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Diagnosing Chronic Fatigue Syndrome

Chronic fatigue syndrome is a debilitating condition characterized by profound, long-term fatigue and other symptoms, such as joint and muscle pain, which cannot be relieved by rest. Chronic fatigue syndrome can affect anyone at any age but it is more common in women than men and usually starts in early or middle adulthood. Although the condition usually starts abruptly, it can also develop gradually with symptoms appearing and disappearing with no apparent pattern.

Many experts regard this syndrome as a cluster of symptoms rather than a disease. Because the cause of chronic fatigue syndrome is yet unknown, there is also no known cure or prevention method for it. Treatment is aimed at relieving symptoms and may involve one or more therapies including stress management, exercise therapy, cognitive behavioral therapy, biofeedback, energy conservation and medications.

Diagnostic Criteria and Methods for Chronic Fatigue Syndrome

To start diagnosing chronic fatigue syndrome a doctor must first review the patient’s medical history and conduct a physical examination focusing on the joints, lymph nodes and other affected body parts and asses the patient’s mental status. To identify or rule out other possible causes of fatigue, blood and urine tests may be ordered. These tests may include:

  • Alanine aminotransferase and globulin to detect liver disease
  • Albumin to detect malnutrition, kidney or liver disease
  • Calcium to detect cancer and other possible disorders
  • Complete blood count and electrolytes to identify possible underlying diseases
  • Glucose to detect diabetes
  • Phosphorus to detect kidney failure and other disorders
  • Sedimentation rate to help determine if inflammation is present
  • Thyroid stimulating hormone to detect thyroid disorders
  • Total protein to detect dehydration
  • Urinalysis to detect lupus, kidney disease and other disorders
  • Waste product tests to identify kidney disease and other disorders

However, more than 90% of patients suffering from severe fatigue will have normal results for the above listed laboratory tests.

Depending on the above lab test results and the patient’s symptoms, imaging tests such as x-rays or computed axial tomography (CAT) scan may be ordered. The doctor may also request a tilt table test to check for neurally mediated hypotension (low blood pressure) present in some patients with chronic fatigue syndrome. To be diagnosed with chronic fatigue syndrome, patients must meet two criteria:

  • Have unexplained, severe, chronic fatigue for at least six months, with other known causes ruled out by clinical diagnosis
  • Have four or more of the following symptoms persisting for at least six months:
  1. Considerably impaired concentration or short-term memory
  2. Discomfort for more than 24 hours after exertion
  3. Headaches of a new type, pattern or severity
  4. Lack of refreshment from sleep
  5. Muscle pain
  6. Multiple joint pains without swelling or redness
  7. Sore throat
  8. Tenderness in the lymph nodes of the armpits or neck

In should be noted here that there is no single diagnostic test that can confirm the presence of chronic fatigue syndrome. It is diagnosed if there is no other explanation for the fatigue and the above conditions were met. This approach is called a diagnosis of exclusion, meaning that other medical conditions that can cause fatigue must be ruled out.

Conditions and disorders with similar symptoms that need to be excluded (besides those already mentioned earlier) include chronic infections such as tuberculosis, mononucleosis or Lyme disease, autoimmune diseases such as multiple sclerosis and lupus, psychiatric and emotional conditions such as schizophrenia, bipolar disorder and major depression, nervous system disorders such as fibromyalgia, glandular and hormonal disorders such as hypothyroidism, alcohol abuse or other substance abuse, eating disorders such as anorexia nervosa and bulimia, anemia, sleep apnea and narcolepsy, cancer, arthritis, chemical sensitivities and reactions to medications. Therefore, diagnosis of chronic fatigue syndrome can be a lengthy and frustrating process.