Chronic Fatigue Syndrome- symptom /investigation check list
Symptoms for Suspecting ME/CFS NICE Guidlines
Explain to people presenting with possible symptoms of ME/CFS that there currently is no diagnostic test for ME/CFS and it is recognised on clinical grounds alone.
1.2.2Suspect ME/CFS if:
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the person has had all of the persistent symptoms in box 2 for a minimum of 6 weeks in adults and 4 weeks in children and young people and
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the person's ability to engage in occupational, educational, social or personal activities is significantly reduced from pre‑illness levels and
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symptoms are not explained by another condition.
Symptoms for Suspecting ME/CFS
All of these symptoms should be present:
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Debilitating fatigue that is worsened by activity, is not caused by excessive cognitive, physical, emotional or social exertion, and is not significantly relieved by rest.
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is often delayed in onset by hours or days
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is disproportionate to the activity
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has a prolonged recovery time that may last hours, days, weeks or longer.
Post-exertional malaise after activity in which the worsening of symptoms:
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feeling exhausted, feeling flu-like and stiff on waking
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broken or shallow sleep, altered sleep pattern or hypersomnia.
Unrefreshing sleep or sleep disturbance (or both), which may include:
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Cognitive difficulties (sometimes described as 'brain fog'), which may include problems finding words or numbers, difficulty in speaking, slowed responsiveness, short-term memory problems, and difficulty concentrating or multitasking.
If ME/CFS is suspected, carry out:
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a medical assessment (including symptoms and history, comorbidities, overall physical and mental health)
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a physical examination
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an assessment of the impact of symptoms on psychological and social wellbeing
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investigations to exclude other diagnoses, for example (but not limited to):
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urinalysis for protein, blood and glucose
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full blood count
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urea and electrolytes
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liver function
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thyroid function
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erythrocyte sedimentation rate or plasma viscosity
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C-reactive protein
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calcium and phosphate
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HbA1c
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serum ferritin
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coeliac screening
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creatine kinase.
Use clinical judgement to decide on additional investigations to exclude other diagnoses (for example, vitamin D, vitamin B12 and folate levels; serological tests if there is a history of infection; and 9am cortisol for adrenal insufficiency).
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Clinical support group
- Cancer, Palliative Care, Pain and Older People
- Dermatology, MSK and Rheumatology
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