New Zealand Doctor HOW TO TREAT article

Myalgic Encephalomyelitis / Chronic Fatigue Syndrome

 
 

Myalgic encephalomyelitis/chronic fatigue syndrome is a common, debilitating and costly disease. Diagnosing and managing complex chronic conditions such as this is not easy with a 15-minute consultation, but this article, by Cathy Stephenson and Rose Silvester, provides a framework of evidence-based information for GPs working with patients with ME/CFS.

Cathy Stephenson is a GP in Wellington and a health columnist. She has had the privilege of learning about ME/CFS from her patients, and is grateful to one of them for sharing their story here.

Rose Silvester is a clinical psychologist and carer of a person with ME/CFS. She is on the steering group of M.E. Awareness NZ.

This article was originally published in the NZ Doctor, 8th April 2020 edition, as a 5-page article.
In August 2021, M.E. Awareness NZ engaged The Health Media Ltd to reprint the article as a 12-page standalone publication, and we have been given permission to share the pdf of the reprint here.  

Medical professionals with a New Zealand Doctor subscription can earn 1 CPD credit
by completing the ELearning assessment for this article.
Non-subscribers can complete online reading and accredited assessment at www.howtotreat.co.nz/cfs,
with free access code CFS

To read the article: The pdf of the 12-page article is available here (use the button below). An image gallery view is also available below of the original 5-page article. A reference list for the article is also included below to provide easy access.

 

Links to References:

Numbered References

  1. CDC: Information for Healthcare Providers
    Research studies describe pathophysiological changes.
    CDC: Info for Healthcare Providers: Etiology and Pathophysiology
    Panel 2 - Obstacles to diagnosis.
    CDC: Info for Healthcare Providers: Factors Complicating the Diagnosis of ME/CFS

  2. Panel 1 - Differential diagnosis.
    Open Medicine Foundation: New Guidelines for Diagnosing and Treating ME/CFS

  3. Table 1 - Symptom comparison between depression /anxiety disorders and ME/CFS in children and adolescents.
    Rowe PC, Underhill RA, Friedman KJ, et al. Myalgic encephalomyelitis/chronic fatigue syndrome diagnosis and management in young people: A primer. Front Pediatr 2017;5:121.

  4. IOM (now NAM) 2015 revision of evidence and proposal of diagnostic criteria.
    Institute of Medicine of the National Academies. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. 2015.
    Panel 4 - Diagnostic criteria for ME/CFS.
    CDC: Info for Healthcare Providers: Diagnosis of ME/CFS

  5. Research studies show ME/CFS is not caused by deconditioning.
    van Campen CMC, Visser FC. The abnormal cardiac index and stroke volume index changes during a normal tilt table test in ME/CFS patients compared to healthy volunteers, are not related to deconditioning. J Thrombo Circ 2018:107

  6. Research studies show marked abnormalities on two-day cardiopulmonary exercise testing.
    Hodges L, Nielsen T, Cochrane D, et al. The physiological time line of post‐exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Transl Sports Med 2020;00:1–7

  7. 2020 US study on prevalence in children in children and young people.
    Jason LA, Katz BZ, Sunnquist M, et al. The prevalence of pediatric myalgic encephalomyelitis/chronic fatigue syndrome in a community-based sample. Child Youth Care Forum 2020; 23 January online.

  8. People with ME/CFS have first-degree relatives diagnosed with ME/CFS.
    Chu L, Valencia IJ, Garvert DW, et al. Onset patterns and course of myalgic encephalomyelitis/chronic fatigue syndrome. Front Pediatr 2019;7:12

  9. Figure 1. A study by Falk Hvidberg and colleagues in 2015 reported that patients with ME/ CFS have the lowest unadjusted EQ-5D-3L-based health-related quality of life compared with 20 other conditions, including multiple sclerosis and stroke.
    Falk Hvidberg M, Brinth LS, Olesen AV, Petersen KD, Ehlers L. The health-related quality of life for patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). PLoS One 2015;10(7):e0132421

  10. Young people with ME/CFS require support in their learning.
    CDC: Pediatric ME/CFS: Fact Sheet for Health Professionals

Diagnostic Criteria

What is post-exertional malaise?

ME/CFS is a spectrum disorder

Panel 4 - Symptoms and signs of orthostatic intolerance

Pacing

Advocacy and Support

Useful resources