Myalgic encephalomyelitis/chronic fatigue syndrome

Diagnosis

Although there is no specific test to diagnose CFS, tests may be required to rule out diseases with comparable symptoms and seek potential reasons. A physical exam and mental health evaluation are also necessary.

To aid in the diagnosis, fatigue associated with ME/CFS is also defined according to specific guidelines.

• Diagnostic criteria: Fatigue in ME/CFS is characterized by its severity, to the extent that it disrupts one’s ability to engage in activities that were manageable prior to the illness. It should also be:
  • New or definite onset
  • Does not show substantial improvement with rest.
  • Worsen when subjected to physical, mental, or emotional exertion

In order to fulfill the diagnostic criteria set forth by the Institute of Medicine for this particular condition, an individual must also manifest at least one of the following two symptoms:

• • Problems with memory, concentration, and focus
  • Increased dizziness upon transitioning from lying down or seated position to standing.

To meet the criteria for diagnosis, an individual must display at least one of the symptoms listed below for a duration of at least six months. This symptom should occur with a frequency of at least fifty percent of the time and manifest with a level of intensity that is categorized as moderate, substantial, or severe. 

Several health conditions may exhibit similar symptoms to ME/CFS. These include:

• Sleep disorders: A sleep study can establish whether conditions like obstructive sleep apnea, restless legs syndrome, or insomnia are interfering with one’s ability to sleep. Sleep issues can lead to fatigue. 
• Other medical conditions: A blood test can determine if other diseases including anemia, diabetes, and underactive thyroid are causing the fatigue. 
• Mental health issues: A consultation with a healthcare provider can help identify whether mental health conditions, including anxiety and depression is causing fatigue. 

Individuals with ME/CFS frequently experience additional health issues, such as sleep disturbances, irritable bowel syndrome, or fibromyalgia. Certain researchers even hypothesize that ME/CFS and fibromyalgia could potentially stem from the same underlying health condition, as they exhibit numerous similar symptoms.

Treatment

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has no definite treatment. In most cases, the symptoms that are most unpleasant or incapacitating ought to be treated first. Treatment options often include changes in the sleep routine, medications, and activity management.

• Medications: Drugs that may be prescribed to treat symptoms include:
  • Pain: Nonsteroidal anti–inflammatory drugs (NSAIDs) may be prescribed for pain. Gabapentin, amitriptyline, pregabalin, and duloxetine are prescription medications for fibromyalgia that may be taken if common NSAIDs such as ibuprofen and naproxen sodium are ineffective.
  • Orthostatic intolerance: Drugs that control cardiac rhythm or blood pressure may be beneficial for people with ME/CFS who experience dizziness or nausea when standing or sitting upright. 
  • Depression: Many patients who suffer from chronic illnesses like ME/CFS also struggle with depression. Antidepressants may be taken for sleep, pain, and fatigue management.

• Pacing for post–exertional malaise: Post–exertional malaise usually starts within 12 to 24 hours after the action and lasts for days or weeks. It is a condition where the symptoms of fatigue worsen as a result of physical activity and mental exertion. 

To address this symptom, healthcare providers often recommend a strategy known as “pacing“. Pacing involves carefully managing and balancing the periods of rest and physical activity to help alleviate the negative effects of post–exertional malaise.

Maintaining a daily journal of the activities and symptoms can be beneficial in monitoring and identifying the individual threshold for excessive activity. One might be able to safely perform more exercise as they get better without developing post–exertional malaise.

• Dealing with sleep issues: In the case of sleep apnea, treatment often involves the use of a device that administers air pressure via a mask while a person sleeps. 

However, before prescribing drugs or beginning other forms of treatment, a healthcare provider may suggest at–home sleeping behaviors to improve sleep. These may include: 

• • Establishing a regular bedtime schedule that includes sleeping in and waking up at the same time each day
  • Caffeine and alcohol abstinence before bed
  • Never taking a nap during the day for longer than 30 minutes