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Chronic Fatigue Syndrome (CFS): a comprehensive approach to its definition & study. International CFS Study Group

  [ 41 votes ]   [ Discuss This Article ] • December 15, 1994

The complexities of the chronic fatigue syndrome and the
methodologic problems associated with its study indicate the
need for a comprehensive, systematic, and integrated approach
to the evaluation, classification, and study of persons with
this condition and other fatiguing illnesses. We propose a
conceptual framework and a set of guidelines that provide such
an approach. Our guidelines include recommendations for the
clinical evaluation of fatigued persons, a revised case
definition of the chronic fatigue syndrome, and a strategy for
subgrouping fatigued persons in formal investigations.

MCM: Defines "fatigue" as "severe mental or physical
exhaustion, which differs from somnolence or lack of
motivation, and which is not attributable to exercise or
diagnosable d."Prolonged fatigue lasts >1mo and "chronic
fatigue" is defined as present at least 6 mo.
"Chronic fatigue syndrome CFS" is diagnosed if severe
fatigue for >6mo, and four or more of these are present: (1)
impaired memory or concentration, (2) sore throat, (3) tender
cervical or axillary nodes, (4) muscle pain, (5) multi-joint
pain [w/o swelling], (6) new headaches, (7) unrefreshing
sleep, (9) post-exertion malaise.If 4 of the criteria are
not satisfied (and there is no other condition that would
"explain" CF (see below)), dx "idiopathic chronic fatigue
IFS".Subgroup CFS and IFS by comorbid psych or other
conditions, current level of fatigue, duration of fatigue, and
level of physical function, w other subgrouping as desired.

Medical and psychiatric conditions that "explain" fatigue
(and exclude CFS/IFS) include (1) active & potentially
fatiguing medical conditions (e.g., untreated hypothyroidism,
sleep apnea, narcolepsy, medications), (2) previous medical
condition that may not have resolved (malignancies, Hep B or
C), (3) past or current dx of [severe] major depression w
psychotic or melancholic features, bipolar affective disorder,
schizophrenia, delusional disorder, dementias, anorexia
nervosa, and bulimia nervosa, or (4) alcohol or other
substance abuse within 2 years before the onset of CF and at
any time after.

Presents minimum lab and clinical assessment needed and
discourages further testing unless under protocol.
Want to wait before changing name of the S until better

The CFS study group consists of: Schluederberg A, Jones
JF, Lloyd AR, Wessely S, Gantz NM, Holmes GP, Buchwald D,
Abbey S, Rest J, Levy JA, Jolson H, Peterson DL, Vercoulen
JHMM, Tirelli U, Evengard B, Natelson BH, Steele L, Reyes M,
Reeves WC.

Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A

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