evidence
Comment:
Virology blog post, by Steven Lubet and David Tuller, 13 Nov 2017: Trial By Error : The Surprising New BMJ Best Practice Guide
Something has changed.
That’s the only explanation for the recent publication of a “Best Practice” guide for “chronic fatigue syndrome” (behind a paywall, unfortunately) from the BMJ Publishing Group. This thing is good. It’s very good, in fact. One bottom line at this stage for any treatment guide is the following: Would it lead a clinician to prescribe cognitive behavior therapy or graded exercise therapy for patients with ME, as opposed to those suffering from a vague fatiguing illness? The answer here is an unequivocal no.
