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Chronic Fatigue Syndrome

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Signs and Symptoms

The Centers for Disease Control and Prevention (CDC), in conjunction with an international panel of CFS research experts, adopted a definition of chronic fatigue syndrome that requires the following signs and symptoms:

  1. Severe chronic fatigue lasting 6 consecutive months or longer with other known medical conditions excluded by clinical diagnosis
  2. Daily activities and work severely affected
  3. Four or more of the following 8 symptoms occurring at the same time and lasting or recurring for more than 6 months:
    • Inability to concentrate; problems with short-term memory or attention span
    • Sore throat that is frequent or persistent
    • Tender lymph nodes in the neck or armpit
    • Muscle pain
    • Pain in multiple joints but without swelling or redness
    • Headaches that are a new type, more severe, or occur in a new pattern
    • Waking up unrefreshed
    • Extreme fatigue lasting more than 24 hours after physical or mental exercise

In 2015, the National Academy of Medicine (formerly the Institute of Medicine (IOM)) Committee on Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome released a report that proposed new diagnostic criteria for CFS intended to improve diagnosis and care of those affected by CFS. Some of the criteria are the same as those listed above and a healthcare practitioner may apply some of them when evaluating a patient. To be diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a person must have the following three symptoms:

  1. Extreme fatigue for more than 6 months with a decreased ability to function in everyday activities, such as work, school, social events or personal care; the fatigue and dysfunction must be new or have a definite beginning, not be caused by continued excessive exercise, and not greatly improved by resting.
  2. Feeling "out of sorts" (malaise) or having a general feeling of discomfort after exercising or expending energy
  3. Waking up unrefreshed

At least one of the following two symptoms must also be present and will be evaluated for how often and how severe they occur. They should affect the person at least half the time and be at least moderately intense.

  1. Inability to concentrate; problems with memory or attention span (cognitive impairment)
  2. Feeling light-headed or dizzy, fainting, or having heart palpitations after standing upright from a seated or resting position (orthostatic intolerance)

**Adapted from Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness

Besides the primary symptoms of CFS, a variety of other symptoms may be commonly seen. These include:

  • Abdominal pain, bloating, nausea, vomiting, loss of appetite
  • Allergies and sensitivities to foods, odors, chemicals, medication, and sound
  • Chest pain
  • Chills and night sweats
  • Chronic cough
  • Depression and anxiety
  • Frequent urination
  • Heat and cold sensitivity
  • Low body temperature
  • Dry eyes or mouth
  • Earaches
  • Jaw pain
  • Low-grade fever
  • Joint stiffness, particularly in the morning
  • Numbness, tingling, or burning sensation in the face hands or feet
  • Shortness of breath

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