Chronic Fatigue Syndrome Test

What is chronic fatigue syndrome?

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis chronic fatigue syndrome (ME/CFS), is a debilitating health condition characterized by persistent and unexplained fatigue that does not improve with rest. This extreme tiredness significantly hinders individuals' ability to engage in normal daily functions.

While the primary symptom is persistent, often disabling tiredness or fatigue, ME/CFS is often accompanied by symptoms such as joint pain, headaches, sleep disturbances, and cognitive impairment (e.g. lack of mental clarity, trouble focusing, "brain fog"). Individuals with CFS typically report that symptoms worsen with physical or mental exertion. Post-exertional malaise can last over 24 hours after physical or mental activity.

Diagnosing chronic fatigue involves a comprehensive medical examination and specific tests to rule out other conditions that may explain debilitating fatigue. While no cure exists for ME/CFS, management strategies focus on alleviating symptoms, improving sleep quality, and enhancing overall well-being. Additionally, mental health support can be a vital component of holistic chronic fatigue coping strategies.

The exact cause of ME/CFS remains unknown, though it is believed to be a complex condition caused by multiple contributing factors, such as:

• Viral infections: E.g. Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), and other pathogens. These infections may trigger an abnormal immune response or contribute to ongoing inflammation.
• Immune system dysregulation: An altered or dysfunctional immune response may lead to chronic inflammation.
• Hormonal imbalances: Hormonal imbalances, particularly in the hypothalamus-pituitary-adrenal (HPA) axis, have been observed in some individuals with CFS. This axis plays a crucial role in regulating stress responses and energy levels.
• Genetic predisposition: ME/CFS may be hereditary, or certain genetic factors may increase susceptibility to the condition.
• Psychological factors: While not solely a psychological disorder, mental health factors can trigger or exacerbate ME/CFS. High levels of stress, trauma, and emotional challenges may play a role.
• Environmental triggers: Exposure to toxins or pollutants, as well as lifestyle factors, may contribute to the development of CFS. These factors may potentially interact with genetic predispositions.

Chronic fatigue diagnosis

Here are the key components involved in the diagnosis of chronic fatigue syndrome:

• Medical history: The healthcare provider will take a detailed medical history, including information about the onset of fatigue, the duration of symptoms, and any factors that worsen or alleviate the fatigue.
• Symptom assessment: Evaluation of the various symptoms associated with CFS, such as post-exertional malaise, cognitive difficulties, and sleep disturbances.
• Laboratory tests: Blood tests and other laboratory investigations may be conducted to rule out other medical conditions with similar symptoms, such as thyroid disorders, autoimmune diseases, and infections, however, no blood test can specifically diagnose the chronic disease.
• Imaging studies: In some cases, imaging studies like MRI or CT scans may be performed to rule out structural abnormalities or neurological conditions.
• Fulfilling criteria: Because no laboratory test exists to confirm ME/CFS, the IOM 2015 criteria is most widely used to determine if a patient's symptoms are sufficient to warrant a chronic fatigue diagnosis.
• Specialist involvement: Depending on the symptoms and findings, individuals may be referred to specialists such as rheumatologists, neurologists, or infectious disease specialists to rule out other conditions.

Institute of Medicine 2015 criteria

Under this set of criteria, the patient must have 3 symptoms and at least one of two additional symptoms to be diagnosed, and they must have a moderate to sever impact on the patient's quality of life (Centers for Disease Control and Prevention, 2024):

Required symptoms

1. Substantial reduction or impairment in pre-illness activity levels: Patients experience a significant decline in their ability to participate in occupational, educational, social, or personal activities. This persists for more than six months and is accompanied by fatigue that:
   • Is severe and often overwhelming.
   • Is new or recent in onset (not lifelong).
   • Is not caused by ongoing or excessive exertion.
   • Does not improve substantially with rest.
2. Post-exertional malaise (PEM): Symptoms worsen following physical, mental, or emotional effort that would not have been problematic before the illness. PEM may trigger relapses lasting days, weeks, or longer. Sensory overload, such as exposure to bright lights or loud sounds, can also induce PEM. Symptoms typically worsen 12–48 hours after exertion and may persist for several days or weeks.
3. Unrefreshing sleep: Despite sleeping through the night, patients wake feeling unrefreshed and as fatigued as before sleep. This occurs even without observable abnormalities in sleep studies.

Additional symptoms

1. Cognitive impairment: Patients struggle with memory, concentration, information processing, and executive functioning. These issues may worsen with exertion, stress, or prolonged upright posture. Impacts can include difficulty maintaining employment or attending school.
2. Orthostatic intolerance: Symptoms worsen when upright (standing or sitting) and improve when lying down. Symptoms may include lightheadedness, fainting, increased fatigue, cognitive decline, headaches, or nausea. This can be evaluated through heart rate, blood pressure changes, or tilt-table testing. Adolescents often find this symptom particularly disruptive.

Other symptoms common to ME/CFS (but are not required for a diagnosis) include:

• Muscle pain.
• Joint pain without swelling or redness.
• New or severe headaches.
• Swollen or tender lymph nodes (neck or armpit).
• Frequent or recurring sore throat.
• Chills or night sweats.
• Sensitivity to light, sound, or other stimuli.
• Nausea or gastrointestinal issues.
• Allergies or sensitivities to food, odors, chemicals, or medications.

How to use this CFS test template?

This CFS test template offers healthcare professionals a systematic approach to collecting key data on a client's health to determine if they meet ME/CFS diagnostic criteria. As there is no a specific laboratory test for this complex condition, this resource guides practitioners to create holistic, comprehensive, and accurate evaluations. Here's how it works:

Step 1: Access the template

Open the template by clicking "Use template," which opens it in the Carepatron app's template editor. You can edit it there, fill it out, or print it. You can also download a ready-to-use PDF by clicking "Download."

Step 2: Input the patient's information and medical history

Input key data in the designated fields at the top of the form, including the client's name and age, the assessment date, and the attending physician.  Conduct a thorough medical history assessment, including any risk factors, the onset and duration of fatigue symptoms, and an evaluation of associated symptoms and their severity. To ensure completeness and to aid in differential diagnosis, record symptoms even if the patient does not believe they are relevant (e.g. mental health problems).

Step 3: Differential diagnosis

A key part of the diagnostic process focuses on ruling out other potential conditions that may cause the symptoms. Describe in detail any laboratory tests conducted to rule out other medical conditions, and imaging studies if necessary.

Step 4: Check the presentation against CFS criteria

Next, indicate whether the patient's symptoms meet each IOM 2015 criteria. Synthesize all the collected information to determine whether a ME/CFS diagnosis is appropriate. Record any referrals or recommendations. A collaborative approach involving specialists (e.g. in rheumatology, neurology, and psychology) may be necessary for a confirmed diagnosis in cases where the patient's condition is undetermined.

Reference

Centers for Disease Control and Prevention. (2024, May 22). IOM 2015 diagnostic criteria. https://www.cdc.gov/me-cfs/hcp/diagnosis/iom-2015-diagnostic-criteria-1.html