OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see DDx and Ix of persistent fatigue; psychiatry and mental health; rheumatology; sleep hygiene

• prevalence of CFS in community is 0.2-0.7%
• predominantly effects young adults
• occurs in individuals from all socioeconomic groups
• whilst most fatigue syndromes are of short duration & resolve spontaneously, people with CFS for more than 5 yrs tend to remain symptomatic, although function may improve slowly over time. A US study estimated a cumulative 5 yr recovery rate of 31%.
• may be triggered by specific infections such as EBV / glandular fever / infectious mononucleosis which is reknown for causing fatigue as its main symptom, and this may last 3 months or well beyond that.

• clinically evaluated, unexplained, persistent or relapsing fatigue persistent for 6 months or more, that:
  • is of new or definite onset
  • is not the result of ongoing exertion
  • is not substantially alleviated by rest
  • results in substantial reduction in previous levels of occupational, educational, social or personal activities
• and four or more of the following symptoms that are concurrent, persistent for 6 months or more & which did not predate the fatigue:
  • impaired short term memory or concentration
  • sore throat
  • tender cervical or axillary lymph nodes
  • muscle pain
  • multi-joint pain without arthritis
  • headaches of a new type, pattern or severity
  • unrefreshing sleep
  • post-exertional malaise lasting more than 24 hours

• provide information about CFS to help pts understand their illness
• encourage increasing levels of physical & mentals tasks, starting at a level tolerated without significant exacerbation of symptoms
• sleep management aiming to establish a regular, unbroken, night-time sleep pattern & to improve perceptions of the quality of sleep:
  • establish regular bed-time routine:
  • going to bed when “sleepy” rather than “tired”
  • put the light out immediately rather than reading or watching TV in bed
  • “anchoring” the sleep routine by setting the alarm to the same rising time each day
  • judicious use of sedative-hypnotic medication to achieve sleep
  • use of analgesics for relief of musculoskeletal pain
  • avoiding (preferably) daytime naps or keeping them under 30mins
  • gentle exercise during the day
  • consider assistance from sleep specialist
• symptomatic drug Rx:
  • many pts report increased susceptibility to drug adverse effects, so minimise & start low dose
• consider contact with support groups
• enlist social welfare agencies

• Chronic fatigue syndrome - Clinical Practice Guidelines 2002. MJA 6 May 2002 vol 176 supplement