Chronic Fatigue Syndrome – Diagnosis and Treatment
Diagnosis
Key Signs Used for Diagnosis
Doctors use specific criteria to diagnose myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) because no single lab test confirms it.
They usually start by ruling out other illnesses with similar symptoms, such as insomnia, sleep apnea, diabetes, anemia, depression, or anxiety.
Severe, long-lasting tiredness that cannot be explained by another health problem is the main sign of ME/CFS. This tiredness should:
- Be new or clearly different from how the person felt before.
- Make it much harder to do everyday tasks and activities.
- Not get much better with rest.
- Get worse after physical, mental, or emotional effort.
People with ME/CFS must also have at least one of these problems:
- Trouble remembering things, staying focused, or thinking clearly.
- Feeling dizzy or faint, especially when moving from lying or sitting to standing.
These symptoms must be moderate to severe at least half the time and last for at least six months.
ME/CFS often shows up alongside other conditions with similar symptoms, like fibromyalgia, irritable bowel syndrome, and some sleep disorders. Some experts think ME/CFS and fibromyalgia may be connected.
Table: Common Signs Looked For in ME/CFS Diagnosis
| Symptom | Details |
|---|---|
| Severe tiredness | New, lasts 6+ months, limits activities |
| Memory or focus troubles | Problems with thinking or concentration |
| Dizziness | Gets worse when standing up |
| Not helped by rest | Sleep does not recharge energy |
| Worsening after effort | Tiredness increases after activity |
Doctors do not have specific lab markers or tests for ME/CFS right now. Researchers are studying possible biomarkers and cytokine levels to improve diagnosis in the future.
Doctors rely on a careful review of symptoms and rule out other causes, following guidance from trusted health organizations.
Treatment
Medicines for Symptoms
Some medicines help with certain symptoms of ME/CFS. For pain, people often try over-the-counter options like ibuprofen or naproxen sodium first.
If pain continues, doctors may suggest nerve pain medications, such as:
- Anticonvulsants used for nerve-related pain
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants (TCAs)
These medications are often used to manage chronic pain and may also be prescribed for other long-term nerve or musculoskeletal pain conditions.
| Symptom | Example Medications |
|---|---|
| Pain | Ibuprofen, Naproxen, Pregabalin, Gabapentin |
| Depression | Low-dose antidepressants |
| Orthostatic intolerance | Blood pressure and heart rhythm regulators |
Doctors may use certain medicines to help with dizziness caused by orthostatic intolerance. These medicines help keep blood pressure and heart rates steady.
Doctors may also prescribe antidepressants for those struggling with depression. These medications can help with mood, improve sleep, and relieve some pain.
Balancing Activity to Reduce Symptom Flare-Ups
People with ME/CFS often find their symptoms get worse after any effort, called post-exertional malaise. The pacing method helps manage this by planning activity and rest and avoiding overdoing things.
People can keep a simple diary to track daily activities and how they feel. This helps them spot patterns and find a balance between activity and rest. The goal is to prevent flare-ups by not pushing too hard.
Improving Rest and Sleep-Related Issues
Sleep problems can make ME/CFS worse. People can try to keep a regular bedtime, avoid caffeine, and make their bedroom calm and dark.
Treating sleep disorders like sleep apnea or narcolepsy is important. For sleep apnea, a machine can give steady air through a mask during sleep to help with breathing.
Some antidepressants may help improve sleep while treating mood issues. Healthcare professionals work with patients to find the right combination of habits, medication, and therapies for better rest.
Other Therapy Options
Some people with ME/CFS try therapies like acupuncture or certain supplements for relief. These may help with problems such as pain, headaches, fibromyalgia, and dizziness.
It is important to avoid expensive or risky treatments. For gut issues like irritable bowel syndrome, gentle dietary changes may be safer.
Handling Daily Life and Finding Help
Managing ME/CFS often means dealing with emotional challenges such as depression, stress, and anxiety. Counseling can help people cope with fatigue, changes at work or school, and family issues.
Talking to a mental health professional may also support those struggling with feelings of sadness.
| Support Option | Possible Benefits |
|---|---|
| Counseling | Builds stress management skills |
| Support Groups | Connects with others in similar situations |
| Online Communities | Provides tips and understanding |
Some people benefit from joining group discussions or online forums for a sense of community. Others may not find groups helpful, so it is important to choose support options that match personal needs.
Getting Ready for Your Visit
Steps You Can Take
Patients who prepare for their healthcare visit often get more out of it. Writing down all symptoms, not just tiredness, helps the healthcare team understand the situation better.
This list might include headaches, trouble remembering things, or poor concentration. It also helps to note important events or stresses that might affect health.
Listing all medicines, vitamins, and supplements taken is important for safety. Writing down questions in advance makes it easier to remember what to discuss during the visit.
| Questions to Consider |
|---|
| What might be causing these symptoms? |
| What tests do you think I need? |
| Are any treatments or lifestyle updates recommended? |
| Should I change my daily activity level? |
| Should I see another specialist, like a counselor? |
Bringing a notebook or using a phone to write down answers from the doctor helps patients remember later. Patients should feel comfortable asking any new questions that come up during the conversation.
How the Doctor May Respond
A healthcare provider will likely ask several questions to learn more about the symptoms.
They often ask when symptoms started and what makes them better or worse. The doctor may also ask if you have any problems with sleep, memory, or focusing. Mood and daily activities are important, too.
The doctor may ask how much symptoms interfere with school, work, or family life. They might want to know if you have had to skip normal activities because of your health.
The doctor will likely ask what treatments or changes you have already tried. They may suggest certain tests or next steps based on your answers.
