Myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) are complex illnesses that cause extreme fatigue and other symptoms that reduce a patient’s ability to function, worsen with exertion and don’t improve with rest or sleep. No one knows what causes ME/CFS, but a combination of factors may be involved.
It is essential that health care providers be trained to recognize and effectively treat ME/CFS. Unfortunately, this has not happened. The lack of training has been exacerbated by the historical misunderstanding and mischaracterization of ME/CFS, an inability to identify diagnostic biological markers, a reluctance to acknowledge ME/CFS within the medical community, and the lingering controversy about whether ME/CFS is a single clinical disease or several overlapping illnesses.
Health care providers who understand ME/CFS can improve patients’ quality of life and help them achieve their goals. The goal of this article is to provide health care providers with a clear path forward in their assessment and management of ME/CFS patients.
Despite the widespread perception of ME/CFS as an overly stigmatized illness, many people with ME are working and contributing to society. They have a rich and diverse background, but they all share common experiences of being ill with an unpredictable disease that can cause significant loss of function and quality of life.
ME/CFS is a multi-factorial, chronic neurological disease that affects a variety of body systems. Susceptibility to ME/CFS appears to be genetic, but the majority of cases are triggered by infection. Some people with ME/CFS are severely disabled, with 75% of them unable to work and 25% housebound or bedbound.
The symptoms of ME/CFS are relapsing and remitting, and many people experience dramatic fluctuations in their symptoms from day to day, week to week and month. The condition is also characterized by orthostatic intolerance, postexertional malaise and chronic pain.
ME/CFS is different from other conditions that may present similar symptoms, such as depression or anxiety. A careful history, physical examination and screening instruments can help distinguish ME/CFS from other diseases. Often, ME/CFS is diagnosed by ruling out other diseases, such as the use of antidepressants or anxiety medication, or by therapeutic trials; if treatment for an alternative diagnosis eliminates ME/CFS symptoms, ME/CFS is the most likely diagnosis.