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:

  • 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

  • the person's ability to engage in occupational, educational, social or personal activities is significantly reduced from pre‑illness levels and

  • symptoms are not explained by another condition.

Symptoms for Suspecting ME/CFS

All of these symptoms should be present:

  • 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.

    • is often delayed in onset by hours or days

    • is disproportionate to the activity

    • has a prolonged recovery time that may last hours, days, weeks or longer.

      Post-exertional malaise after activity in which the worsening of symptoms:

    • feeling exhausted, feeling flu-like and stiff on waking

    • broken or shallow sleep, altered sleep pattern or hypersomnia.

      Unrefreshing sleep or sleep disturbance (or both), which may include:

  • 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:

  • a medical assessment (including symptoms and history, comorbidities, overall physical and mental health)

  • a physical examination

  • an assessment of the impact of symptoms on psychological and social wellbeing

  • investigations to exclude other diagnoses, for example (but not limited to):

    • urinalysis for protein, blood and glucose

    • full blood count

    • urea and electrolytes

    • liver function

    • thyroid function

    • erythrocyte sedimentation rate or plasma viscosity

    • C-reactive protein

    • calcium and phosphate

    • HbA1c

    • serum ferritin

    • coeliac screening

    • 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).

 

  • Clinical support group
    • Cancer, Palliative Care, Pain and Older People
    • Dermatology, MSK and Rheumatology

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