Differential diagnosis between “chronic fatigue” and “chronic fatigue syndrome”, 2019, Son

Andy · Jun 15, 2019

Fatigue is a common complaint experienced by most of subjects during lifetime, which affects approximately 30–50% of general population as point prevalence.1According to the fatigue-lasting duration, it is classified as acute (<1 month), prolonged (>1 month, <6 months), and chronic fatigue (≥6 months), respectively. Acute fatigue is generally disappears after taking a rest or treating the causative diseases, while uncontrolled prolonged and chronic fatigue limit the physical and social activities.2 Especially, medically unexplained chronic fatigue is a debilitating status, such as idiopathic chronic fatigue (ICF) and chronic fatigue syndrome (CFS).

On the other hand, to distinguish CFS from chronic fatigue or ICF is very important in clinical practice. The reason is that although patients present fatigue symptom as their main complaint in subjects suffering from chronic fatigue or CFS, CFS is considered as to being in totally different pathologic illness.3 In 2015, US Institute of Medicine (IOM) reported diagnostic criteria for CFS as follows; three mandatory symptoms, a substantial impairment in activities accompanied by fatigue persisting for more than 6 months, post-exertional malaise (PEM) and unrefreshing sleep, and one optional symptom among cognitive impairment or orthostatic intolerance.4Unlike chronic fatigue, CFS has characteristics of brain and CNS symptom and is counted as a complex, multisystem neuroimmune disease. As commonly referred to myalgic encephalomyelitis (ME)/CFS together, brain inflammation is frequently implied in pathology of CFS.5
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Open access, https://www.sciencedirect.com/science/article/pii/S221342201930071X?via=ihub

Hoopoe · Jun 15, 2019

Regarding therapeutics for CFS, a large-scale clinical study (called the PACE trial) results supported the cognitive behavior therapy (CBT) and graded exercise therapy (GET) as more effective therapies improving both fatigue and physical function.10 They were however abandoned or revised in both the U.S. and UK due to serious criticism by both scientists and patients. The criticisms were for the biases and limitations of their results as well as the unmatched recommendation of GET in contrary to PEM, a main feature of CFS by IOM diagnosis criteria.
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Jonathan Edwards · Jun 15, 2019

They were however abandoned or revised in both the U.S. and UK due to serious criticism by both scientists and patients.

Seems like an alternative reality out there somewhere.

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Differential diagnosis between “chronic fatigue” and “chronic fatigue syndrome”, 2019, Son

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Differential diagnosis between “chronic fatigue” and “chronic fatigue syndrome”, 2019, Son

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Jonathan Edwards Senior Member (Voting Rights)

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