CHRONIC FATIGUE

CHRONIC FATIGUE

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Quick reference guide
Issue date: August 2007
Chronic fatigue syndrome/myalgic
encephalomyelitis (or encephalopathy)
Diagnosis and management of CFS/ME in adults
and children
NICE clinical guideline 53
Developed by the National Collaborating Centre for Primary Care

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CFS/ME
About this booklet
This is a quick reference guide that summarises the recommendations NICE has made to the NHS in
`Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and
management of CFS/ME in adults and children' (NICE clinical guideline 53).
Who should read this booklet?
This quick reference guide is for GPs, other staff in primary care, and specialist healthcare
professionals who care for people with CFS/ME.…read more

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CFS/ME Contents
Contents
Key priorities for implementation 4
Patient-centred care 5
Presentation, diagnosis and pathway of care 6
General principles of care 9
General management strategies after diagnosis 11
Specialist CFS/ME care 17
Key to terms 21
Implementation 23
Further information 23
Introduction
Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy) (CFS/ME) is a relatively
common illness: a general practice with 10,000 patients is likely to have up to 40 patients with
CFS/ME.…read more

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CFS/ME Key priorities for implementation
Key priorities for implementation
General principles of care
G Shared decision-making between the person with CFS/ME and healthcare professionals should
take place during diagnosis and all phases of care. The healthcare professional should:
­ Acknowledge the reality and impact of the condition and the symptoms.
­ Provide information about the range of interventions and management strategies as detailed in
this guideline (such as the benefits, risks and likely side effects).…read more

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CFS/ME Key priorities for implementation
G Healthcare professionals should proactively advise about fitness for work and education, and
recommend flexible adjustments or adaptations to work or studies to help people with CFS/ME
to return to them when they are ready and fit enough.…read more

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Presentation, diagnosis and pathway
CFS/ME of care
Presentation, diagnosis and pathway of care
CFS/ME is recognised on clinical Person presents with symptoms that
grounds alone. Primary healthcare may indicate CFS/ME (see box 1)
professionals should be able to
identify the characteristic
features of CFS/ME. Do an initial assessment
· Take a full history (including exacerbating and alleviating
factors, sleep disturbance, intercurrent stressors).
· Examine the person.
· Assess their psychological wellbeing.…read more

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Presentation, diagnosis and pathway
CFS/ME of care
Box 1 Symptoms that may indicate CFS/ME
Consider the possibility of CFS/ME if a person has:
G fatigue with all of the following features:
­ new or had a specific onset (that is, it is not life long)
­ persistent and/or recurrent
­ unexplained by other conditions
­ has resulted in a substantial reduction in activity level characterised by post-exertional malaise
and/or fatigue (typically delayed, for example by at least 24 hours, with slow recovery over
several days)…read more

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Presentation, diagnosis and pathway
CFS/ME of care
Box 3 Investigations
These tests should usually be done:
G random blood glucose
G urinalysis for protein, blood and glucose
G serum creatinine
G full blood count
G screening blood tests for gluten sensitivity
G urea and electrolytes
G serum calcium
G liver function
G creatine kinase
G thyroid function
G assessment of serum ferritin levels (children
G erythrocyte sedimentation rate or plasma
and young people only).…read more

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CFS/ME General principles of care
General principles of care
Shared decision-making
G Share decision-making with the person with CFS/ME during diagnosis and all phases of care.
­ Acknowledge the reality and impact of the condition and the symptoms.
­ Provide information about the range of interventions and management strategies covered in this
guideline, including their benefits and risks.…read more

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CFS/ME General principles of care
Information about CFS/ME
G Give honest, realistic information about CFS/ME at diagnosis. Encourage cautious optimism.
­ Most people with CFS/ME will improve over time and some will recover and be able to resume
work and normal activities.
­ However, others will continue to experience symptoms or relapse and some people with severe
CFS/ME may remain housebound.
­ The prognosis in children and young people is more optimistic.…read more

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