Criteria for Diagnosis
Chronic Fatigue Syndrome
Fibromyalgia patients tend to battle more fatigue than any other rheumatic disease diagnosis. Whether you do not quite meet the diagnosis of fibromyalgia or you do but your fatigue is overwhelming, perhaps you should be evaluated for chronic fatigue syndrome, sleep disorders, and other common overlapping conditions.
Chronic fatigue syndrome is diagnosed using the Centers for Disease Control and Prevention (CDC) 1994 guidelines published in the Annals of Internal Medicine 121(12):953-9. A summary of this article can be downloaded from the CDC website at: http://www.cdc.gov/cfs/general/case_definition/complete.html.
In January of 2007, board members of the International Association for Chronic Fatigue Syndrome voted to change the name to chronic fatigue syndrome/ME. The ME stands for myalgic encephalopathy, meaning that the pain, fatigue, and other symptoms in the muscles (myalgic) are produced by an unspecified malfunctioning in the central nervous system (encephalopathy). Given that several brain imaging studies in patients with chronic fatigue syndrome (as well as fibromyalgia) have shown abnormal changes in brain blood flow and function, the addition of "ME" to the name appears substantiated. Chronic fatigue syndrome patients fought for ten years to change the name of their condition to better reflect the disorder so doctors and researchers could approach it more seriously.
To meet the criteria, patients must have:
A. Fatigue
Severe, unexplained fatigue that is not relieved by rest, can cause disability, and has an identifiable onset (i.e., not lifelong fatigue). It must be persistent or relapsing fatigue that lasts for at least six or more consecutive months.
B. Four or more of the following symptoms:
- impaired memory or concentration problems
- tender cervical or auxillary lymph nodes in neck region (note: they do not have to be swollen, just tender; this can be a symptom for people with fibromyalgia who have tenderness in these areas as well)
- sore throat (may not show signs of infection)
- muscle pain
- multi-joint pain (not arthritis)
- new onset headaches (tension-type or migraine)
- unrefreshing sleep (wake up in the morning feeling unrested)
- post-exertional malaise (fatigue, pain and flu-like symptoms after exercise)
NOTE: Five of the above eight criteria relate to pain and are often present in fibromyalgia patients as well. For both the fibromyalgia and chronic fatigue syndrome diagnosis, patients should be evaluated for other problems that could cause pain and fatigue, such as low thyroid function, low iron stores, arthritis, and many other medical conditions. If any of these conditions are found and corrected, but the individual still meets the fibromyalgia diagnosis, these other disorders (fibromyalgia and chronic fatigue syndrome) are viewed as co-existing and deserving of special medical attention. Unfortunately, the CDC criteria excludes people with other medical problems such as hypothyroidism and lupus, but it is okay to have the tender points of fibromyalgia or a mild case of depression/anxiety.
If you have the symptoms of chronic fatigue syndrome, you should pursue therapy options with your doctor. However, when it comes to research studies or prevalence figures determined by the CDC, you will not be included as a chronic fatigue syndrome patient if you have any other co-existing medical condition (other than fibromyalgia and mild depression/anxiety). On the other hand, fibromyalgia is viewed as a distinct clinical entity that stands on its own, regardless of whether a person has other medical conditions. This may be one reason why the prevalence figures for fibromyalgia (2% of the general population) are so much higher than chronic fatigue syndrome (roughly 0.5% of the general population).
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